What Is PACE?

PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that provides all preventive, primary, acute, and long-term care services needed to help frail older adults live safely in the community for as long as possible. Essentially, PACE provides all the care and services covered by Medicare Parts A, B, and D, along with Medicaid services such as transportation and meals.

The PACE concept was born in San Francisco in 1971, earned permanent provider status under Medicare and Medicaid in 1997, and continues to grow to this day. As of March 2019, there were approximately 45,000 participants (5% of whom live in nursing homes) and 126 PACE programs operating in 31 states, with seven new programs in development.

Every PACE program has at least one Center, which is the heart of the program. This is where participants receive care and the Interdisciplinary Team (IDT) coordinates and provides care customized to each participant’s needs. All PACE Centers have a medical clinic, rehabilitative therapy facilities, social work services, a dining room where meals are served, and at least one recreational activity room. How often or when participants attend the Center is based on the PACE care plan and participants’ personalized needs.

PACE Eligibility Requirements

Participants must meet the following criteria to enroll in PACE:

  • Be at least 55 years of age
  • Live in a PACE service area
  • Meet nursing home level of care by state requirements
  • Be able to live safely in the community at the time of enrollment with PACE services

Disabled individuals, regardless of age, may be considered for PACE.

Why Open a PACE Program?

PACE Is a Win-Win!Because PACE Organizations do not depend on fee-for-service reimbursements, there is more flexibility to provide and coordinate services based on participants’ needs, which leads to better patient outcomes and lower healthcare costs. PACE participants have access to comprehensive and coordinated care with a focus on wellness. PACE participants experience fewer emergency department visits, hospitalizations, and nursing home admissions, and enjoy a higher quality of life in their communities. For example, a person with asthma may need an air conditioner unit, or a person with trouble walking and at risk for falling may need a ramp added to their walkway to help avoid falls and resulting hospitalizations. These are benefits that PACE would be able to provide that are not available under Medicare Advantage or fee-for-service Medicare benefits.

Financing PACE

Start-up costs: Some PACE organizations can self-fund start-up and other costs. Additional funding sources can include charitable donations, grants, partnerships, loans, guarantees, tax-exempt bonds, private equity and state financing. Reimbursements: PACE organizations receive monthly capitated payments from Medicare and Medicaid and, in some cases, private payments from participants. There are no deductibles, coinsurance, or other Medicare or Medicaid cost-sharing fees.

How to Become a PACE Organization

First, organizations that wish to become PACE program providers must contact their state’s PACE Administering Agency to establish a service area. From that point, it can take from 18 months to three years to explore the feasibility of and then develop a PACE program. Because of the complexities involved in the exploration and development processes, organizations often hire consultants to assist.

This is where CareVention HealthCareTM can help. CareVention HealthCare offers services and solutions for organizations at every phase of the process. Partnering with CareVention HealthCare means your organization will receive expert guidance at every step of your journey to becoming a PACE provider.

Read on to learn more about exploring and developing a PACE program ― and to determine if PACE could be a good fit for the expansion of services for your organization!

Services and Solutions for Every Stage of PACE

Exploring, Developing, and Improving PACE

For states or organizations exploring PACE or those in the start-up stage, the experienced staff of Capstone Performance Systems’ PACE Technical Assistance Center (TAC), provides expert guidance at all stages, from exploring the feasibility of establishing a program at the state or organizational level, through the application and the start-up development processes, to enrollment and ongoing operations. Services include feasibility studies, application, operational framework design and implementation, and more. For additional information, visit CapstonePerformanceSystems.com, contact info@cpstn.com, or call 314-810-2456.

Health Plan Management/Third-Party Administrator Services

PeakTPA helps organizations manage the business functions that drive reimbursement revenues and utilization costs. With extensive experience in health plan management, PeakTPA helps ensure your organization is compliant with government regulations and reimbursed accurately for services to a high-risk population. Peak assists organizations with all aspects of PACE health plan management, including enrollment management, accounts receivable, claims adjudication, risk adjustment, data submission, and more. For more information, visit PeakTPA.com, email info@peak.cpstn.com, or call 314-474-7342.

Electronic Health Records and Workflow Integration

Cognify offers EHR, care planning, mobile, integration, and health plan management capabilities that are the top-rated and fastest-growing solutions within PACE. Cognify’s PACElogic integrates data, processes, and workflows across the enterprise, bringing clarity and consistency to interdepartmental processes. Capable of integrating with any EHR, PACElogic also delivers value as a robust, stand-alone solution without an EHR. Cognify’s turn-key solutions enable PACE organizations to respond quickly and effectively to initiatives and challenges. For more information, visit Cognify.com, email success@cognify, or call 1-888-COGNIFY (1-888-264-6439).

Mediture is the leading provider of EHRs for PACE programs nationwide. Mediture’s proprietary TruChart software provides care coordination and financial management in one comprehensive system. TruChart enables capitated health plans to manage patients’ EHRs, care planning, service authorizations, and adjudication and claims processing, while providing robust reporting. To find out more about Mediture, visit Mediture.com, email info@mediture.com, or call 1-800-430-2045.

PACE Medication Safety and Comprehensive Pharmacy Management and Distribution

CareKinesis® partners with at-risk healthcare organizations to provide and coordinate comprehensive and personalized medication safety services for individuals with complex medication needs. CareKinesis is the first national PACE-centric pharmacy that focuses on reducing medication-related risk and streamlining workflow for PACE. For additional information, visit CareKinesis.com, email info@carekinesis.com, or call 888-9-PharmD (888-974-2763).

Risk Adjustment Consulting and HCC Coding Services

Capstone Performance Systems provides expert Medicare risk adjustment services to PACE and at-risk health plans/organizations to optimize compliance and revenue. Physician-led training for providers, auditing, coding, and analytics provide greater understanding of the operational nuances that impact payments. Clients typically achieve outstanding returns on investment, enjoy more stable revenue, and feel confident knowing that the risk of noncompliance is low. For more information on Capstone’s risk adjustment services visit CapstonePerformanceSystems.com or contact info@cpstn.com.

To learn more about CareVention HealthCare’s services and the benefits of using our full suite of integrated PACE services, contact info@CareVentionHC.com or call 1-866-335-3413.