Transcript LeadingAge-NPA Webinar

Program for All-Inclusive Care
for the Elderly:
An Important Addition to Your CCRC
Webinar: 266130329
November 2, 2011
“The Road to Success
is Always Under
Construction”
Lily Tomlin
Agenda
TIME
TOPIC
3:00p-3:10p
Welcome-Overview of Session
Speaker Introductions
Larry Minnix, President/CEO, LeadingAge
Shawn Bloom, President/CEO, NPA
3:10p-3:25p
PACE 101: Shawn Bloom, President/CEO, NPA
3:25p-3:35p
Integrated Medical Delivery: Cheryl Phillips, MD
Senior VP, Advocacy, LeadingAge
3:35p-3:50p
PACE and CCRCs: Dan Gray
President, Continuum Development Services
3:50p-4:00p
Case Study-Presbyterian Senior Living
Steve Proctor, CEO
4:00p-4:10p
Case Study-Presbyterian Villages of Michigan
Roger Myers, President/CEO
4:10p-4:30p
Questions/Answers
PACE 101
Presented by:
Shawn Bloom, President/CEO
National PACE Association
www.npaonline.org
Overview
Program of All-inclusive Care
for the Elderly (PACE)
www.NPAonline.org
Presentation Outline
 PACE Overview and Brief History
 PACE Experience with Dual
Eligibles
 Questions/Comments
The Program of All-inclusive Care for the Elderly
Is an integrated system of care for the frail elderly
that is:
• Community-based
• Coordinated
• Comprehensive
• Capitated
Who Does PACE Serve?
 Adults 55 years of age or older and who are:
• Living in a PACE organization’s service area
• State-certified as eligible for nursing home level of
care
• Able to live safely in the community with the
services of the PACE program at the time of
enrollment
PACE is Community-Based
 PACE provides innovative,
person-centered care for older
adults that allows them to stay
in their homes and
communities and out of nursing
homes
“PACE’s help in being able to keep mom at
home has enabled us to keep our family
together.”
Family Member of a PACE Participant
PACE Provides Coordinated, Comprehensive Care
 Employs interdisciplinary teams to
deliver and coordinate care across
care settings
• Doctors, nurses, therapists, social workers,
dieticians, personal care aides, and other
providers
• Day centers, clinics, occupational and physical
therapy facilities
• Individuals’ homes
• Hospitals and nursing homes, if necessary
PACE Provides Coordinated and Comprehensive Care
 Bundles Medicare and Medicaid
payments to provide full range of
health care services
 Medical care, social services, and
other long-term services and
supports
Capitated, Pooled Financing
 Integration of Medicare, Medicaid and private
pay payments by PACE providers
 Medicare A/B capitation payments risk- and
frailty- adjusted for PACE participants
 Medicare Part D payments based on bid
amounts
 Medicaid capitated payment amounts based
on states’ expenditures for long-term care
populations
Sources of Service Revenue
 PACE Programs receive approximately
$5,349 PMPM in 2011:


60% of their revenue from Medicaid
40% from Medicare
(A small percentage of program revenue comes
from private sources or enrollees paying privately)
 2011 Mean Medicare PMPM Rate: $2,018
 2011 Mean Medicaid PMPM Rate: $3,331
 PACE Programs are Medicare D providers
PACE Organizations Provide:
All Medicare and Medicaid covered–
services and more
•
•
•
•
•
•
•
•
•
•
medical care
nursing
physical therapy
occupational therapy
recreational therapy
meals
nutritional counseling
social work
home health care
hospital care
•
•
•
•
•
•
•
•
•
•
personal care
prescription drugs
social services
audiology
dentistry
optometry
podiatry
speech therapy
respite care
SNF/NH care
PACE History and Evolution
 1983 – On Lok demonstration
 1986 – PACE replication demonstration
 1997 – Congress established PACE as
permanent Medicare provider and Medicaid
state option (Balanced Budget Act)
 Distinct statutory and regulatory designation
as a provider-based entity


Sections 1894 and 1934, Social Security Act
Title 42, Part 460, Code of Federal Regulations
PACE Core Competencies
 Operates as a provider-based model
 Serves exclusively a nursing home eligible
population
 Produces good outcomes:



Participants more likely to have advance care
directives and die at home
PACE participants, caregivers, and employees
report high satisfaction with the program
PACE participants have reduced
hospitalizations and permanent residency in
nursing homes
Integrated, Interdisciplinary Team Care
 Hands-on interdisciplinary team approach
to care management vs. individual case
management
 Continuous process of assessment,
treatment planning, service provision, and
monitoring
 Focus on prevention, primary, secondary,
and tertiary care
PACE is:
 Fully-Accountable for the Cost and Quality
of Care Provided
 How can we move from successfully treating
individual diseases, to successfully caring for
individuals? Can we do it for less?
 Proven track record in preserving wellness and promoting
quality care
 Integrated and fixed-rate financing system reduces the cost
of care compared to nursing home care substantially
 A recent HHS report found PACE generates better health
outcomes
PACE has:
 A long history serving dual eligibles, where one size
does not fit all
 90 percent of PACE participants are dual eligibles
(Medicare & Medicaid eligible)
 Dual eligibles have multiple, complex conditions
and benefit from the PACE model of
comprehensive, individualized care
PACE is Distinct
 PACE has a long history and unique approach
 30+ year track record
 Direct, hands-on provider
 Accepts full financial risk for participants’ cost and
health care
 Exclusively serves a subset of the dual eligible
population – frail, older adults
Status of PACE (as of 10/11)
 Currently there are 166 PACE centers,
operated by 81 sponsoring organizations in 29
states
 Over 23,000 PACE participants
 One-fifth of PACE organizations indicate that
they are approaching enrollment cap imposed
by their states
 Over one-half of PACE organizations plan to
expand with the development of one or more
centers in 2011
PACE Responds to Tough Health Care Challenges
For Consumers—Participants/Caregivers:
 Comprehensive, preferred method of care
 Stay in the community as long as possible
 One-stop shopping
For Providers:
 Freedom from traditional FFS restrictions
 Focus on the entire range of needs of individual
For Payers:
 Value and predictable expenditures
 Comprehensive service package
New Opportunities for PACE
Recent
History
 Number of PACE organizations doubled in last 5
years to 76:
• Rural PACE grants – 13 rural programs
• More diversity among interested sponsors
(e.g., hospices)
• State interest in PACE expansion
Looking
Ahead
 PACE/Veterans Administration Start-up Program
 New demonstrations being developed to
• Expand current PACE program and offer the
model to different populations that would
benefit from its services
Integrated Medical Delivery
Presented by:
Cheryl Phillips, MD
Senior Vice President, Advocacy
LeadingAge
www.LeadingAge.org
How is PACE Clinical Care Delivered?
 The center of care delivery is the
interdisciplinary team (IDT)
 Care plans are created with (not just for) the
individual and family and includes social,
cultural, functional aspects of care – in
addition to the medical needs
 Most of the services are coordinated through
the adult day center – thus social care is
integrated directly with medical care
25
What Does the IDT Look Like?
Interdisciplinary teams assess need,
deliver & manage care across settings:
Home
Care
Primary
Care
Recreation
Nursing
Speech
Social
Services
OT/PT
Nutrition
Transportation
26
Settings/Services
• Adult Day Health Care
• Personal Care
• Home Care
• Nursing Home
• Hospital
• Medical Specialists
• Pharmacy
• Lab/X-ray
Medications/DME
Care Management = Care Coordination
 Interdisciplinary Team (IDT) Care Planning
• Integrates skilled assessment and evaluation findings and
regular assessments by PACE IDT members (physician, nurse,
rehab therapists, social worker, dietary, recreation and home
care staff) into new or revised person-centered care plan.
 Frequent Monitoring
• Regular attendance at day center combine with home care
according to individualized care plan
• Input from professionals and paraprofessionals
27
Care Management = Care Coordination
 Collaborative Care Planning with Participants
and Family Members
• Insures and improves quality of care
• Maintains participant autonomy
• Comprehensive medical record integrates
person-centered goals across the team
28
Medical Management
 The goal is to maximize medical
management in the outpatient
setting and integrate social and functional
support needs with IDT
 Primary care team on-site: MD, NP, RN
29
Medical Management
 Full-service clinic for urgent care and
management of chronic conditions
•
•
•
•
IV and Respiratory therapy
Wound care management
Frequent visits for management of chronic disease
Daily clinic care and observation can often prevent
hospitalizations
• 24 hour call system with on-call physicians and
nurses linking to IDT
• Effective person-centered and team-based delivery
of end-of-life care
30
CCRCs Have Much of the Clinical Structure
 Many already have on-site clinics and nursing
staff
 Culture of wellness and prevention is central to
CCRC model
 Care Coordination is already a skill set –
coordinating information and person-specific
goals across settings of care
 CCRC staff understand the intersection of
clinical conditions with function and the goal to
maintain independence for as long as possible
Synergies of PACE and the CCRC
Presented by:
Dan Gray, President
Continuum Development Services
www.consulting-cds.com
CCRC Challenges
 Chronic downturn in the economy
 Continuing housing crisis
 Upcoming 11% reduction in Medicare Part A
reimbursement for skilled nursing
 States slashing Medicaid payments
 Plummeting investment income and value
 Shrinking charitable contributions
Broadening Your Market
Mission
Market
Business
CCRCs and The Future
 Mission—reach out to older adults who
cannot afford to be in a CCRC or wish to
remain in their own home
 Market—broadens the market from 2%
served to the possibility of serving all
seniors
 Business—diversify into revenue not
capital intensive services
CCRCs and The Future
 Many CCRCs have strategically
developed home- and communitybased services for the broader
community

Mission: develop a broad array of
services for older adults regardless of
economic or functional status
Continuum of Care
E c o n omic S ta tus
Adequate
Inadequate
Impoverished
F u n c tiona l S ta tu s
Independent
Retirement Communities
Life Care at Home
Rental Retirement Communities,
Middle and low income Tax-credit
financed housing
Affordable Housing
Needs Assistance
Home Care
Adult Day Care
Assisted Living
Home Care
Adult Day Care
Assisted Living
Home Care
Adult Day Care
Frail
Private Pay PACE
Home Care
Nursing Home
Spend Down into PACE
Home Care
Nursing Home-Spend Down
PACE
Home Care
Nursing Home
Synergies
 Housing with Services
 Care Management across the
Continuum
 Social Accountability/Medicaid
 Capital to Fund PACE Start-up
 The Future of Senior Living and PACE
 Common Not-for-Profit and FaithBased Traditions
Housing With Services
 Great place to market PACE—up to
20% may be nursing home eligible
 Let costly place to provide services
 Transportation, which can be costly,
can be avoided

CCRCs are experienced developers and
operators of housing with services—a
valuable component of PACE
Care Management Across the Continuum
 Several CCRCs are adding Chief
Medical Directors to integrate services
across continuum
 In PACE, Medical Directors and Nurse
Practitioners are integral to the model

PACE is a platform for improving care
management and developing a comprehensive
service continuum
Social Accountability/Medicaid
 Increasing need to document social
accountability efforts—tax issue
 Opportunity to serve Medicaid population
combined with Medicare—more profitable
than serving Medicaid only population

PACE allows CCRCs to expand their mission
to the economically disadvantaged while
being good stewards of the organization’s
resources
Capital to Fund PACE
 Reasonable estimate is $15k per
participant slot--$4.5m to develop a 300participant program
 Financing opportunities include short-term
bank loans, internal loans refinanced into
long-term debt after stabilization

Many CCRCs have the liquidity and the
mission imperative to make a strategic
investment in PACE
Future of Senior Living and PACE
CCRCs having PACE in their
continuum will be the leaders
in these innovations and in
ACOs
Not-For-Profit and Faith-Based Traditions
Senior living organizations have led
innovations in caring for the frail elderly
for past 100 years
 Restraint-free environments
 Small households
 Greenhouses®
 Culture change
 Assisted living
 PACE
CCRCs and PACE
CCRCs should become the
leading provider of PACE in
the future
Presbyterian Senior Living
Presented by:
Steve Proctor
President/CEO
Presbyterian Senior Living
www.presbyterianseniorliving.org
Presbyterian Senior Living
 9th largest senior care provider on Zeigler 100
 24 locations in Pennsylvania, Maryland,
Delaware and SE Ohio
 Upscale CCRCs to affordable housing, skilled
nursing, personal care, and assisted living
 Historic commitment to serving low to moderate
income seniors throughout the continuum
 Approach to social responsibility – we earn
money from upscale operations to fund services
to those in need
Strategic Focus—Long-Term Care Continuum
 Offer a continuum of care to persons in a wide
range of financial circumstances
 The continuum should be flexible, cohesive,
quality driven
 Elements of the continuum provided directly by
PSL or in partnership with others
 PACE is an extension of our affordable housing
and services strategy which enables PSL to offer
a full range of services to those with limited
resources
PACE in Pennsylvania
 Called Living Independently for Seniors
(LIFE)
 County by county franchise
 Commitment to expansion has faded
with leadership changes within state
government
PACE in the Lehigh Valley
 Separate location from other operations (2
CCRCs, 1 free standing AL with specialty
dementia product, and adult day program with a
20-year history)
 Opened in February 2009, first enrollment May
2009
 Slower than expected start up due to resistance
from AAA
 Current census is 58
 Program benefits from the synergy of a wider
continuum
PACE in Lancaster
 Market saturation–county has 18 retirement
communities
 New location opening in December 2011
 Located next to 1500 member church with
extraordinary physical plant available to
retirement community
PACE in Lancaster
 Campus will serve 200 senior families with AL,
market rate rental, tax credit housing – no
skilled nursing component
 Relationship with Albright Senior Services—
PACE provider
 Strong response—considered model for the
future
Presbyterian Villages of Michigan
Presented by:
Roger Myers
President/CEO
Presbyterian Villages of Michigan
www.pvm.org
PVM Locations
PACE Eligibles
Program Outcomes
Program Outcomes
Program Outcomes
Program Outcomes
East Jefferson Project Area
East Jefferson Building Design
61
East Jefferson Building Design
East Jefferson Condo Structure
East Jefferson Organizational Chart
Questions
LeadingAge
www.LeadingAge.org
National PACE Association
www.npaonline.org