CEO DIALOGUE ON PACE GROWTH · NPA Annual Meeting October 22, 2018 1 CEO DIALOGUE ON PACE GROWTH...

NPA Annual Meeting October 22, 2018

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CEO DIALOGUE ON PACE GROWTH

OCTOBER 22, 2018

AGENDA

Jade Gong, Moderator

Peter Fitzgerald

PACE 2.0 Overview

Eric Gurley

Immanuel Growth Story

Scott La Rue

ArchCare Growth Story

DIALOGUE


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“When it comes to innovation, an ounce of execution is worth more than a ton of theory”

Phil McKinney, Syndicated Talk Show Host of Killer Innovations and Businessman

PACE LEADERS PURSUING GROWTH NOW

Incremental Growth Exponential Growth

Enrollment

Revenues

More Capacity

More Capacity

Enrollment

Revenues

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GROWTH STRATEGIES IN PLAY

Community Physician Waiver

State IDD PilotContiguous Rural

Markets

Risk Sharing Partnership

Creative Flexibility on State

Requirements

Notable Policies Awaiting Action

• PACE Final Regulationo HR 6157 directs CMS to release the final PACE regulation

• Part D Waiver for Medicare-only Beneficiarieso Huron Valley PACE Expansion Project, funded by the

Michigan Health Endowment fund has requested a waiver to allow a Medicare-only beneficiary to obtain Part D plan on the marketplace

o Lower Part D premium will make private pay PACE moreaffordable

For Profit PACE Allowed by CMS as of June 2015


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Peter Fitzgerald

Executive Vice President, Strategy & Policy

NPA

Growth and Mission

• PACE results in better self-rated health status

• PACE results in fewer unmet needs

• PACE adds years of life


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Without PACE, Participants and their Families are Struggling

Frail Elders• Isolated

• Bored

• Dependent

• Difficulty accessing care

• Uncoordinated care

• Fear of nursing home placement

Family Caregivers

• Worried

• Tired

• Running around (to get to care)

• Hard to maintain work schedule

Source: NPA review of PACE participant and caregiver interviews

Only One in Ten Eligible Individuals are Enrolled


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Our PACE 2.0 Goal

Serve 200K participants by 2028!

-

50,000

100,000

150,000

200,000

250,000

Aug'18 Aug-19 Aug-20 Aug-21 Aug-22 Aug-23 Aug-24 Aug-25 Aug-26 Aug-27 Aug-28

Exponential Growth

GS1 - Current PACE Programs GS2 - New PACE Programs GS3 - New Populations Total Baseline Participants

Serve 100K Participants by 2021

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Scale and Spread

• Scale – serving more people through the growth of currently operating PACE organizations, serving our current target population (Growth Stream 1)

• Spread – serving more people through current and new PACE organizations expanding into new service areas, serving our current target population (Growth Stream 2)

• Scale and Spread – serving new populations (Growth Stream 3)


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How?

• Retain essential elements

• Identify bright spots achieving high growth• Net Monthly enrollment: 10-15

• Market penetration: 20% or more

• Develop Growth Model

• Field Test Model

• Support dissemination and implementation

Essential Elements

• High functioning IDT

• Effective, ongoing care coordination

• Clinical utilization management

• Presence in the home

• Efficient transportation system

• Socialization systems


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PACE Growth Mindset

Incremental Growth Exponential Growth

If they come, we’ll Build it! If we Build it, they’ll come

Enrollment

Revenues

More Capacity

More Capacity

Enrollment

Revenues

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Field Test – PACE of the Triad

3 Month Field Test


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West Coast PACE 2.0 Learning Collaborative

• Includes 10 PACE organizations from California (8), Washington, and Oregon

• Kicked-off with an in-person learning session on October 3rd

• Will continue for 12-months with bi-weekly all team calls and 3 more in-person learning sessions with coaches & Bright Spot faculty

• Participants will conduct rapid cycle tests of tactics, collect data, and share lessons learning

The Collaborative will help spread & refine growth tactics

Learnings will be incorporated in the driver diagram and shared with the broader NPA membership

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Growth Pledge

• Potential Service Populationo Census

oMedicare & Medicaid claims

• Managed Care Market Factorso Special Needs Plans

oMedicaid Managed Care

• State Policy Factors

• Organizational Factorso Capacity

o Financing


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How Will Sponsors View

Growth?

Eric Gurley

President & CEO

Immanuel


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Immanuel

• Omaha, Nebraska based – Established in 1887

• Original mission:o To meet the health needs of the communityo To meet the needs of orphaned and neglected childreno To meet the needs of older people

• Historically identified as a hospital provider

• 1996 partnered with Catholic Health Initiatives to create largest health system in Nebraska

• 2012 resigned co-sponsorship to pursue aggressive growth in senior care

• Currently serve through 15 locations: market rate and affordable communities; PACE; skilled nursing

Immanuel Pathways -- PACE

• First Site 2012 – Council Bluffs, Iowa

• Second Site 2013 – Omaha, Nebraska

• Third Site 2014 – Des Moines, Iowa (expansion application)

• Relatively smaller regional markets, border on rural service

• Only PACE provider in Nebraska, 2 of 3 providers in Iowa

• Growth limited by processes, risk management, market size


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Immanuel Pathways Enrollment by Site

Future of Immanuel Pathways -- PACE

• Key Performance Indicator – Source of revenues

35%

37%

28%

FY2018 @ 6-30-18

Private Pay Third Party Investments

40%

42%

18%

FY2018 @ 6-30-18

IL/AL/MS Pathways LTC


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Future of Immanuel Pathways -- PACE

• Adapt internal processes to more effectively use space and transportationo Use of Home Care and In-Home services

o Processes for participants in nursing homes and assisted living

o Use of clinic and clinical staff

• Adapt PACE skills to serve the non-dual eligible population

• Use market rate communities as central hub for expansion

Future of PACE

• Immanuel embraced the PACE concept as the future of health delivery and chronic population management

• Immanuel believes that it can capitalize on PACE skills to serve new populations; market rate and specialized needs

• Partnering with other ACO models to share clinical services and to extend ACO model of chronic care management

• Isolate financial risks through private pay markets and partnerships


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Scott LaRue

President and CEO

ArchCare

ArchCare, An Overview

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Service Area 2018

74%

9,000

HOME/COMMUNITY

4,400CARE MEMBERS

SERVED DAILY

9COUNTIES

MEDICAID92%

VULNERABLE95%


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ArchCare Senior Life

• Based in New York City

• Part of the ArchCare system, sponsored by the Archdiocese of New York

• Currently serving o750+ participants

o7 locations (4 centers and 3 alternate care sites)

o4 (Bronx, Manhattan, Staten Island, Westchester) of the 10 counties in the Archdiocese service area

Growth of ArchCare Senior Life over time

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

PACE Opens in Harlem

PACE Opens in Bronx

PACE Opens in Staten Island

PACE Opens ACS in Staten Island

PACE Opens ACS in Bronx

PACE Opens 2nd

ACS in Bronx

PACE Opens in Westchester


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Where we are today…

Where we could be tomorrow

754

1304


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Where we will be under PACE 2.0

754

1304

1844

500Additional Participants required in addition to traditional

growth to meet PACE 2.0 target.


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Growth Opportunities

• New PACE Centers and ACS in existing service areas and service area expansion

• Develop specialized programs (e.g. IDD)

• Non-traditional partners (e.g. NYS OMH)

• Leveraging the Community Physician Waiver

• Adult day medical center conversions

Growth Opportunities

• Partner with Hospitals for existing infrastructure

• State approval to allow Assisted Living Program residents to enroll in PACE

• Mobile Health Clinics for rural counties

• Positioning PACE as the Integrated Product in NYS (FIDA replacement)


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Requirements

• Capital

• Partnerships

• Financial model and risk arrangement flexibility

• Policy change (state and federal)

• Program awareness (patients, physicians, etc.)

LET’S DIALOGUE

38


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THANK YOU!!!

Jade Gong

[email protected]

Peter Fitzgerald

[email protected]

Scott LaRue

[email protected]

Eric Gurley

[email protected]

CEO DIALOGUE ON PACE GROWTH · NPA Annual Meeting October 22, 2018 1 CEO DIALOGUE ON PACE GROWTH...

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