Home Health Care News: Despite Formidable Challenges, PACE Leaders Keep Expansion Dreams Alive

By Joyce Famakinwa

The Program of All-Inclusive Care for the Elderly (PACE) concept has gained significant business and policy momentum over the past several months, with recent research also highlighting just how successful programs were at avoiding COVID-19 deaths compared to other care settings.

Despite that traction and the model’s clear benefits, PACE still faces a long list of formidable growth barriers.

An alternative to nursing homes, PACE is a Medicare and Medicaid program that helps keep people in their communities. Oftentimes, programs are run out of community-based centers with the support of in-home care providers and their staff.

“Embedded in this model is that the PACE program also addresses the social determinants of health for the enrollees and wraps around this care with a very comprehensive interdisciplinary care team,” Jade Gong, founder and principal of consulting firm Jade Gong & Associates, told Home Health Care News.

At any particular time, 95% of PACE enrollees are living in the community, with about 5% in nursing homes, according to Robert Greenwood, senior vice president of public affairs at the National PACE Association.

“This is pretty remarkable, given that you have to be eligible for nursing home care before you can even enroll in PACE,” he told HHCN.

Based in Alexandria, Virginia, the National PACE Association is an industry advocacy group that focuses on federal and state policies to support the financial viability of the PACE model.

Broadly, the majority of PACE participants are eligible for both Medicare and Medicaid. PACE operators receive a set monthly payment for each participant. Typically, PACE is both payer and provider.

“Having a capitated payment really helps the PACE model because we’re able to emphasize providing primary and preventive care over the things that are really expensive, which are emergency room visits, hospital visits or permanent placement in a nursing home,” Greenwood said.

While the PACE model has been attracting interest over the past few years, the COVID-19 emergency played a major role in ramping up this attention, according to Gong.

“The model just performs so well under COVID,” she said. “There are many different kinds of providers — nonprofit, for-profit, housing — that are interested in PACE or relationships with PACE programs.”

If one provider exemplifies the performance success the model saw amid the public health emergency, it’s WelbeHealth, a Menlo Park, California-based operator of PACE programs.

Overall, WelbeHealth and the PACE community had lower death rates than their nursing homes counterparts, research has found.

In fact, the national PACE COVID-19 death rate was 3.8%, compared to 11.8% in nursing homes. WelbeHealth’s COVID-19 death rate was 2.4%, according to a recent case study conducted by UC Berkeley.

For context, WelbeHealth serves LA and Central Valley, which have both been COVID-19 hotspots at times.

“These were places where crematoriums listed their pollution caps because they had too many bodies piling up,” Si France, founder and CEO of WelbeHealth, told HHCN. “This is where paramedics were asked to start rationing care. The hospitals were full, and they had to fill up their parking lot pop-up units. That was the nightmare context where we had these dramatically lower death rates.”

Over the years, WelbeHealth has seen growth as the organization aimed to serve underserved markets in California. The company added a Fresno program in late 2020 and will serve about 1,000 participants by the end of the year.

“We ranked California cities by highest unmet need, and started working on serving them, in order, beginning with Stockton and Pasadena in 2019, then Long Beach in 2020,” France said. “None of these communities had any PACE services despite having a high need. You had no access to this program that increases quality of life and length of life.”

France noted that PACE enrollees experience an 80% reduction in depression and generally have a higher life satisfaction. They also tend to live longer under the comprehensive and interdisciplinary care model.

Despite strong outcomes from many PACE providers, such as WelbeHealth, there is still room for expansion.

In total, there are 140 PACE organizations operating 272 PACE centers in 30 states, serving over 56,000 participants, according to the National PACE Association.

One of the major barriers to furthering PACE expansion is how high the cost of entry can be for new operators.

“When an organization wants to look at developing a PACE program, it’s not just building the center, hiring the staff, having the right information systems, and leasing or buying the vans to provide transportation,” Greenwood said. “Part of the startup costs is operating in those initial months when you don’t have a big enough enrollment to bring in the revenue that really covers all your expenses.”

Another roadblock is the PACE application process, which requires the state to develop a rate-setting methodology for anyone who’s a Medicaid eligible PACE enrollee. States must also agree to take on certain oversight responsibilities.

“One of the things that really stops a provider from being able to develop PACE is the willingness of the state they’re operating in to support that development,” Greenwood said.

In an effort to drive PACE expansion, Sen. Bob Casey, a Democrat from Pennsylvania and chairman of the Senate Special Committee on Aging, introduced the “PACE Plus Act” in April.

The legislation has received a warm reception from industry insiders for being comprehensive and attempting to cut through red tape.

“I have some sense of optimism that we’re going to get some real traction on the bill this year,” Gong said. “I have talked to some of the senators in states where I have clients, and there’s tremendous interest in seeing PACE expansion.”

If passed, the PACE Plus Act would make room for the creation of new PACE programs and the expansion of current ones through federal grants. The legislation also encourages non-PACE states to take up the model by providing incentives.

Additionally, the legislation would lessen the bureaucratic burden that growing PACE programs face while also providing technical assistance resources.

Another bright spot has been various states’ willingness to consider the PACE model, according to Greenwood.

“States have been looking more closely at how they want to provide long-term care supports and services in the future,” he said. “They’re looking at what else they can do beyond offering nursing home residential care. I think they’ve become a lot more open to supporting PACE as a way to provide more healthy community-based services.”

UC Berkeley Study Reveals WelbeHealth’s Rapid Adaptation To COVID-19 Eldercare Yielded Exceptional Results And Saved Lives

As policy momentum grows toward home and community-based services, study recommends that policy choices focus on the Program of All-Inclusive Care for the Elderly (PACE), and it’s 45-year track record of success in serving the most complex elderly patients.

SILICON VALLEY, Calif., July 14, 2021 — A new study from UC Berkeley’s Berkeley Roundtable on the International Economy (BRIE) features WelbeHealth in a case study illustrating how this California eldercare PACE provider responded early and decisively to the COVID-19 crisis with exceptional results.

“By rapidly transforming its care model, WelbeHealth had exceptional results: as COVID-19 cases rose across the country — and in particular within nursing home populations — WelbeHealth did not have a single COVID-19 death during the first 8 months of the pandemic. The first WelbeHealth loss from COVID-19 occurred on November 21, 2020 and 10 WelbeHealth participants died of COVID-19 since the beginning of the pandemic.”

-UC Berkeley

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Welbehealth: Case Study of Adapting PACE Under COVID-19

Key findings:

  • WelbeHealth and the PACE community overall had lower death rates than nursing homes; the national PACE COVID-19 death rate was 3.8%, nearly one-third the 11.8% death rate in nursing homes. WelbeHealth calculated a death rate of 2.4%.
  • WelbeHealth acted early and decisively to minimize exposure with an Incident Command response strategy, dispersing tablets for telehealth visits, PPE, thermometers, food, medication, and other essentials into participants’ homes, and providing nearly all care remotely, which proved effective.
  • PACE’s capitated payment model moves the risk from payor to care provider, aligning incentives and encouraging innovation and efficiency in keeping patients well.
  • Technology provided an important amplification to PACE’s model of care — it allowed for regular check-ins and informed decision-making on care needs. However, the social aspect of the PACE day center cannot be replaced by technology, and it is clear that in-person visits are vital.
  • With America’s senior citizen population set to double by 2040, the demand for long-term care will skyrocket. The pandemic underscored that work must begin now to meet the needs of present and future vulnerable elders.
  • Existing home and community-based services (HCBS) such as PACE demonstrated profound success during the pandemic leading to fresh momentum among policymakers to expand these options further.

PACE’s person-to-person, fully integrated approach maintains the participant’s highest level of independence and quality of life[i]; PACE participants experience an 80% drop in rates of depression after joining.[ii] At a time when America is searching for a better way forward in eldercare, PACE is a proven approach for this vulnerable group.

 

“While PACE has a 45-year track record of success, it remains optional in Medicaid while nursing home benefits are required — it’s time for every vulnerable elder in the country to have access to this gold standard of long-term care,” said Elizabeth Carty, Chief Regulatory Affairs Officer of WelbeHealth.

 

Many PACE participants reside in medically underserved areas like San Joaquin County, California, where WelbeHealth’s creative problem-solving and speed to action kept seniors safe in their homes when resources for the elderly were relatively scarce.

 

“As other healthcare organizations were assessing the potential impact and spread of the pandemic, the WelbeHealth team had already taken its crisis response to the next level, ” said Amy Shin, former CEO of Health Plan of San Joaquin. “I was impressed with how nimbly this team charted out a plan not only to keep seniors safe and vaccinated but to vaccinate the community as well. This study’s findings should alert legislators that this style of home and community-based services is the ideal model of care for frail seniors.”

 

What is PACE?
PACE (Program of All-Inclusive Care for the Elderly) serves low-income seniors who meet their state requirement for nursing home level care allowing them to live independently in their own homes and communities while receiving fully coordinated medical and dental care, physical and occupational therapy, transportation, meals, day programs, home care assistance and more, managed by an 11-person integrated care team. The “one-stop-shop” PACE day centers are the hub of the program, offering seniors a pleasant place to receive care, socialize and enjoy meals within a state-of-the-art facility.

About WelbeHealth
WelbeHealth is a physician-led healthcare organization that provides seniors with high-quality, compassionate care so they can live in their own homes and communities rather than a nursing home. To accomplish this, WelbeHealth uses the PACE (Program of All-Inclusive Care for the Elderly) model. WelbeHealth currently operates four programs in the Stockton/Modesto, Pasadena/Burbank, Long Beach, and Fresno communities of California.


[i] Center for Consumer Engagement in Health Innovation, “Care That Works: Program for All-inclusive Care for the Elderly.” https://www.healthinnovation.org/resources/publications/care-that-works-pace

[ii] National PACE Association, “COVID Data Demonstrates That the PACE Model Is Safer Than Nursing Home Care.” https://www.npaonline.org/about-npa/press-releases/covid-data-demonstrates-pace-model-safer-nursing-home-care

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mHealthIntelligence: California Provider Sees Telehealth as an Integral Part of PACE Programs

WelbeHealth President Matt Patterson says COVID-19 has taught the industry a good lesson on how to use telehealth, and it should be a permanent part of the senior care service.

By Eric Wicklund

 – A California-based healthcare provider is integrating telehealth into its PACE programs, saying the connected health platform improves its ability to provide value-based care for seniors in their own homes.

While the focus of PACE programs has been on in-person care, the coronavirus pandemic prompted many to shift to connected health to maintain contact with their patients. For WelbeHealth, that meant partnering with Grandpad to equip patients with senior-friendly mHealth tablets that allow them to connect with caregivers on-demand and access health and wellness resources online.

“COVID-19 introduced the need for us to pivot to telehealth,” says WelbeHealth President Matt Patterson. “And in the process, we have saved lives.”

WelbeHealth is one of hundreds of providers focused on the senior care market, many of which participate in the Centers for Medicare & Medicaid Services’ Program of All-inclusive Care for the Elderly (PACE) program. Developed by CMS roughly 30 years ago as a capitated model of care for dual-eligible beneficiaries (ninety percent are dual-eligible), it provides all necessary medical care, therapies, long-term care and services, meals, socialization, transportation, day center services, and activities.

There are currently 135 PACE programs in 31 states, enrolling between 50 and 3,000 patients, for a total of more than 54,000 seniors served. The programs are based in a care center and feature an interdisciplinary care team (IDT) of primary care physicians, nurses, therapists, social workers, dieticians, home care professionals, and others and offers a variety of services on-site and in the home.

PACE programs have traditionally shied away from telehealth, but COVID-19 changed that line of thinking. Now Patterson and his team are at the forefront of a new wave of care providers who want to make telehealth an integral part of the program.

“It’s an exciting opportunity to extend the reach of PACE (and) do more to improve and enrich the lives of our participants,” says Patterson, a former naval surgeon who served as president of digital health pioneer AirStrip before moving into the senior care space.

Telehealth gives PACE programs with WelbeHealth’s the ability to be there for seniors at any time, and to address issues that might not be addressed during in-person visits. That’s important at a time when, mostly due to COVID-19 restrictions, seniors are experiencing high rates of depression, anxiety, stress and substance abuse.

That point has been proven in the Grandpad project. According to a case study, seniors in the WelbeHealth program logged nearly 34,000 hours on the tablets – using both synchronous and asynchronous services – between March of 2020 and March of 2021, including more than 1,500 hours accessing mental health treatment. They also used the tablets to access medical care and exercises aimed at treating cognitive decline.

Patterson says emergency measures adopted by both state and federal governments during the COVID-19 public health emergency have enabled PACE programs to use telehealth more freely. He and his company have been lobbying state officials to make those freedoms permanent.

On the federal level, a bill introduced in March and now before Congress would ensure permanent coverage for audio-only telehealth services for Medicare Advantage and PACE programs, giving providers like WelbeHealth the freedom to incorporate phone calls and non-video telehealth platforms into care plans.

The benefits of connected care are numerous. On-demand access to care providers means seniors can go about their day knowing there’s someone always available should an emergency occur. They have instant access to health and wellness resources that go beyond what they’re getting when the nurse comes by for a visit. They can also collaborate more often on medication management, keep track of daily vital signs, or just talk to someone if they’re lonely or depressed.

Patterson says the pandemic is giving WelbeHealth and others the time to prove the value of connected health and to gather data and experiences to support permanent coverage.

That will be important. CMS has traditionally been very reluctant to expand telehealth coverage and has long argued that it needs evidence that these tools and platforms improve clinical outcomes and reduce wasteful expenses and unnecessary treatments. In short, they want proof.

“PACE is an ideal model for integrating high-touch and virtual care,” Patterson counters. And he wants to do more of that.

“Telehealth is definitely not a replacement (for in-person care), but it gives us more tools, and we want to use these tools for what our participants desire,” he says. “As an organization, we only do well when our participants do well. And they’re doing well.”

 

Click on the logo to view the article.

 

KSEE 24: WelbeHealth PACE in Fresno vaccinates 500th person against COVID-19

Home-based eldercare startup acts as community vaccinator to protect locals.

March 18, 2021 (KSEE) – The team at WelbeHealth PACE in Fresno celebrated on Thursday as they administered the 500th COVID-19 vaccine to a member of the Fresno community. 

“I feel good, I feel great. The staff is great too… I will recommend it to anybody,” said Samuel Sousa, their 500th person to be vaccinated.

“We sit kind of in the heart of a lot of the underserved population when it comes to the senior population, so we’re a perfect location for them to come in.”

WelbeHealth has worked hard to reach out to the public by vaccinating communities in all 4 of its locations, frequently offering to help people reach the site. It was among the first PACE operators in the nation to receive COVID-19 vaccines in 2020.

“We’re unique in the sense that we provide transportation. So anybody that is 55 years and older that isn’t able to get a vaccination, they can actually call us, and we’ll go pick them up,” said Nicole Butler, Director of Center Operations for WelbeHealth.

WelbeHealth partnered with Fresno County to serve as a community vaccination site at the start of 2021, with appointments filling up and long lines forming as people waited patiently for the jab.

“And we sit kind of in the heart of a lot of the underserved population when it comes to the senior population, so we’re a perfect location for them to come in,” said Butler.

 

Click on the logo to view the story.

Welbe’s Long Beach PACE Center Launches

The Long Beach Press Telegram covered the launch of our newest PACE center in Long Beach – LA Coast PACE:

LONG BEACH

By Gary Metzker

The golden years aren’t so golden for many these days, as the coronavirus pandemic shows no signs of abating.

At least 38,000 U.S. residents of nursing homes and other long-term care facilities for older adults have died from the coronavirus, according to the Centers for Disease Control. More than 142,000 people at those facilities have contracted the virus, and at least 90,000 more cases are suspected.

In California, there have been more than 2,400 deaths in long-term care facilities, and according to the Long Beach Health and Human Services Department, 118 deaths have been associated with long-term care facilities in the city.

Many families are not aware that there are other alternatives besides skilled nursing or assisted living facilities, especially during this health crisis.

WelbeHealth is an operator of Medicaid’s Program of All-Inclusive Care for the Elderly (PACE) across California. Its newest facility is in Long Beach at 1220 E. Fourth St., but because of the coronavirus pandemic, no one is visiting the location. Instead, the company has transitioned to a remote, at-home care model to serve seniors while keeping them physically shielded from the spread of the virus.

According to Sophia Guel-Valenzuela, regional vice president and executive director of the Long Beach facility, having seniors in a PACE program is a safer alternative because it can provide necessities, meal deliveries throughout the day, assistance in the home and meaningful social engagement.

“There has never been a stronger imperative to keep seniors living more independently in their homes and communities,” she said. “Our goal is to keep seniors socially engaged through games and special events. It’s important to keep people safe.”

Guel-Valenzuela said each client gets a 4G LTE tablet to use that enables them to talk to a doctor or a social worker as well as interacting with other people.

“The highlight of my week is to see the engagement going on,” she said. “Engagement coordinators host trivia games, bingo, card games. It’s like a big Zoom meeting.”

Guel-Valenzuela believes the combination of staying at home with interactivity is the template of the future for senior care.

“It’s safer to stay at home now,” she said. “I’ve been doing this for 18 years and this model of coordinated care is something I believe in.”

PACE provides comprehensive medical and social services enabling older adults to live in the community instead of a nursing home or other care facility. Its services are available at no cost to most participants as part of their Medicare and MediCal benefits.

“In our HomePACE model of remote care, we help seniors stay healthy and thriving while avoiding nursing facilities, which have tragically become hotbeds for the spread of coronavirus,” said Dr. Si France, founder and CEO of WelbeHealth in a statement. “We’re excited to expand our all-inclusive model of care into greater Long Beach to serve more vulnerable seniors when they need it most.”

WelbeHealth’s Long Beach location is accepting applications. Families can call 1-800-734-8041.

To learn more about PACE and services we provide, click here.

Spectrum 1 News: PACE Offers Alternative to Assisted Living Facilities

Spectrum News 1 aired a news story highlighting how PACE offers an alternative to assisted living facilities and nursing homes for seniors.  The story featured our new Long Beach facility – LA Coast PACE and discuss how we have changed the model to deliver many of the health and long-term care services to the participants home via technology.  Also included in the story was an interview with one of our participants, Bernadette McCoy, who was drawn to the program because it helped keep her living independently in her home and because it was covered under Medicare and Medicaid.  Click here to view the story in its entirety.

To learn more about the services PACE provides, click here.

Reflecting on our values

An open letter to our WelbeHealth team members

Dear team,

Thank you for persevering through this difficult week. I continue to reflect with heartache on the tragic injustice of George Floyd’s death, and on the systemic racism faced by people of color day after day, generation after generation.

As an organization, we condemn these senseless and racist acts of police brutality. These violations of basic human rights are antithetical to our personal values and our values as a company. More broadly, we must also condemn racial injustice and prejudice wherever we encounter it: in our society, in our healthcare industry, and in ourselves.

We don’t have to look far to see examples of racial injustice in our own sphere of healthcare. People of color have been hit disproportionately hard by Covid-19, with black Americans dying at rates nearly double their proportion of the population. More news emerges every day about the stark disparities in testing and care for disenfranchised communities.

I believe the work we do can be part of the solution. WelbeHealth was founded on the conviction that every person has immeasurable worth and beauty. Our sole purpose since day one has been to serve the most vulnerable seniors with love and compassion in un-served and under-served communities. We directly combat many social injustices through our PACE services and our culture of cherishing each person, which we call Courage to Love.

But we also understand that status quo is not good enough. We must always strive to do better. As our company grows, I am committed to building a foundation of diversity, inclusion, and belonging. I am committed to better understanding the experiences of our team and our participants — including the experience of being a person of color in our society and our organization. I am committed to self-reflection, learning, and improvement.

To those in our WelbeHealth family who themselves are victims of racism, I know that I will never fully understand the pain you must be experiencing. But I do stand with you. And I recommit personally and as an organization to working every day toward meaningful positive change in our society.

Si

PACE Brings the Senior Daycare Center Home

The Pasadena Now published an article on the changes that WelbeHealth and Pacific PACE have made to continue to deliver health and wellness services to nursing home eligible seniors in the safety of their own home:

If there is one thing that the pandemic has taught us, it’s that just about everything, except going somewhere, can be done at home. This has naturally had a huge effect on businesses, retail, and now, senior care.

At the outset of the COVID 19 crisis, and in response to the state’s “shelter at home” order, WelbeHealth in Pasadena transitioned from a central Pasadena location to a remote at-home care model to serve seniors, while keeping them physically shielded from the spread of the virus.

As explained on their website, PACE (The Program of All-Inclusive Care for the Elderly) individually coordinates the care of each participant enrolled in the program, based on his or her needs with the goal of enabling them to remain living in their community. PACE is both a primary care provider and a health insurer. Currently, there are more than 240 PACE centers operating in more than 30 states.

“We had a day center where we wanted to prevent nursing home placement,” Regional VP & Pacific PACE Executive Director Sophia Guel-Valenzuela, explained Thursday. “We wanted to prevent trips to urgent care, or to the emergency room. We wanted to prevent people from isolation and loneliness.”

“So we bring them to our daycare center in Pasadena,” she continued. “We have activities, we have music therapy, we have recreation, we give them lunch. We have so many things to do, so many interactive, stimulating activities.”

But when the executive order came out for “shelter in place,” Pacific PACE suddenly had to support its participants in the home.

“So we basically implemented HomePACE,” said Guel-Valenzuela. “We transitioned to a HomePACE model where we are communicating with our participants with a Welbe Link. It’s a 4G LTE tablet.”

The simple-to-use tablet has become the key to instant communication between caregivers and patients, Guel-Valenzuela explained.

“We’re having video calls with our patients. And so we do recreation therapy. We have virtual bingo with them,” said Guel-Valenzuela. “They talk to their doctor, their social worker. Our personal care attendants have social calls with the patients. And so we’re supporting them as if they were in the center, but they’re out there at their home.”

The system organizes meal delivery as well, so patients don’t have to go out and be exposed unnecessarily to the grocery store or the pharmacy.

Pacific PACE Home also delivers all their medications to their home, and helps them with essentials like toothpaste and toilet paper.

‘We’re coordinating everything that they need to be safe,” Guel- Valenzuela pointed out. PACE also offers home care services, such as light housekeeping, and help with bathing and dressing.

Perhaps most importantly, though, the rate of confirmed COVID positive cases in PACE programs nationally is just 2.2%.

As Guel-Valenzuela noted, “Our care team is conducting daily phone calls for COVID-19 signs and symptoms among nearly 95 participants. We have not had any positive cases of COVID19, nor any hospitalizations related to COVID-19. We are equipped with appropriate PPE to serve our participants, and are literally saving lives through our HomePACE model of care.”

Following the success of the Pasadena program, WelbeHealth PACE plans a new operation in Long Beach on June 1.

For more about the services that PACE provides seniors so they can live more independently in their homes and communities, click here.

Senior Isolation – Interview with Debbie Sanchez

Radio Centro America conducted an interview with our own Debbie Sanchez, an Outreach Specialist for our Pacific PACE program in Pasadena.  She discussed the challenges of senior isolation during this global coronavirus pandemic and how WelbeHealth and Pacific PACE have made changes to safely deliver the health and wellness senior care to frail elderly in our service areas, allowing them to continue living more independent lives in their homes and communities.  Click here to watch the interview in Spanish.

For more about the services that PACE provides to help promote senior independence, click here.

Separation anxiety: Coronavirus takes toll on those with Alzheimer’s, their loved ones

Alzheimer’s is a tough disease to contend with in the normal, everyday world.  Some of the individuals suffering more than most during this time of crisis are those challenged with some form of dementia, especially those with Alzheimer’s.  In our transition to a home-based model, we have taken steps to ensure that these individuals and their loved ones continue to get our support.  The Record recently wrote a story on this topic here, and our own Executive Director Jillian Simon commented on how our changes provided continued support to this group.

To learn more about PACE services, click here.