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Setting The PACE: A Care Model For Aging Seniors

posted by Alicia Caramenico

on November 13, 2019

By 2050, about 22% of the U.S. population will be over the age of 65. Health insurance providers are finding new ways to adapt to the needs of this aging population. Programs of All-Inclusive Care for the Elderly (PACE) is an approach that aims to help seniors age safely at home while addressing social and emotional wellbeing, in addition to their physical health.

The Centers for Medicare and Medicaid Services (CMS) estimates that today there are about 45,000 individuals enrolled in PACE in the United States. And a new rule from the agency will allow health insurance providers more flexibility in how they staff caregiving roles, which in turn should enable them to better meet the increasing need for their services.

To learn more about PACE, AHIP spoke with Dr. Ann Wells, the Chief Medical Officer for Population Health at InnovAge – a PACE provider for more than 20 years and the provider serving more seniors in the program than any other.

Your background is in population health – what drew you to PACE?

Dr. Wells: My grandparents moved into my family’s home when they could no longer care for themselves. At a young age, I gained a real appreciation for their desire to stay with family and maintain their independence. The PACE model (Program of All-inclusive Care for the Elderly) is focused on helping older adults do just this. It’s an alternative option to nursing facilities that helps seniors age independently, at the place they call home, while addressing physical, social, and emotional well-being. InnovAge provides all medical care and social support within local neighborhoods and is an excellent example of a model of care that addresses social determinants of health.

I consider it a privilege to be a part of a company that is dedicated to keeping seniors healthy, independent, and in their homes with their loved ones.

How do social needs impact your member population?

Dr. Wells: The wellbeing of our participants is greatly influenced by social and environmental factors. These factors include the physical environment where the participant lives, access to needed services like food and transportation, and social support for physical and emotional needs. These factors affect the participants’ clinical conditions and influence treatment options. When resources are available to overcome negative social determinants of health, they can have a significant impact on population and individual health outcomes. Many times, a participant requires support services to stay in their home. At PACE, a variety of services are available: adult day care, housekeeping, meal delivery, transportation, and Chaplaincy services.

Participants in PACE receive individually centered care plans, including attention to home care needs, nutrition, oral health, physical and cognitive functioning, along with medication delivery, caregiver support, and transportation to and from all levels of care. This focus on the health of individuals has proven value and clinical outcomes, fulfilling core aspects of health care’s value equation. PACE deserves to be at the heart of the current dialogue of how social determinants of care can exist seamlessly within care delivery. Unfortunately, the dialogue on social determinants of health seems to be silent on, or barely mentions PACE, with many people still unaware of the PACE model.

Health organizations, institutions, and education programs are encouraged to address underlying factors related to social determinants of health. PACE has been doing this since it was introduced more than 40 years ago.

How does PACE address social barriers to good health?

Dr. Wells: As the U.S. population becomes more diverse and at greater risk for poor health outcomes due to the impact of negative social determinants of health, there is a growing need to coordinate services across the care continuum. Collaboration among members of the PACE Interdisciplinary Care Team (IDT) goes a long way in achieving this. Each senior enrolled in PACE has a team of medical experts who collaborate to develop a personalized care plan that considers social factors that influence health-related behaviors and health status.

This results in a unique experience for each participant, and includes assessments of food accessibility, in-home safety, and family/caregiver dynamics. PACE participants have access to an adult day center which provides meals, activities, and social connectivity. In addition, InnovAge acts as a resource for local, state, and national policy makers to enable improved health equity for all frail seniors, regardless of their access to PACE.

What are some of the ways you’re leveraging data to better understand your members’ needs?

Dr. Wells: Having comprehensive and accurate data on the seniors we serve allows InnovAge to measure important health outcomes. Like all PACE providers, InnovAge is required to maintain a formal Quality Improvement (QI) program that evaluates opportunities for clinical and operational improvement and tracks success through formal analysis and reporting. Examples of some of the outcomes we have seen include:

  • 94% of participants have had their flu shot
  • 85% of participants received the pneumonia vaccine
  • 94% have completed advance directives
  • 15% 30-day all cause hospital readmission rate
  • An average of less than 1 ER visit per year

How are you measuring success?

Dr. Wells: Each year InnovAge develops a formal quality improvement plan with outlined clinical and operational outcomes goals. These outcomes are measured at least quarterly with a formal report out by each of InnovAge’s 16 PACE centers.

In addition, InnovAge sends out participant satisfaction surveys to get feedback on how we are delivering care. Our target is to achieve at least a 90% satisfaction rate company-wide and at each location.

How has the elder care industry changed in recent years?

Dr. Wells: As the Baby Boomer generation and others continue to age, our society is on the cusp of dealing with an unprecedented number of seniors who will need care. AARP reports that the number of seniors requiring additional care due to chronic illness will increase from about 14% of the senior population in 2010 to 21% by 2050. The opportunity for greater expansion of PACE nationally is driven by this growing older adult population, as well as by the number of us who wish to age in place. We strongly believe that PACE is the best model to care for frail seniors, those who otherwise may be sent prematurely to skilled nursing facilities. PACE has existed for more than 40 years and it is now time to expand this model and make it available to more seniors in more communities throughout the country.

An intensifying shortage of U.S. home health aides and physicians (particularly those in specializing in geriatrics), a booming senior population, and the prevalence of chronic illnesses all point to a need for transformative solutions when it comes to senior care services. Innovative care models, like PACE, can help meet this need.