Essential Considerations for Starting a PACE Program

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The Program of All-Inclusive Care for the Elderly (PACE) care model has emerged as a comprehensive and integrated care delivery model for the frail elderly eligible for both Medicare and Medicaid or Medicaid only.

The goal of PACE is to allow its enrolled participants to remain in the community for as long as possible, avoiding institutionalization, by providing all medical and social services in their homes or places of residence.

The successful establishment and operation of a PACE program requires careful planning and the consideration of several essential factors.

In this review, we discuss four crucial aspects, which must be carefully evaluated before embarking on the journey of starting a PACE program:

  • Service area geography and access to care,
  • Population demographics,
  • Ability to staff the program with qualified professionals and paraprofessionals,
  • and potential competition posed by other care choices available to dual-eligible individuals in the target area.

Service Area Geography

The geographical region in which the PACE program operates plays a pivotal role in its success. The service area should be strategically chosen to ensure accessibility to the target population and to all specialty providers, facilities, and other supportive services needed with which PACE organizations must contract.

Factors such as transportation infrastructure and traffic patterns; distance to medical facilities, specialists, and access to qualified staffing are paramount.

In urban areas, transportation options might be more varied, but traffic congestion and parking availability can impact access.

In rural areas, travel distances to reach the program’s target populations, care centers, specialist providers, or qualified staffing may be longer, requiring creative solutions such as mobile clinics, telehealth services, and staffing transportation support.

Additionally, the service area should be assessed for its potential to support program growth and expansion.

Population Demographics

Comprehensive knowledge of the population demographics within the prospective service area is essential for determining if there is an adequate population to support a PACE organization.

Demographic data, including age distribution, prevalent health conditions, socioeconomic backgrounds, and cultural diversity, will determine the likelihood of enrolling sufficient participants. This analysis will help predict the potential demand for the program and be a major factor in determining its feasibility.

Access to Staff and Specialty Providers/Services

The success of a PACE program hinges on its ability to provide adequate staffing levels, comprised of skilled healthcare professionals and support staff, as well as a robust network of specialty providers and facility partners.

Staffing requirements include providers (doctors, nurse practitioners, physician assistants, etc.), registered nurses, social workers, dieticians, physical and occupational therapists, aides, drivers, and administrative personnel. Access to specialists will require contracted partnerships with existing specialty medical groups, and hospitals, or establishing in-house specialized services.

Collaboration with specialists guarantees participants receive necessary care, especially for complex health conditions common among the frail elderly. The availability of qualified staff and specialists should be assessed against the program’s projected participant volume.

Sufficient staffing ensures participants receive timely medical attention, personal care, and social engagement and the program’s ability to meet regulatory care requirements. Regular communication and coordination among providers (staff and contracted) is essential to deliver seamless, proactive care that helps mitigate unnecessary hospitalizations or placements by preventing fragmented care and service delivery.

Competitive Headwinds from Choices for Dual-Eligibles

Dual-eligible individuals are eligible for both Medicare and Medicaid, making them the largest potential target for enrollment in the PACE programs. Potential enrollees may have Medicaid only or pay privately for a portion of the services, but the dual-eligible population comprises the largest percentage of PACE participants nationally.

The PACE option will compete with alternative choices such as nursing homes, home healthcare services, state-funded home and community-based services, and managed care plans. These choices present competitive headwinds, which need to be evaluated. A thorough analysis of the services offered by these alternatives; their quality, cost, accessibility, and what they may not provide, will help position the PACE program as a compelling option.

This assessment guides the program in highlighting its advantages, such as a more comprehensive offering of services including care coordination, community-based services, transportation, personalized attention, and more.

Launching a successful PACE program demands careful consideration of multiple factors.

  • Service area geography shapes accessibility and expansion possibilities.
  • Population demographics determine the program’s services and cultural competence.
  • Adequate staff and a network of specialist providers ensure comprehensive care and qualified staffing guarantees operational efficiency and participant satisfaction.
  • Lastly, understanding competitive challenges aids in positioning the PACE program strategically.

By addressing these essential considerations, a sustainable PACE program can be designed and implemented to provide holistic, person-centered care for the elderly, fostering their well-being and enhancing their quality of life.

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