The Best-Kept Healthcare Secret

Update: The ongoing shift to value-based reimbursement models in healthcare will continue to be a top issue in 2017. In October 2016, we talked risk for hospitals as they adjust their business models:
To read more, check out our recent posts on value-based care:, and our posts on long-term care:

We’ve seen the future of healthcare in America, and it’s called PACE. The PACE (Program for All-inclusive Care for the Elderly) integrates preventive, primary, acute, behavioral and long-term services for people at least 55 years old who are eligible for both Medicare and Medicaid.

As executives who ran the country’s largest PACE program, we saw firsthand how PACE provides dignity and better outcomes for some of the country’s most economically, socially and medically disenfranchised citizens. But we also saw that PACE is too well-kept a secret among doctors and other healthcare providers.
Fortunately, new Medicare rules can change that. Medicare proposes to update and modernize this decades-old program by improving care for beneficiaries and providing administrative flexibility and regulatory relief for PACE organizations.

This is a big deal for the 34,000 older adults currently enrolled in PACE organizations nationwide. PACE goes way beyond the traditionally constructed views of primary care. It is an engine to coordinate an array of services that primary care physicians can’t afford to provide under current Medicaid reimbursement rules. Without the high degree of coordinated care that frail adults need, institutional care is the only option. Institutional care does not always convey dignity and is more expensive than the array of services provided through PACE.

Medicare also proposes to lift restrictions on what the care team can do for beneficiaries, allowing team members to participate in more aspects of a participant’s care. If you were trained in both nursing and pharmacy, for example, you could provide both services at the same time rather than just one, as is the case now. By taking on more roles, team members could provide even more coordination. Patients could get better care because they’d be seen by multiple teams.

Tailoring care is one of the things we did in the PACE program we ran, and it was deeply satisfying – for the program participants and for us. We were making every individual the center of his or her own universe. We aimed to provide the right sets of services at the right time to minimize the risk of that individual defaulting to institutional care.

Our experience tells us that this is the future of post-acute care in the United States. The patients themselves need to be the center of the universe, not the hospitals and health systems. All the changes in healthcare reimbursement tell the same story. Providers are increasingly being paid based on the value they provide. You perform heart surgery and you’re responsible for making sure the patient doesn’t bounce back to the hospital 27 times in the first 90 days. After all, if you buy a gallon of milk at the store and the milk is sour, isn’t the store responsible for that? Then why aren’t physicians and hospitals responsible for the outcome of their work?

It’s no longer enough simply to discharge patients alive to recuperate on their own (with varying degrees of success), which was the historic goal of hospitals. Today’s value-based payment system requires hospitals to take responsibility for what happens inside and outside their walls. This enables patients who have had a heart attack, for example, to use inpatient and outpatient therapeutic interventions as ways to continue engaging with life.

The entire healthcare community should be dedicated to this kind of patient experience. The patient should be able to function in society to the best extent possible, given their injuries and illness. Sick or infirm people shouldn’t be hidden away. That’s why PACE should grow so that patients can age in place.

Aging in place is far more dignified than having individuals confined to life in skilled nursing facilities. Nursing homes can be expensive to run and they can be complicated. We know because we ran 1,185 skilled nursing beds along with the PACE program. Individuals residing in these facilities typically didn’t have any other options.

PACE can be that other option for many individuals. It’s the only program with an interdisciplinary team specifically designed to quarterback patient care. Patients aren’t locked away. The program provides an embracing set of services aimed at keeping people involved and functional in their communities.

Patients get better care, and their health outcomes prove it. Last year the quality of health for PACE beneficiaries in the state of New York was twice as high as that of other managed long-term care participants. Participants’ emotional health was better and not surprisingly, so was their quality of life.

The PACE care model allowed us to bring individuals with diagnoses whose care needs to be carefully monitored, like diabetics directly to a PACE center. The PACE center is essentially an adult day care center where we can engage lots of chronic problems, measure blood sugar, provide nutritious meals, assure that medications are properly administered, provide rehabilitation services, yoga classes, access to entertainment and the ability to interact in a supportive social environment.

Nearly half of the 3,400 participants for whom we cared had memory disorder problems, and 40 percent of those had a primary diagnosis of dementia or other memory loss. It doesn’t make sense to keep individuals with memory impairment alone at home all day. The PACE centers are specifically designed and operated to deal with these kinds of issues.

All of this begs the question: why limit the PACE program to dual-eligible individuals? And if PACE works so successfully in New York City, why can’t it work just as well in the rest of the country? It can, but too many organizations want to continue delivering traditional and, in our experience, less effective care.

Home health agencies want to keep patients at home. Nursing homes want to keep heads in beds. Hospitals want to keep up admissions. Drug companies want to sell as many prescriptions as possible. As a result, we’re getting exactly what we pay for – and it’s outrageously expensive. Meanwhile, primary care is collapsing outside of physician centers like PACE. The typical primary care practice is simply unable to provide what a PACE program can offer.

To make matters worse, it takes six weeks to enroll in PACE. If you can buy deodorant on Amazon with one click, why does it take six weeks to start improving your health? New regulations would streamline this process.

A new final rule with many positive changes for PACE programs is slowly finding its way through the regulatory process. We are in the process of implementing PACE programs and PACE growth strategies in communities nationally. We hope other healthcare professionals will take the time to learn about the program and understand the value that PACE programs can deliver. 

As Bette Davis famously said, “Getting old is not for sissies.” We’re walking away from what it means to age with dignity. When we stop believing that older people have something to offer, we’ve diminished ourselves and our society. That makes PACE not just a medical issue, but a moral one as well.