Health Dimensions Group (HDG) will be attending the National PACE Association’s 2016 Annual Conference October 23–26 in San Francisco, California. HDG consultants will be presenting at three sessions.
Program of All-inclusive Care for the Elderly (PACE) Overview
Sunday, October 23, 3:00–4:30 p.m.
Lori Aronson, MBA, NHA, Manager, Consulting Services
Melissa Van Bruggen, MBA, CPA, Consultant, Financial Analysis and Reimbursement
Lori Aronson and Melissa Van Bruggen will be presenting on the history and financial performance of PACE during the PACE Basics pre-conference workshop. Participants will learn what the PACE model includes, the history and basics of the program, and the financial performance of the model. Participants must be registered for the pre-conference workshop to attend.
Rising to the Challenge: What Is the Growth Potential of PACE in Your Market and Across the Nation?
Tuesday, October 25, 8:00–9:30 p.m.
Peter Fitzgerald, MSc, National PACE Association
Colin Higgins, Director of Analytics and Research, Health Dimensions Group
Tracy Robledo-Clark, Immanuel Pathways
In this presentation, participants will learn about the current enrollment and market penetrations of all operating PACE programs by selected characteristics in order to benchmark realistic enrollment projections; and about the size of the PACE market relative to the total dual eligible market for select states where state policymakers are pursuing statewide expansion. Additionally, participants will hear a case study of how an operational PACE program used a demographic and market study to guide PACE expansion.
Taking a ‘Fourth-Right’ Approach: Using Systemic Benchmarking to Guide the Management of Service Utilization
Wednesday, October 26, 9:30–10:00 a.m.
Lori Aronson, MBA, NHA, Manager, Consulting Services
Carrie Hays McElroy, MSN-HCA, RN, Gero-BC, Trinity Health PACE
The presenters will describe how to implement performance tracking for internal and/or external benchmarking purposes. The session will also identify two areas where uniform tools can help guide decision-making related to service utilization. At the end of the session, participants will be able to identify the “four rights” of care management.
For more information about the conference, visit www.npaonline.org/education/conferences; and check out conference activities on Twitter using hashtag #NPA2016AC and at @HDGConsulting; @colin_higgins77; @lori_aronson; and @VanVanbruggen.
Authored by Brent T. Feorene, Vice President, Integrative Delivery Models, Health Dimensions Group
Rapidly expanding value-based payment initiatives have presented providers with the ability to be rewarded financially for providing high-quality and cost-effective care, while imposing penalties on providers that do not meet performance thresholds.
Palliative care offers an unparalleled solution by enhancing the patient experience, improving population health, and reducing spending. A recent study revealed a 40 percent decrease in health care costs ($2,362 per day) when palliative care services are provided within the first 48 hours of a hospital admission.[i] The director of the Johns Hopkins Palliative Care Program indicated annual patient savings of $5,000 to $7,000 when palliative care is incorporated into a patient’s care program (2014).
It is important to distinguish palliative care from palliative medicine and hospice. Palliative medicine is specialized medical care for people with serious and advanced illness and is provided by a physician or advanced practice provider who specializes in this board-certified medical subspecialty. Palliative medicine becomes palliative care when an interdisciplinary team practices and delivers the care. While hospice focuses on care delivery at end of life and forgoes therapeutic patient interventions, palliative care is provided as appropriate and indicated throughout the disease trajectory of a patient—and patients can continue to receive curative treatments.
While hospice is a defined insurance benefit with clear payment streams, payment for palliative care is more varied and less defined, presenting both challenges and opportunities for providers.
Among health systems that have successfully integrated palliative care is Sharp HealthCare, a large health system based in San Diego. Sharp developed the Transitions Advanced Illness Management Program that uses risk assessments and algorithms to identify people at the very beginning of an illness that would benefit from palliative services. Results have been exceptional, highlighted by a 94 percent reduction in emergency department visits. Sharp’s program does well in a risk-based environment including Medicare Advantage plans, and, as an integrated system and owner of its continuum, Sharp realized a significant return on investment.
Post-acute and senior care providers are uniquely positioned to integrate palliative care within post-acute care delivered. Under the Bundled Payments for Care Improvement (BPCI) pilot, participants (skilled nursing facilities and home health agencies) developed care pathways that integrate palliative care as a means of quality improvement, enabling these providers to more effectively manage readmissions, length of stay, and potentially avoidable costs and services.
House call programs (HCPs) have also found tremendous value through integration with palliative care, and this growing strategy is evidenced by the palliative care HCPs offered by Jewish Senior Life, Southern Ohio Medical Center, and Northwell Health’s House Calls.
In this era of value-based care with payment increasingly tied to outcomes, payors and providers will be continually challenged to deliver high-value care. The integration of palliative care is not only imperative in this expanding value-based care environment, but also essential for person-centered, compassionate care.
To learn more or to request a copy of our white paper Palliative Care at the Intersection of Value-Based Payment, please contact Brent Feorene, Vice President, Integrative Delivery Models, at 440.871.2756 or email@example.com.
[i] Bharadwaj, P, et al J Palliat Med 2016 Mar; 19(3):255-8. doi: 10.1089/jpm.2015.0234
The Centers for Medicare & Medicaid Services (CMS) will be holding a stakeholder meeting on Monday, August 15, 2016, at 1:00 p.m. CT. The topic will be regarding the newly released proposed rule updating the Programs of All-Inclusive Care for the Elderly (PACE). CMS has summarized the proposed rule as follows.
This proposed rule would revise and update the requirements for the Programs of All-Inclusive Care for the Elderly (PACE) under the Medicare and Medicaid programs. The proposed rule addresses application and waiver procedures, sanctions, enforcement actions and termination, administrative requirements, PACE services, participant rights, quality assessment and performance improvement, participant enrollment and disenrollment, payment, federal and state monitoring, data collection, record maintenance, and reporting. The proposed changes would provide greater operational flexibility, remove redundancies and outdated information, and codify existing practice.
The proposed rule can be accessed at: https://www.federalregister.gov/public-inspection
The call in number is: 1-800-267-1577
Meeting number is: 999 551 883#