Transcript Rural PACE TAP

An Overview of Rural PACE
1st Educational Series Conference Call –
2:00 PM, 1/26/04
Presented by: Rural PACE Technical Assistance Program
An Overview of Rural PACE
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What is PACE
What is Rural PACE
Technical Assistance Services
Questions and Discussion
What is PACE?
PACE is a model of care
built on the foundation
that seniors with
complex health care
needs should be able
to live in as least
restrictive
environment for as
long as possible.
PACE participants must
be:
 55 Years old and older
 Certified to Need
Nursing Home Care
 Able to Live Safely in
the Community at the
Time of Enrollment
The Four C’s of PACE
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Community-Based
Comprehensive
Capitated
Coordinated
The PACE Model –
Community Based
• 9 out of 10 PACE participants live in the
community
• PACE programs deliver services in the
participant’s home and provide
transportation to needed services and
activities
• The PACE Center is located in and a part of
the community
The PACE Model
Comprehensive Service Package
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Integrates preventive, acute & long-term
care services
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All Medicare & Medicaid services plus
community long-term care service
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No benefit limitations, co-payments
or deductibles
The PACE Model
Capitated, Pooled Financing
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Medicare capitation rate adjusted for the
frailty of the PACE enrollees
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Integration of Medicare, Medicaid and
private pay payments
The PACE Experience
Source of Service Revenue
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PACE Programs receive monthly capitated
payments
For dually-eligible participants, approximately 2/3
of PACE revenue is provided by Medicaid and 1/3
by Medicare.
A very small percentage of program revenue comes
from private sources or enrollees paying privately.
The PACE Model
Coordinated Care
An interdisciplinary team
 Team managed care vs. individual case
manager
 Continuous process of assessment,
treatment planning, service provision and
monitoring
 Focus on prevention, wellness, quality of
life
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PACE: Interdisciplinary Teams
Care Needs Assessment, Planning and Delivery
Social Services
Pharmacy
Home Care
Activities
Nursing
Primary Care
Personal Care
OT/PT
Transportation
Nutrition
Why PACE in Rural Areas
Frail elder population at
high risk of
institutionalization
Current environment
supports service
integration
Emerging flexibility
supports adaptation
PACE and Rural Areas:
Challenges
Lack of population
density
Shortage of providers
Low reimbursement for
other risk-based models
PACE in Rural Areas:
Innovations
 Use of adjunct sites
 Use of new technologies
 Expanded populations (disabled, children,
Veterans)
 Risk sharing/Stop Loss for outliers
 Care giver and health professional mix
The Rural PACE Technical
Assistance Program
• Funded by HRSA’s Office of Rural Health
Policy and the Bureau of Health Professions
• Operated by the National PACE Association
in partnership with the National Rural
Health Association
– Peter Fitzgerald, NPA, 703/535-1521
– Shelly Ten Napel, NRHA, 703/519-7910
Technical Assistance Services
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Quarterly Education Series
Workgroups – Strategies for Rural PACE
Opportunities for Health Professions Training
Rural PACE Workshops
Rural PACE Self-Assessment Instrument
Desk Review of Self Assessments
On-Site Consultation
Rural PACE Workgroups
Staffing - general staffing requirements, recruitment and retention,
skill level requirements, health professions training opportunities
Financing - need for start up funding, operating revenues and
costs, sources and uses of funds
Infrastructure - developing the underlying transportation and
delivery site infrastructure needed to provide services
Technology - applying telehealth, telemedicine and
teleconferencing technologies in the PACE model
Rural PACE Workgroups, continued
Provider Network Development - developing
provider networks to assure delivery of the full scope of PACE
services across a rural service area, integrating direct delivery of
care/services with contracted services
Risk Management Strategies - effective caremanagement and its link to risk management, stop-loss insurance,
contract terms, and other approaches to risk management
Community Needs Assessment - critical elements in
the community (resident needs, service provider capacity) that shape
the need and delivery of PACE in a rural setting
Health Professions Training
Opportunities
• University of Missouri-Columbia - Rich Oliver, Ph.D.
• Existing PACE training programs
– Model curricula (interdisciplinary, geriatrics, all professions)
• Existing rural training programs
– Model curricula (interdisciplinary, geriatrics, all professions)
• Opportunities for rural PACE training programs
– Build on existing relationships
– Establish new relationships
Rural PACE Workshops
Workshop Delivered at
Two Sites:
– May 12 and 13,
Columbia, SC
– June 3 and 4,
Milwaukee, WI
• Review and Understand
PACE Model
• Identify Opportunities to
Adapt the Model
• Develop Strategies for
PACE in Rural Areas
• Observe PACE
Interdisciplinary Team,
with Q&A
• Self-Assessment
Instrument
Desk Review and On-Site Consultation
Desk Review
On-Site Consultation
• Submitted by provider
after Workshop
• Reviewed by team of four
• For viable and interested
providers
• Goal: Develop a start-up
plan
• Consultation Team
Tailored to Site
– Two from a TAC
– One external rural expert
– One external health
professions expert
• Prerequisite for On-Site
Consultation