Academic journal article Generations

Picking Up the PACE: The Affordable Care Act Can Grow and Expand a Proven Model of Care

Academic journal article Generations

Picking Up the PACE: The Affordable Care Act Can Grow and Expand a Proven Model of Care

Article excerpt

The Program of All-Inclusive Care for the Elderly (PACE) already embodies several reforms in the ACA. Now it needs to expand its offerings to help more people with chronic conditions.

The Affordable Care Act (ACA) presents the Program of All-Inclusive Care for the Elderly (PACE) with opportunities for growth, development, and evolution. The current interest and concern regarding how to best assure high-quality, appropriate, and effective care for frail older adults in the community also allows PACE, with its history of serving this population well, to contribute some of its lessons learned.

PACE is an innovative, person-centered approach to comprehensively meeting the medical and long-term-care needs of older adults with complex chronic conditions, and functional or cognitive disabilities. Working with program participants and their caregivers, PACE programs strive to help elders maintain their independence for as long as possible at home and in their communities by delaying or avoiding permanent nursing home placement.

A Short History of PACE

On Lok, the first PACE program, was established in San Francisco in 1973. It began a major cultural shift in health and long-term care by integrating all Medicare- and Medicaid-covered services and financing into a single comprehensive benefit. PACE participants-who are at least 55 years old and eligible for nursing-level care- receive all medically necessary services, including Medicare- and Medicaid-covered services, along with other social supportive services from their PACE organizations. Many services are provided by PACE staff; others through contracts with community providers. Regardless, PACE is fully accountable for the quality and cost of all services.

Like a health plan, PACE organizations become the payer for services. In contrast to most health plans, PACE organizations provide healthcare directly. An interdisciplinary team of healthcare professionals works with participants and their caregivers to assess needs, and to develop and implement care plans.

Based on its success as a national demonstration program, in 1997 PACE became a permanent Medicare and Medicaid provider. Now there are seventy-five PACE organizations nationwide, serving more than 23,000 participants in twentynine states. A number of these programs serve rural areas where access to community-based alternatives to institutional care is often limited.

Despite consistent growth in the number of PACE organizations, several barriers prevent PACE from growing more quickly. Among these are the considerable time and monetary investment required of prospective PACE organizations. Also, developing a PACE program requires the active support of state Medicaid agencies. Support for a new program, regardless of its merit, can be difficult in times (such as we are currently experiencing) of severe budget and resource constraints. It is also possible that characteristics of the PACE model may deter some eligible individuals from enrolling. The requirement that PACE participants receive their primary medical care from a PACE physician is off-putting to some, although several PACE organizations include community-based physicians on their interdisciplinary teams and more will likely do so in the future.

In order to respond to the growing numbers of individuals who need the comprehensive, coordinated care provided by PACE, and the need to improve the effectiveness of care for persons with complex, chronic care needs, attention has focused on expanding PACE. This may involve increasing the pool of individuals eligible for PACE, perhaps to include individuals younger than age 55, or to alter the model in other ways that would expand enrollment without jeopardizing outcomes.

Encouraging PACE Expansion

Given its focus on improving care for the population enrolled in PACE, the ACA presents several opportunities that may encourage PACE growth.

Within the Centers for Medicare and Medicaid Services (CMS), the ACA established an office focusing exclusively on opportunities to improve care for Medicare and Medicaid beneficiaries (the Duals Office). …

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