Total Support for Your PACE Journey

HDG supports provider organizations and other potential PACE sponsors in assessing the market and financial viability of a new or expanded PACE program. Using current census and other proprietary data, as well as a comprehensive competitor and market review, HDG will determine PACE demands, identify where potential enrollees live, and project the ideal locations
for a PACE center.

HDG’s financial feasibility studies utilize a proprietary financial model to develop a comprehensive financial analysis including a complete set of 10-year pro forma financial statements, a summary of key assumptions, sensitivity analyses, and detailed supporting schedules. The financial analysis dashboard report will provide a summary of the estimated capital required for the development of the PACE program including building and equipment costs, start-up expenses, and working capital needs, as well as a cash flow break-even analysis, projected financial performance, and other financial ratios and metrics. The market and financial feasibility study reports are designed to be used for the state and federal PACE application submissions.

sponsors in all aspects of PACE development and implementation support. Our development and implementation assistance engagements begin with assistance with the full scope of PACE application submission and start-up activities fulfilling provider application requirements.

HDG’s assistance during this phase encompasses these primary areas:

• Application and implementation workplan development and delivery
• State Request for Proposal (RFP) response preparation assistance
• CMS and state provider application development and approval process
• PACE policy and procedure manual development
• State readiness review preparation
• Other licensure requirements
• Waiver requests
• Medicare Part D application and implementation support

Using a systematic and stepwise approach, HDG’s assistance encompasses federal and state regulatory requirements, business and operational plan development, staff readiness and training, and outreach, communications, and marketing. Specific components include the PACE center location and design, staffing planning and onboarding, board and governance structure, clinical and other system development, provider network development, and more.

HDG also provides post-implementation operational support to ensure PACE operations adhere to PACE regulatory requirements — and to provide ongoing support as program operations evolve.

Given the realities of the current environment, PACE leaders are seeking innovative approaches to achieve better health and patient experience at lower costs. HDG’s experienced PACE operational team combines off-site financial benchmarking analysis and on-site review to develop a robust plan to improve program performance. This informed assessment will guide your management team in making knowledgeable decisions about how to refine operations and track the future performance of your PACE organization. As next step, the HDG team can also provide hands-on assistance with implementation of the recommendations.

PACE managers are under significant pressure to ensure the financial viability of their programs. HDG can complete an off-site benchmarking analysis to give PACE organizations a high-level guideline of their financial performance in comparison to other similar markets and programs. Utilizing years of operational and financial experience, as well as internal proprietary data, HDG can assess your organization and inform your leaders of the greatest areas of fiscal opportunity.

Continued PACE growth and expansion is essential to success in a dynamic marketplace. A well-developed business plan provides an essential road map to navigate the risk and opportunities of expansion for each unique sponsor. HDG’s carefully constructed strategy will assist your organization in securing internal and external capital for expansion; evaluating capacity for PACE growth in the market versus competing programs; and explore program development options. Should the plan identify expansion opportunities, HDG can assist your organization in securing regulatory approvals for PACE expansion application from your state and the Centers for Medicare and Medicaid Services (CMS).

HDG’s vast experience in PACE finance and operations positions our consultants to provide effective, ongoing health plan management for PACE organizations like yours. Our health plan management services include:

• Interim finance support
• Financial due diligence support
• Medicare and Medicaid capitation payment reconciliations and review
• Risk adjustment reporting review
• Risk score analysis
• Medicare risk adjustment settlement reserves analysis
• Medicare Part D reserve analysis
• Medicare Part D bid support
• CMS one-third financial audit support
• Claims processing review
• Incurred but not reported (IBNR) accrual analysis
• Encounter reporting