Program of All-Inclusive Care for the Elderly PACEProgram of All-Inclusive Care for the Elderly PACE...
Transcript of Program of All-Inclusive Care for the Elderly PACEProgram of All-Inclusive Care for the Elderly PACE...
Program of All-Inclusive Care for
the Elderly
PACE
Dr. Adam Vossen, Medical Director, Immanuel Pathways
Randy Ehlers, MSW, Executive Director, Siouxland PACE
What is PACE?
Comprehensive Care
Community Based
Coordinated
Capitated
Who Does PACE Serve?
55 and older
Meet Nursing Facility Level of Care
Able to live safely in the Community with PACE services
How Does PACE Operate?
PACE Center
• Primary Care
• Rehabilitative Care
• Activities
• Meals
In-Home Services
Transportation
Contracted Network
• Specialists
• Hospitals
• Assisted Living
• Other
Integrated Service Delivery and Team
Managed Care
Outcomes
Comprehensive Care
• Coordination of all care
• Reduce unmet needs
• Improve chronic care management
• Functional support
Delay or prevent long term placement
Higher quality of life
PACE Costs
Reduce high cost of uncoordinated care
• Fewer hospitalizations
• Reduction of emergency room use
Capitation = Predictable
PACE rate less than current Medicaid costs
No copays
Who Pays for PACE Care
PACE is a financially at-risk capitated program, serving as a medical
provider and health plan for enrolled members
PACE provides services above and beyond those covered by Medicare
and Medicaid
Organizations receive a per member, per month payment to deliver all
necessary care
Breakdown of participant eligibility (percentages are approximates)
• 90% dually eligible for Medicaid and Medicare
• 9% Medicaid only
• 1% private pay, Medicare only, other
PACE in Iowa
Total Number of Individuals served in Iowa: 558
Siouxland PACE
Immanuel Pathways -
Southwest Iowa
Immanuel Pathways –
Central Iowa
11
Immanuel Pathways - Southwest Iowa
Location: Council Bluffs, IA
Opening Date: January 2012
Service Area: Mills, Pottawattamie, and Harrison Counties
Enrollment: 177 participants (~23% penetration of eligibles)
55-64: 24%
65+: 76%
Center Capacity: 230-240 participants
12
Immanuel Pathways - Central Iowa
Location: Windsor Heights, IA
Opening Date: October 2015
Service Area: Boone, Dallas, Jasper, Madison, Marion, Marshall, Polk,
Story and Warren counties
Enrollment: 164 participants (~4% penetration of eligibles)
55-64: 30%
65+: 70%
Center Capacity: 250 participants
Siouxland PACE
Location: Sioux City, IA
Opening Date: September 2008
Service Area: Woodbury, Plymouth, Cherokee, and Monona counties
Enrollment: 197 participants (~20% penetration of eligibles)
55-64: 28.4%
65+: 71.6%
Center Capacity: 270 participants
What the PACE Population Looks Like
Immanuel
Pathways –
Central Iowa
Immanuel
Pathways –
Southwest Iowa Siouxland PACE
Average Age 72 72 70
Minimum Age 56 56 56
Maximum Age 98 100 94
Female
Percentage 65% 62% 58%
Independent
Living 94% 89% 86%
What the PACE Population Eligibility
Looks Like.
Immanuel Pathways
– Central Iowa
Immanuel Pathways
– Southwest Iowa Siouxland PACE
Dual 157 95.7% 166 93.8% 173 88%
Medicare Only 1 .6% 0 0% 7 3%
Medicaid Only 6 3.7% 11 6.2% 17 9%
Barriers for PACE
Strict cut-off dates for enrollment
Awareness in the State of Iowa
Lack of referrals from the Enrollment Brokers to PACE
Substantial start up capital
Methodology used to calculate PACE payments
Questions?