A tried-and-true program serves hospitals as a learning laboratory for new kinds of care delivery.
Achieving the Triple Aim—improved experience of care, improved health of a population, and reduced costs—has become the mantra of healthcare reform, particularly among organizations that are focused on serving the so-called “dual eligibles,” people who qualify for both Medicare and Medicaid. Our healthcare delivery system has failed to meet the complex and costly needs of this population, in particular the overwhelming consumer preference for community-based alternatives to institutional long-term care.
On the journey to value-based healthcare, providers of all types are embracing new Medicare models of care, including accountable care organizations and patient centered medical homes. In addition, 25 states are moving towards implementing new managed care or financial alignment models specifically for dual eligibles, with the hope of stemming the rise in costs while improving outcomes of care.
However, long before the Affordable Care Act (ACA) spawned such intense interest in these population-based models of care, Programs of All-inclusive Care for the Elderly (PACE) were delivering the full spectrum of care in the community to frail seniors clinically assessed at the nursing facility level of care, 90 percent of them dual eligibles. PACE is recognized as the gold standard of care for this complex population precisely because it achieves the Triple Aim.
The PACE Model of Care
Beginning as a Medicare demonstration in 1983 and becoming a permanent program in 1997, PACE provides and manages all services needed by enrollees, including preventive, primary, acute, and long-term support services (LTSS), regardless of type or location—and without regard for what services Medicare and Medicaid will reimburse.
Three key features of PACE have led to its success:
The Case for PACE in a Health System
All PACE programs must be nonprofit organizations and, while there are a wide variety of PACE sponsors—including long-term care providers and community organizations—hospitals have always been the predominant sponsors. Two examples demonstrate why.
Inova Health System, Fairfax, VA
With five hospitals and more than 1,700 beds, Inova Health System is northern Virginia’s leading not-for-profit provider, serving 2 million residents across northern Virginia and the Washington, DC, metro area. Inova sought and received state and Centers for Medicare and Medicaid (CMS) approval to operate InovaCares for Seniors, which opened in May 2012 with one center in Northern Virginia. Future plans call for expansion throughout the northern Virginia service area with multiple PACE centers and/or alternative care sites.
Cheyenne Regional Medical Center, Cheyenne, WY
Cheyenne Regional Medical Center (CRMC) is a regional healthcare system serving Cheyenne and southeastern Wyoming, western Nebraska, and northern Colorado. CRMC received state and CMS approval to open a PACE center on January 1, 2013.
Many hospitals, health systems, and not-for-profit providers along the continuum of care are embracing PACE as an effective, population-based model of care for nursing facility level dual eligibles—and as a learning laboratory for population-based models in general. The ability of healthcare organizations to serve as the integrator in caring for this population is well-established. But there is an opportunity and a need to do more, and healthcare providers and PACE are helping each other adapt to an increasingly complex marketplace.
Written by:Jade Gong Vice President of Strategic Initiatives Health Dimensions Group Arlington, VA 703.243.7391 firstname.lastname@example.org https://healthdimensionsgroup.com/ Anne Lewis Manager, PACE Advisory Services Health Dimensions Group Billings, MT 406.669.3332 email@example.com https://healthdimensionsgroup.com/