1. PACE: A Foundation for Serving People with Intellectual Disabilities? Peter Fitzgerald National PACE Association Alexandria, VA Peterf@NPAonline.org

2. What is PACE? Program of All-Inclusive Care for the Elderly An integrated system of care for the frail elderly that is: Community-based Comprehensive Capitated Coordinated

3. The PACE Model: Who Does It Serve? 55 years of age or older Living in a PACE service area Certified as needing nursing home level of care Able to live safely in the community with the services of the PACE program at the time of enrollment

4. PACE Demographics Average age at enrollment: 78 75 percent of enrollees are women Average length in the program 2.5 years Most common reason for disenrollment: death

5. Milestones in the PACE Model History On Lok Waivers/ Full Risk 1983 On Lok Ongoing Waivers 1985 First Center – On Lok 1973 1978 On Lok Demo. Project

6. First Demonstration Sites Operational 1986 Legislation Authorizing PACE Demonstration 19901997 Congress Authorizes Permanent Provider Status Balanced Budget Act of 1997, H.R. 2015 Washington, D.C. (Nov) 1999 Publication of Interim Final PACE Regulation First Program Achieves Permanent PACE Provider Status (Nov) 2001 Milestones in the PACE Model History

7. Final PACE Rule (Oct) 2002 Publication of 2 nd Interim Final PACE Regulation enhancing opportunities for program flexibility November 2006 Milestones in the PACE Model History PACE required to be a Part D Plan 2005

8. The PACE Model Philosophy Honors what elders want To stay in familiar surroundings To maintain autonomy To maintain a maximum level of physical, social, and cognitive function

9. PACE Services Provided nursing physical therapy, occupational therapy recreational therapy meals nutritional counseling social work medical care home health care personal care prescription drugs social services audiology dentistry optometry podiatry speech therapy respite care Hospital and nursing home care when necessary & All medically necessary care and services

10. Locations of Care

11. PACE Provides Transportation

12. Integrated Service Delivery and Team Managed Care Interdisciplinary Teams Participant and Family Home Care Pharmacy Nutrition OT/PT Primary Care Transportation Personal Care Activities Social Work

13. Integrated, Team Managed Care An interdisciplinary team of professionals with a direct care relationship to the participant Team managed care vs. individual case manager Continuous process of assessment, treatment planning, service provision and monitoring Focus on prevention Aligned quality and payment incentives –More of the right care means –Less high cost care –Look at long term needs, vs. short-term savings –No cost shifting

14. PACE is Small in Scale Each PACE center and IDT can serve up to about 200 enrollees.

15. Capitated, Pooled Financing Medicare capitation rate adjusted for the diagnoses and frailty of the PACE enrollees Integration of Medicare, Medicaid and private pay payments

16. Source of Service Revenue For Dual Eligible individuals 2010 Mean Medicare PMPM Rate: $2063 2010 Median Medicaid PMPM Rate: $3258 PACE also the Part D prescription drug plan for Medicare beneficiaries

17. 172 PACE centers, operated by 80 organizations, in 28 states, serving 23,000+ Between 2005-2010, number doubled Enrollment grew 20% in 2008, 13% in 2009 15 new programs in development “pipeline” Status of PACE Development (as of October 2011)

18. National Census Growth 1996 – 2010

19. PACE Programs Around the U.S.

20. PACE Core Competencies  Provider-based model  Serves a nursing home eligible population in the community (90% +)  Good care outcomes, high enrollee satisfaction and low disenrollment rates  Because PACE is still unfamiliar, a well known, trusted provider has an advantage

21. .Begin to think in terms of People vs. Sentinel Events. Abandon the assumption that more is better. Understand that not all aspects of care are clinically based, some require simple creativity. Embrace the importance of a consistent care delivery system over time. Challenge for Providers

22. Benefits for Stakeholders Providers: Flexibility to provide the right care and services for each individual. Gov’t Payors: Predictable, lower costs. Shifts financial risk to providers. Family Caregivers: A model of care that supports their efforts. Participant: A model of care focused around their goal to live independently, in the community.

23. Serving People with Intellectual Disabilities Foundation to Build on – Experience managing complex needs – Provider-sponsored – Direct relationship with individual – Recognition of medical AND social dimensions of care – Care in the home, and in other settings – Some experience with consumer directed care

24. Challenges and Questions Does PACE provide the range of services needed by individuals with intellectual disabilities? If not what additional services and supports are needed? What core competencies are needed by PACE staff serving individuals with ID? Would an ID only PACE Organization be necessary? How should PACE be integrated with community living options and services? Appropriate cost-basis and rate setting?