An Overview of Rural PACE 1 st Educational Series Conference Call – 2:00 PM, 1/26/04 Presented by: Rural PACE Technical Assistance Program

An Overview of Rural PACE 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 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

 Integrates preventive, acute & long-term care services  All Medicare & Medicaid services plus community long-term care service  No benefit limitations, co-payments or deductibles Comprehensive Service Package The PACE Model

 Medicare capitation rate adjusted for the frailty of the PACE enrollees  Integration of Medicare, Medicaid and private pay payments Capitated, Pooled Financing The PACE Model

Source of Service Revenue The PACE Experience  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

PACE: Interdisciplinary Teams Care Needs Assessment, Planning and Delivery Social Services Home Care Pharmacy Nutrition OT/PT Primary Care Transportation Personal Care Activities Nursing

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/ –Shelly Ten Napel, NRHA, 703/

Technical Assistance Services 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 care- management 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 Submitted by provider after Workshop Reviewed by team of four –Two from a TAC –One external rural expert –One external health professions expert Prerequisite for On-Site Consultation On-Site Consultation For viable and interested providers Goal: Develop a start-up plan Consultation Team Tailored to Site