by Victor Hirth, MD, MHA, Judith Baskins, RN, and Maureen Dever-Bumba, MSN, DrPH(c)
PACE is a very logical approach to health care, offering all Medicare and Medicaid services through a single point of delivery targeted to frail elderly with a host of chronic care needs. As a provider-based model of care, participants are at the center of the plan of care developed by an interdisciplinary team of health care providers. This model offers access to the full continuum of preventive, primary, acute, rehabilitative, and long-term care services. PACE programs take many familiar elements of the traditional health care system and reorganize them in a way that provides comprehensive care in a fiscally responsible manner for families, health care providers, government programs, and others that pay for care.
As the only current model of care that integrates Medicare and Medicaid funding at the point of care, PACE programs have the opportunity to truly integrate these funding streams in the most cost-effective way possible, unlike special needs plans and other managed care models that maintain ‘‘silos’’ between both funding and services. For families caring for an elderly individual needing long-term care services, the PACE model offers caregivers a program that assesses each participant and develops an individualized plan of care as well as the option to live in the community as long as possible while receiving one-stop shopping for all necessary health care services including medications.
For those who pay for care, PACE provides cost savings and predictable expenditures, a comprehensive service package emphasizing preventive care, and a model that allows numerous choices for older individuals focused on keeping them at home and out of institutional settings.
For health care providers, PACE offers a capitated funding arrangement that allows providers to be flexible and creative in providing care, the ability to coordinate care for individuals across settings and medical disciplines, as well as the ability to meet increasing consumer demands for individualized care and supportive services arrangements. Once persons are enrolled as PACE participants, their care and services are coordinated by the PACE Interdisciplinary Team (IDT) through a plan of care. The IDT establishes the plan of care at enrollment and reassessments are conducted at least twice a year (reassessments may occur more often based on changes in a participant’s health condition or anticipated needs). The plan of care is developed by the IDT based on the individual discipline-specific assessment of each IDT member.