Program of All-Inclusive Care PACE

1. Program of All-Inclusive Care(PACE®) Presented to: Healthy Berrien Consortium May 8, 2009

2. What is PACE®? An optional benefit under both Medicare and Medicaid Comprehensive medical and social services For most patients, permits them to continue living at home while receiving services A team of health professionals assess participant needs, develop care plans, and deliver all services Built around Adult Day services PACE or Program of All-inclusive Care for the Elderly is a comprehensive and seamless health care service delivery system and integrated Medicare and Medicaid financing. An optional benefit under both Medicare and Medicaid Comprehensive medical and social services – An array of coordinated services is provided to support participants to prevent the need for nursing home admission allowing most patients to continue living at home while receiving services. An interdisciplinary team, consisting of professional and paraprofessional staff, assess participants' needs; develops care plans; and delivers or arranges for all services (including acute care and, when necessary, nursing facility services), either directly or through contracts. PACE programs provide social and medical services, primarily in an adult day health center setting referred to as the "PACE center," and supplement this care with in-home and referral services in accordance with the participants' needs. PACE or Program of All-inclusive Care for the Elderly is a comprehensive and seamless health care service delivery system and integrated Medicare and Medicaid financing. An optional benefit under both Medicare and Medicaid Comprehensive medical and social services – An array of coordinated services is provided to support participants to prevent the need for nursing home admission allowing most patients to continue living at home while receiving services. An interdisciplinary team, consisting of professional and paraprofessional staff, assess participants' needs; develops care plans; and delivers or arranges for all services (including acute care and, when necessary, nursing facility services), either directly or through contracts. PACE programs provide social and medical services, primarily in an adult day health center setting referred to as the "PACE center," and supplement this care with in-home and referral services in accordance with the participants' needs.

3. What does PACE® provide? For consumers: The option to continue living in the community as long as possible One-stop shopping for all health care services  For health care providers: Capitated funding arrangement Ability to coordinate care across settings and medical disciplines Ability to meet increasing consumer demands for individualized care and supportive services  For those who pay for care: Cost savings and predictable expenditures Comprehensive service package emphasizing preventive care A model focused on keeping participants at home For consumers: PACE provides access to the full continuum of preventive, primary, acute, and long term care services. It provides:  The option to continue living in the community as long as possible One-stop shopping for all health care services   For health care providers: this comprehensive service delivery and financing model of acute and long-term care provides: Capitated funding arrangement - PACE programs receive Medicare and Medicaid capitation payments for all eligible enrollees Ability to coordinate care across settings and medical disciplines Ability to meet increasing consumer demands for individualized care and supportive services arrangements   For those who pay for care: Cost savings and predictable expenditures Comprehensive service package emphasizing preventive care A model of choice focused on keeping participants at home For consumers: PACE provides access to the full continuum of preventive, primary, acute, and long term care services. It provides:  The option to continue living in the community as long as possible One-stop shopping for all health care services   For health care providers: this comprehensive service delivery and financing model of acute and long-term care provides: Capitated funding arrangement - PACE programs receive Medicare and Medicaid capitation payments for all eligible enrollees Ability to coordinate care across settings and medical disciplines Ability to meet increasing consumer demands for individualized care and supportive services arrangements   For those who pay for care: Cost savings and predictable expenditures Comprehensive service package emphasizing preventive care A model of choice focused on keeping participants at home

4. Whom does PACE® Serve? PACE serves seniors with chronic care needs by providing access to the full continuum of preventive, primary, acute, and long term care services. PACE enrollees must: Be at least 55 years of age Live in the PACE service area Be able to safely live in a community setting May or may not be eligible for Medicare/Medicaid Meet nursing home level of care requirements In order to qualify for PACE, a person must be 55 years of age or older, live in a PACE service area, and be certified by the state to need nursing home-level care. The typical PACE participant is similar to the average nursing home resident.  On average, she is 80 years old, has 7.9 medical conditions and is limited in approximately three activities of daily living.  49%of PACE participants have been diagnosed with dementia.  More than 90% of PACE participants are able to continue to live in the community.In order to qualify for PACE, a person must be 55 years of age or older, live in a PACE service area, and be certified by the state to need nursing home-level care. The typical PACE participant is similar to the average nursing home resident.  On average, she is 80 years old, has 7.9 medical conditions and is limited in approximately three activities of daily living.  49%of PACE participants have been diagnosed with dementia.  More than 90% of PACE participants are able to continue to live in the community.

5. What are PACE® covered services? Adult day care Medical care Home health care and personal care All necessary prescription drugs Social services Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy Respite care Hospital and nursing home care when necessary Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible.  Care and services include: Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant Home health care and personal care All necessary prescription drugs Social services Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy Respite care Hospital and nursing home care when necessary Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible.  Care and services include: Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant Home health care and personal care All necessary prescription drugs Social services Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy Respite care Hospital and nursing home care when necessary

6. PACE patient outcomes  PACE has been approved by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidenced based model of care and placed on the National Registry of Evidenced Based Programs and Practices web site.  SAMSHA recently began reviewing models of care for the elderly and PACE is one of the first to be recognized PACE participants had significantly lower rates of hospital, nursing home, and emergency department utilization and lower overall rates of inpatient days than participants in the comparison groups PACE participants reported better health status and quality of life and less deterioration in physical function than comparison group members (individuals who expressed an interest in PACE but decided not to enroll) Overall, the PACE group up had slightly fewer diagnoses per discharge than the nursing home group. Over the course of the observation period, 19% of PACE enrollees died, compared with 25% of comparison group members Full report available on the National registry of Evidence based programs website. PACE has been approved by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidenced based model of care and placed on the National Registry of Evidenced Based Programs and Practices web site.  SAMSHA recently began reviewing models of care for the elderly and PACE is one of the first to be recognized PACE participants had significantly lower rates of hospital, nursing home, and emergency department utilization and lower overall rates of inpatient days than participants in the comparison groups PACE participants reported better health status and quality of life and less deterioration in physical function than comparison group members (individuals who expressed an interest in PACE but decided not to enroll) Overall, the PACE group up had slightly fewer diagnoses per discharge than the nursing home group. Over the course of the observation period, 19% of PACE enrollees died, compared with 25% of comparison group members Full report available on the National registry of Evidence based programs website.

7. PACE® in Berrien County Knowledge Base of Key Community Partners Area Agency on Aging – home and community based services Lakeland – acute and rehabilitative care Hospice At Home – palliative care Child & Family Services – day care center Other Geographic Scope – Berrien County; western Van Buren County The AAA explored the feasibility of a PACE project in Berrien County in 2001 as part of a larger 8-county project we were working on  at that time AAA has been developing day care centers in southwest Michigan for a number of years – the Benton Harbor site is a  solid business at this point and worth exploring as a PACE site PACE requires a collaborative effort - AAA handout does not commit anyone or limit partnerships but presents some obvious “likely” partners Any brainstorming about ways to address the consultant fees [all HBC?, just interested partners?] The AAA explored the feasibility of a PACE project in Berrien County in 2001 as part of a larger 8-county project we were working on  at that time AAA has been developing day care centers in southwest Michigan for a number of years – the Benton Harbor site is a  solid business at this point and worth exploring as a PACE site PACE requires a collaborative effort - AAA handout does not commit anyone or limit partnerships but presents some obvious “likely” partners Any brainstorming about ways to address the consultant fees [all HBC?, just interested partners?]

8. PACE® in Berrien County  Pre-Application – place-holding Consultant assistance National PACE Association Technical Assistance Centers – associated with operating PACE programs Michigan based start-ups Market feasibility Medicaid LTC eligibles # of dual eligibles [Medicare Savings Program] Projected PACE eligibles New eligibles entering Medicaid monthly Analysis of existing PACE experience   Two-part application process Letter of intent (pre-application that includes a feasibility study) Application  PACE must be approved by Michigan first, then CMS Application is a 2-part process: 1) Letter of Intent [pre-application], and 2) Application Submission of a Letter of Intent [pre-application] will hold a geographic area for the applicant to continue to phase 2 The pre-application is actually the required feasibility study and covers all components of the project DCH strongly recommends using John Tucker from Palmetto health Care in Columbia, South Carolina as consultant to write the Letter of Intent. He was the consultant for all recent Michigan PACE sites.  [Battle Creek and Muskegon]. The pre-application would likely take 3-5 months to complete at a cost of up to $35,000 and does not obligate the partners Two-part application process Letter of intent (pre-application that includes a feasibility study) Application PACE must be approved by Michigan first, then CMS Application is a 2-part process: 1) Letter of Intent [pre-application], and 2) Application Submission of a Letter of Intent [pre-application] will hold a geographic area for the applicant to continue to phase 2 The pre-application is actually the required feasibility study and covers all components of the project DCH strongly recommends using John Tucker from Palmetto health Care in Columbia, South Carolina as consultant to write the Letter of Intent. He was the consultant for all recent Michigan PACE sites.  [Battle Creek and Muskegon]. The pre-application would likely take 3-5 months to complete at a cost of up to $35,000 and does not obligate the partners

9. PACE® in Berrien County  Benefit Design Organizational design – exploration of options Financing Start-up costs: planning, facility, fixed costs prior to breakeven enrollment Potential equity partners Budget: operational analysis Additional Additional

10. Developing PACE® in Berrien County Orientation of Healthy Berrien Consortium - HBC resolution in support of PACE development Analysis of Partner Interest Engagement/Financing of Pre-Application Consultant

11. Healthy Berrien Consortium Proposed PACE® Resolution: “Healthy Berrien Consortium supports collaborative development of a Berrien County based PACE project and encourages all HBC members interested in pursuing PACE development to form a sub-committee for the purpose of further discussion and securing needed resources and consultant support to conduct the PACE feasibility study required as a component of a Letter of Intent to the State of Michigan.”