A Program of All-Inclusive Care for the Elderly (PACE) is instrumental in providing comprehensive healthcare for the frail elderly population served. However, periods of increased emergency room and hospital utilization within PACE programs represent increased risk to the financial stability of the program and require a thorough examination. To tackle this challenge, the Interdisciplinary Team (IDT) must adopt a comprehensive approach that addresses the root causes and implements targeted interventions. In this article, we briefly explore various strategies to consider when utilization is seemingly trending higher than normal. This is not a comprehensive list, but rather a starting point for PACE leadership to consider and expand upon.
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Root Cause Analysis: Intentionally conduct a thorough analysis to identify the root causes of the increased emergency utilization. This could involve reviewing participant records, analyzing trends, and seeking input from the care teams, participants, and caregivers.
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Enhanced Care Coordination: Evaluate mechanisms to strengthen communication and coordination among members of the IDT, including the primary care team, nursing, homecare, social workers, and other relevant staff. Ensure that all members are aware of participants’ health status, care plans, recent changes in their conditions, and propensity for using the Emergency services.
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Proactive Health Monitoring: Introduce strategies for proactive health monitoring to identify potential issues before they escalate. This can involve regular health assessments, the use of remote monitoring technologies, proactive touchpoints, and the implementation of early warning systems for participants with chronic conditions. Additionally, consider identifying individuals with high utilization rates and developing personalized strategies to provide proactive, additional support.
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Education and Prevention Programs: Create and implement educational initiatives for participants and caregivers with a specific focus on preventive care. Emphasize the recognition of early signs of health issues and provide guidance on when to seek non-emergency medical assistance. Regularly reinforce awareness and usage of after-hours support systems among participants and their caregivers. This approach empowers participants to manage their health effectively, ultimately reducing unnecessary emergency visits.
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Enhanced virtual outreach or Home Visits: Examine the possibility of introducing virtual outreach support or home visit programs. Utilizing technology for virtual outreach or conducting in-person visits to participants’ homes can aid in basic medical assessments, offer mental health support, manage medications, and address health concerns proactively before they escalate.
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Transportation Services: Evaluate and enhance the availability of transportation services to facilitate participants’ easy access to primary care and preventive services. Insufficient access to suitable transportation can result in participants resorting to emergency services for routine healthcare requirements.
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Crisis Intervention Plans: Develop personalized crisis intervention plans for participants with a history of frequent emergency utilization. These plans should outline specific actions to be taken in crisis situations and include strategies for preventing emergencies.
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Behavioral Health Support: Increase access to behavioral health services, including counseling and support groups. Emotional and mental health issues can contribute to emergency utilization, and addressing these concerns proactively can reduce the need for emergency care.
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Medication Management: Improving strategies for medication management is crucial in ensuring that participants are well-informed and compliant with prescribed regimens, a pivotal measure in minimizing unnecessary emergency room visits. Non-compliance with medications can exacerbate health conditions and contribute to a rise in emergency visits, especially significant during transitions of care. Implementing a comprehensive and meticulous medication reconciliation process becomes a vital step in mitigating adverse events and downstream costs.
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Participant and Caregiver Engagement: Actively engage participants and their caregivers in the care planning process. Solicit feedback on their experiences and involve them in decision-making regarding their care. This can improve adherence to care plans and enhance overall satisfaction with the PACE program.
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Continuous Quality Improvement: Create and support a utilization committee and provide training in performance improvement methodologies, such as Lean Six Sigma. Establish an ongoing process for continuous quality improvement, regularly reviewing and adjusting interventions based on continual assessments of emergency utilization. This approach enables the IDT to adapt strategies as necessary.
Addressing higher-than-normal emergency room and hospital utilization in PACE programs requires a multifaceted approach from the Interdisciplinary Team and program leadership. By considering and implementing one or more of these interventions, informed by industry best practices and expert insights, the IDT can optimize emergency care utilization, ultimately enhancing the quality of care for elderly participants and reducing downstream costs. Regular monitoring, evaluation, and collaboration with participants and caregivers are key components to the success of these strategies in supporting sustainable utilization metrics within PACE programs.
For more information or if you have any questions, please contact Carlos Perez at carlos@akeroconsulting.com.
