PACE Proposes Ways to Lower Dual-Eligible Costs While Improving Care

New innovations expand the availability of PACE programs to more Medicare and Medicaid beneficiaries with high health care needs

ALEXANDRIA, Va.--(BUSINESS WIRE)-- The National PACE Association (NPA) today announced a series of proposals to overcome regulatory barriers and expand access to new populations that could benefit from PACE’s integrated care model. With more than 25 years of experience serving the oldest and most frail members of society, the nation’s Programs of All-inclusive Care for the Elderly (PACE®) have proven that a well-designed coordinated care delivery approach in community settings can achieve quality outcomes while reducing the cost of care for the sickest, most at-risk populations.

Appearing before the U.S. House Energy and Commerce Committee hearing entitled, “Dual-Eligibles: Understanding This Vulnerable Population and How to Improve Their Care,” Shawn Bloom, President and CEO of the National PACE Association, identified the barriers to continued PACE growth and proposed a series of program changes and demonstration projects to care for additional patient populations.

“The nation’s 76 PACE organizations provide high quality care for more than 22,000 of the nation’s most medically complex beneficiaries,” said Bloom. “Through the use of interdisciplinary medical teams that provide comprehensive care and services, PACE delivers exceptional outcomes, which we feel can be expanded to reach other dual eligible individuals with complex medical needs. For the nation to succeed in improving health care quality and lowering the cost, proven approaches like PACE must be allowed to expand more quickly.”

NPA’s decision to seek greater flexibility in PACE regulations responds to requests from health care leaders searching for effective ways to bring community-based, high quality, high value models of care to serve more people. With 25 years of experience many experts feel the PACE model is well suited to address many of the challenges facing our health care system. Among its innovative concepts, PACE uses a bundled payment from Medicare and Medicaid and creates a medical home for each beneficiary including clinicians, therapists, pharmacists, dieticians and personal care attendants and others. By stressing prevention and wellness, PACE helps enrollees avoid hospitals, nursing homes and other costly medical interventions.

“The unique nature of our bundled payment is that programs become totally accountable for the health and wellness of each beneficiary,” continued Bloom. “If a care team sees that a person will be helped by adding a non-medical service to their care plan like transportation, meal delivery or installing grab bars in the home, then the PACE organization can make the change and it does not cost the enrollee or the government any more money. Often doing simple things will keep a beneficiary in their home and out of an institution. The end result is lower costs and a healthier patient.”

In his testimony, NPA’s Bloom proposed removing several barriers that prevent PACE organizations from serving more beneficiaries. NPA proposed the following recommendations:

1. Allowing PACE organizations more flexibility in contracting with community-based primary care physicians (PCPs). Because of a limited number of PCPs this will allow PACE organizations to move beyond employed physicians and expand the number of participants;

2. Permitting advanced practice nurses to conduct certain activities currently assigned to PCPs like assessments and care plan development;

3. Allowing for more flexibility in the composition and processes of the PACE Interdisciplinary Team; and

4. Encouraging states to utilize PACE as a means for transitioning Medicaid eligible beneficiaries residing in nursing homes back to the community.

Additionally, Bloom outlined a series of demonstration projects that would expand the populations PACE organizations serve. The proposals include:

1. Allowing PACE to enroll individuals under age 55 who meet their states’ eligibility criteria for nursing home level care;

2. Allowing PACE to enroll high-need, high-cost beneficiaries who do not yet meet the state’s eligibility criteria for nursing home level care;

3. Reducing PACE’s reliance on the PACE Center as the primary location for care delivery through the use of alternative settings and contracted community-based providers;

4. Encouraging alternative approaches to providing Medicare Part D drugs to participants; and

5. Increasing the enrollment of Medicare-only beneficiaries in PACE.

“PACE is a tangible program with a proven track record,” concluded Bloom. The PACE community is looking forward to contributing to the state and federal governments’ need to improve the health care received by a greater number of dual-eligible beneficiaries. We look forward to continuing working with the Committee, Congress and the Administration on this effort.”

The National PACE Association’s testimony comes on the heals of MedPAC’s June 2011 Annual Report to Congress, which states that, “fully integrated managed care plans and PACE providers offer the best opportunity to improve care coordination for dual-eligible beneficiaries across Medicare and Medicaid services.” (page 139)

PACE is an innovative, fully-integrated provider of care for the most frail, sick and costly members of our society, allowing participants to stay in their homes or communities and out of nursing home. Led by a comprehensive care team, PACE bundles Medicare and Medicaid payments to provide the full range of health care services a person needs for a fixed rate. Often called the gold standard for older adult care, PACE’s focus on prevention and wellness has resulted in health improvements and proven cost savings. The National PACE Association is the voice of PACE providers across the country.


National PACE Association
Robert Greenwood, 703-535-1522
[email protected]

KEYWORDS:   United States  North America  Virginia

INDUSTRY KEYWORDS:   Seniors  Health  Public Policy/Government  Healthcare Reform  Public Policy  White House/Federal Government  Consumer  General Health  Managed Care