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Medi-Cal Changes for California Seniors

January 12, 2022

New and expanded Medi-Cal eligiblity criteria in 2022 will allow more people to access Medi-Cal coverage. Medi-Cal changes for California seniors offer many a new chance to qualify for Medi-Cal. Read on to learn more about these changes, which for some seniors could include becoming eligible for WelbeHealth or other PACE programs in your area.

For more detailed information, see the resources listed at the bottom of the article.

Expanded Coverage for Undocumented Seniors
Beginning in May 2022, Medi-Cal benefits will be provided to all individuals over the age of 50 who meet financial eligibility requirements, regardless of immigration status. This includes primary, specialty, behavioral health, long-term care, and much more. Those not currently enrolled in restricted scope Medi-Cal will need to apply to find out if they meet eligibility requirements.
Increased Asset Limits
In July of 2022, the asset limit will increase for many Medi-Cal programs from $2,000 to $130,000 for individuals (plus $65,000 for each additional family member). Once this change is in effect, DHCS will send letters to those who were denied Medi-Cal or terminated coverage for being over the asset limit during the 90 days before the effective date of the change.

How this may affect you: If you were previously denied Medi-Cal enrollment due to immigration status or assets, you may want to consider re-applying.

Changes to Medi-Cal Managed Care in 2022 and 2023

The California Advancing and Innovating Medi-Cal (CalAIM) initiative standardizes managed care enrollment and benefits, addresses social determinants of health, and reduces inequities. As part of the CalAIM initiative, some health coverage changes will impact Medi-Cal enrollees across all of California. Other changes only impact certain populations or enrollees in certain counties.

How this may affect you: The way you receive Medi-Cal benefits through your managed care plan may be changing, including the health plan you are enrolled in or the services available through your current Medi-Cal managed care plan.

Changes for Dual-eligible, Medi-Cal and Medicare Individuals
Starting January 2023, dual-eligible individuals will be required to enroll in a Medi-Cal managed care plan. If you are eligible for both Medicare and Medi-Cal, you will receive enrollment forms to choose the plan you want to enroll in. PACE programs such as WelbeHealth will be listed as an option on these enrollment forms. This is a great time to consider participating in WelbeHealth’s PACE services if you are eligible and live in one of our service areas.
Changes for those with a Medi-Cal share of cost
As part of CalAIM, some Medi-Cal beneficiaries* with a share of cost are moving out of managed care, into fee-for-service Medi-Cal. If you have been on a Medi-Cal plan that has a share of cost, you will automatically be enrolled in fee-for-service Medi-Cal unless you live in a long-term care facility. This change affects those enrolled in both Medi-Cal and Medicare and those enrolled in Medi-Cal only.If you were previously enrolled in a Cal MediConnect plan, you will be disenrolled from Cal MediConnect. You will need to select a new Part D prescription plan to cover prescription drugs.Note that under fee-for-service Medi-Cal, there may be some changes to how transportation is made available to you. DHCS’s Transportation Services web page provides instructions on how you can get transportation under fee-for-service.
Managed Care Enrollment for Certain Populations
Certain population groups who are required to enroll in a Medi-Cal managed care plan are expanding statewide. If you are part of one of these special groups, you would have received two notices in the Fall of 2021. You can make a managed care selection or be added to a state-selected managed care plan.
End of MediConnect Plans in December
As of December 31, 2022, if you are enrolled in a Cal MediConnect plan, you will automatically move to a dual special needs plans operated by the parent organization of your Cal MediConnect plan. If you have questions or would like to select a different health plan (including PACE), contact the Health Consumer Alliance (HCA) at 1-888-804-3536. The HCA can assist Californians who are trying to get or keep their health coverage.

Could you now be eligible for PACE?

WelbeHealth’s PACE provides all-inclusive coordinated care. Visit welbehealth.com for information about our services.

You may have questions about these Medi-Cal changes for California seniors. At WelbeHealth we have experts available to assist you in evaluating whether you qualify for Medi-Cal. Call us at (888) 530-4415, TTY (800) 735-2922 to learn more.

References and Resources:

“DHCS Frequently Asked Questions for Medi-Cal Transportation Services” https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation_Beneficiaries_FAQ.aspx
Justice In Aging Fact Sheet: https://justiceinaging.org/wp-content/uploads/2021/10/Important-Health-Care-Changes-Coming-in-2022-for-Low-Income-Older-Californians.pdf
Justice in Aging, Free Webinar, “Upcoming Changes to Medi-Cal in 2022” https://vimeo.com/657159550?eType=EmailBlastContent&eId=2631b516-92df-470c-aca3-4d63c7480c2a

*Some changes only affect individuals residing in a CCI county (Los Angeles, San Bernadino, Riverside, Orange County, San Diego, Santa Clara, and San Mateo) or a COHS county (Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo).

Care Coordination for Seniors

December 29, 2021

Seniors with complex medical conditions often need help managing their care. They see multiple doctors and specialists. They’re taking multiple medications, have several medical appointments a month, and may need assistance in their home. Professional care coordination for seniors can help manage a senior’s health care.

Research shows that 35 percent of those over age 65 have no one assisting them with coordinating their care. Thirty-four percent say a family member coordinates their care.

Care coordination can be beneficial for seniors and caregivers, especially for the 85 percent of older adults who live with one or more complex medical conditions.

What is care coordination?

Seniors, or their spouse or adult child, often do the work of coordinating their care. They make appointments, provide transportation, communicate with physicians, and assist in the home.

Professional care coordination for seniors is more in-depth and comprehensive. It involves multiple medical experts who specialize in the health of the elderly. The team helps the senior meet their medical needs, provides the needed resources, and updates the care team. Care coordination is personalized and uses the input of the patient and caregiver.

The benefits of care coordination for seniors and their families

Doctors stay informed. Living with a complex medical condition often means having more than one doctor who provides your care. One goal of care coordination is to keep all healthcare providers informed. This saves the patient from redundant testing, screening, and treatment. Changes in medication, new or worsening symptoms, and changes in medical history are all topics to be shared among your team of physicians.
Better healthcare outcomes. Studies have shown that professional care coordination results in better health outcomes. Patients are often more satisfied with the quality of care because it is personalized and streamlined.
Social and emotional needs met. Care coordination focuses on the patient’s physical, social and emotional health. Healthcare professionals connect the patient to resources such as counseling and support groups and promote wellness of the mind.
Relief for caregivers. Family members often take on coordinating care for their aging loved one. As their loved one’s condition grows more complex, it can be a lot to manage. Professional care coordination for seniors relieves caregivers of doing this, while keeping them informed. Therefore, they have more time to work, rest, or tend to their own health needs.

WelbeHealth provides care coordination for seniors with complex medical conditions.

WelbeHealth’s program of all-inclusive care for the elderly (PACE) provides professional coordinated care to seniors.

Interdisciplinary Team

At the heart of WelbeHealth’s PACE is the interdisciplinary team. This team stays current on each senior in their care, and adjusts care as needed. Each team member specializes in caring for seniors with complex medical conditions. The team includes specialists such as:

Primary care physician
Nurse
Physical therapist
Occupational therapist
Recreation therapist
Dietician
Social worker
Home care coordinator
Transportation professional

Day Center

WelbeHealth’s day centers make providing coordinated care seamless. In the day center, seniors can get many physical needs met and socialize with other participants. Under one roof, participants can receive:

Primary care
Dental, vision, and hearing care
Physical and occupational therapy
Recreational therapy
Nutritious meals and socializing with other seniors and staff
Exercise
Personal care (bathing, grooming, etc.)

Telehealth and Home Care

Professional care coordination for seniors often involves home care. Seniors sometimes need help with housekeeping and personal care. WelbeHealth coordinates that care when it is medically necessary.

Telehealth can help keep seniors connected with healthcare professionals 24/7. This accessibility can help give peace of mind to seniors and their caregivers.

Coordinated Care is Impactful for Seniors.

Coordinated care is impactful for seniors with complex medical conditions. WelbeHealth provides personalized, coordinated care, keeping seniors living well, at home.

Costs of Caring for an Aging Loved One

October 20, 2021

Many adult children care for a parent in their golden years. Some are surprised by the costs of caring for an aging loved one. Family caregivers spend an annual average of $7,400 of their own money on caregiving expenses. In combination with a possible loss of income due to time away from work, it can sometimes be a financial strain for families.

Here are three steps you can take to reduce out-of-pocket caregiving expenses and recover some financial costs.

1. Create a budget and track expenses.

Caring for an elderly loved one includes many expenses that you may not think of. Keep track of these expenses. After a few months, you can better predict what your caregiving expenses will be and adjust your budget accordingly. If you have siblings or other loved ones who may share the caregiving costs with you, it is a useful tool to split costs evenly. If you haven’t already, consider asking your loved ones for help with these caregiving expenses.

Possible Recurring Caregiving Expenses

Possible One-time Caregiving Expenses

· Groceries

· Medical co-payments

· Travel to and from doctor’s appointments

· Incontinence supplies

· Clothing

· In-home professional care

· Housekeeping

· Mortgage

· Home modification (railings, shower seat, etc.)

· Medical alert system

· Vehicle modifications

2. Research tax implications of caregiving.

Understanding IRS guidelines for caregiver and senior filing can save you money and help you recoup some of your caregiving costs. If you meet these seven requirements outlined by the IRS, you may be able to claim an elderly parent as a dependent on your tax return. You may also be able to deduct medical expenses and home modification costs up to a certain amount. If you’re not sure about IRS rules and guidelines, talk to a tax professional to make sure you qualify for these benefits.

3. Consider professional support.

For caregivers who want to keep their loved one at home, participating in a local Program of All-Inclusive Care for the Elderly (PACE) can provide professional medical care and significantly reduce the costs of caring for an aging loved one.

PACE provides eligible seniors the following services, typically at no added cost:

Preventive care and routine screenings
Dental and vision care
Transportation to medical appointments
Medical supplies, home safety modifications, and much more

PACE participants have a team of health care professionals that work to develop a customized care plan for each individual.

To learn more about WelbeHealth’s PACE services, visit welbehealth.com.

3 Tips to Stay Well While Being the Caregiver of a Senior

September 22, 2021

Nearly 17 percent of Americans are caregivers to an elderly adult over the age of 50. Choosing to care for an older relative is a selfless act. One of the best things you can do for them is to stay physically and emotionally strong. Here are three simple tips to maintaining your well-being as a caregiver of a senior.

1. Take Care of Yourself

As a caregiver of a senior, it is important to continue taking care of yourself. Caregivers commonly neglect their own health needs. In the long run, this can wear you down and make it harder to provide care to your loved one. Make sure you continue to maintain your own doctor appointments, mental health, and other health and wellness needs.

2. “Caregiver of a Senior” Support Groups

Caregiver support groups can be a source of community and friendship. By joining a support group, you can find the support and wisdom that makes a world of difference. Here are some resources to help you find in-person or virtual support groups to connect with other caregivers.

3. Ask for Help

As the caregiver of a senior, it can be difficult to admit that you need help. But as a caregiver, asking for and accepting help can be a gift to yourself and your loved one. Siblings, in-laws, friends, and neighbors can often provide relief when you’re feeling overwhelmed.

If your loved one has more complex medical needs, then finding professional help may be necessary. At WelbeHealth, we provide caregivers with respite care, transportation to medical appointments, and home care assistance.

Learn more about how WelbeHealth can support you as a caregiver.

Did You Know? More than 58% of family members experience less caregiver burden after enrollment in a Program of All-Inclusive Care for the Elderly (PACE).

WelbeHealth Celebrates National PACE Month

September 9, 2021

September is National PACE Month, celebrating the Program of All-Inclusive Care for the Elderly (PACE). WelbeHealth’s innovative PACE model helps California’s frailest seniors live in their homes as long as possible. More than 95 percent of participants enrolled in the PACE program live outside of a nursing home.

“This year, we celebrate National PACE Month as we work to recover from the historic COVID-19 pandemic, which provides us a unique perspective to celebrate the original development of the PACE model of care and envision a future where every American will have access to PACE,” says Shawn Bloom, president and CEO of the National PACE Association (NPA).

Did you know? The incidence of PACE participants contracting or dying from COVID-19 was one-third the rate of nursing home residents.

PACE: A History of Innovative Senior Care in California

There are currently 140 PACE organizations in 30 states. The organizations serve more than 55,000 seniors. Before PACE grew to what it is today, it started in California. The program began in San Francisco in 1971 as a unique way to care for elderly with chronic conditions and to help them maintain independence, dignity, and quality of life in their communities.

PACE has a proven history of providing excellent senior care, while allowing individuals to live safely in the homes and communities they know and love. On average, PACE participants are 76 years old and live with multiple medical conditions. Around 46 percent have some form of dementia.

Fun Fact: In California, 65 PACE centers and alternative care settings care for over 13,000 seniors in 22 counties.

Tapping PACE’s Potential

California’s senior population is growing faster than any other age group. By 2030, 25 percent of Californians will be 60 or older. Senior care must evolve to meet the challenges of caring for the older population. PACE is a critical part of the solution.

“Now the time is right to demand more from our long-term care delivery system. PACE is ready to help every community meet that challenge,” says Bloom.

PACE provides home care, prescription drugs, transportation, meals, therapies, and any other services seniors need to remain safely in their homes. This comprehensive care is preventive in nature and results in better health outcomes for participants.

The PACE model is a critical part of keeping seniors independent and out of the hospital. About 92 percent of seniors enrolled in the program are very satisfied with the care provided by PACE. Additionally, 97 percent of caregivers would recommend PACE.

More Accessible Senior Care

Nearly 90 percent of Californians want access to services that help them live at home in their communities as they age. But, non-white and lower-income Americans report less access to local services that would help them do so. PACE can meet the needs of a diverse aging population, including lower-income seniors and individuals of color. In California, 80 percent of PACE program participants are from communities of color.

Supporting the Mental Health of Seniors

September 1, 2021

Health care doesn’t just include care for the physical body; it includes care for the mind too. Solely focusing on physical health and disregarding the mental health of seniors can reduce their quality of life. WelbeHealth recognizes this. As a PACE provider (Program of All-Inclusive Care for the Elderly), WelbeHealth addresses all aspects of wellness to keep seniors living safely in their community.

An estimated 20 percent of Americans over age 55 have a mental health disorder. Unfortunately, only three percent of those individuals seek out mental health services. WelbeHealth supports the mental health of seniors through a collaborative, gentle approach to improve well-being and health outcomes.

1. Building Trust

Rona Lomeda is a Complex Case Nurse for WelbeHealth. Her 30 years of experience in behavioral health and geriatric care have shown her the key to successfully treating the mental health of seniors is trust.

Lomeda says, “The most important thing we do is make sure our seniors feel loved. That’s what develops trust in the relationship. Ultimately, that’s how we provide the best care to seniors struggling with mental illnesses.”

WelbeHealth also builds trust by being available 24/7. Whether participants are at the day center, in their home, or on the road, WelbeHealth is just a call away. Staying in close communication with seniors lets them know that they always have someone they can lean on in times of fear, confusion, or loneliness.

2. Nurturing Companionship Among Peers

Over 40 percent of seniors report feeling lonely on a daily basis. And, studies have shown that loneliness can be as bad for your health as smoking 15 cigarettes a day. That’s why WelbeHealth helps provide companionship for all participants, especially those with mental illness.

WelbeHealth participants find companionship through:

Coming to the day center
Eating meals with other participants
Engaging in center activities that interest them
Visiting with caring staff members
Calling the WelbeHealth team via phone or tablet
Visiting with drivers and other participants during transportation rides

3. Providing Individual Care and Education

Untreated mental illness can have a domino effect on other areas of health. For example, a senior who is severely depressed may not feel like taking their diabetes medication, which can harm other areas of their body.

To help solve this, WelbeHealth provides individualized care and education.

Lomeda says, “If a patient has trouble taking daily pills, we consider administering their medicine through injection once a week. These kinds of adjustments can make all the difference in the health of the participant. Once we have trust built, we can educate them on the importance of taking their medication and find the best ways to administer it for them.”

Professional therapists are also available to support the mental health of seniors at WelbeHealth. Therapy sessions are done in person or via telemedicine when needed. Visiting with a therapist regularly can help older adults work through feelings of grief, accept a challenging health diagnosis, and support them in overcoming anxious thoughts and feelings.

“We try to connect seniors to therapy instead of prescribing medication right away,” says Lomeda.

4. Giving Relief to Caregivers

Some WelbeHealth participants live alone. Others live with a caregiver, such as a spouse or adult child. Being a caregiver can be exhausting, especially if your loved one has a mental illness. WelbeHealth makes it a priority to provide support to caregivers, so they can best care for their loved one.

Caregivers of WelbeHealth participants benefit from:

Respite care
Education
Transportation for their loved one
Support groups
Home care assistance

Supporting the mental health of seniors is just one way WelbeHealth helps older adults and their families. WelbeHealth provides primary care, physical and occupational therapy, dental care, vision care, and more. Visit our FAQ page or contact us for further information.

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

July 14, 2021

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

READ THE STORY:

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

TIME MAGAZINE: COVID-19 Exposed the Faults in America’s Elder Care System. This Is Our Best Shot to Fix Them

June 15, 2021

June 15, 2021 (Time Magazine) – When COVID-19 hit the United States, nursing homes in Washington State took the first hit, producing deadly outcomes for older adults. Conditions within long-term care facilities enabled a harrowing spread of any pandemic, let alone a novel coronavirus. Compounding on this, leaders within institutional care were slow to respond when it arrived.

The plight of residents in long-term care facilities across the United States is detailed in a report by Abigail Abrams from Time Magazine. It begins with individuals living at Life Care Center in Kirkland, Washington, in late February 2020 where COVID-19 killed dozens in just a few weeks.

The shocking death rate created a sense of panic and by early March the families of those living within Life Care Center held a press conference appealing to the public on behalf of their loved ones.

“Our families are dying. We don’t know what to do. Our calls for help aren’t working,” said Kevin Connolly, whose father-in-law lived in the facility. “We have limited resources to battle this disease, and I think somebody somewhere decided that this population of people wasn’t worth wasting resources on.”

Nursing homes vs infection

Many nursing home residents live in shared rooms and rely on staff who tend to numerous patients and who often work at various other facilities. The industry’s low pay and long hours make for high turnover. These characteristics can create a lack of consistency in controlling the spread of infection.

The nursing home industry is losing occupancy rates, workers, and money. The long-term care industry could lose an estimated $94 billion between 2020-2021 due to the costs involved in both fighting the pandemic and losing occupancy, according to The American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

America is aging rapidly. According to the Census Bureau, around 10,000 Americans turn 65 every day. Most people want to age at home rather than in an institution. Still, people who qualify for Medicaid and Medicare have little to no choice in where they receive long-term care after reaching old age. Governments in many states mandate that they enter long-term care facilities even when home-based care services are available.

In many cases, when a person does not qualify for government-funded care or chooses to avoid mandated care in a nursing home, a family member must often forfeit a job to take on the responsibility of caregiving. And if no one in the older adult’s circle of support can provide that care, paid home based care is challenging to find due to worker shortages. Many workers are leaving the historically low-wage industry, according to the Bureau of Labor Statistics.

Policy helps pave the way to home and community-based care.

Policy momentum is growing toward home and community-based care for the elderly across the nation. One home-based care program available to Medicaid/Medicare recipients has a 45-year proven track record of success and operates in more than 31 states. PACE (Programs of All-Inclusive Care for the Elderly) saves the government money while offering a high-touch, team-based approach to eldercare for people 55 years or older who qualify for nursing home level care. It receives a payment per participant to provide medical care and dental care, day center programs, meals, home health aides, and many other services to keep seniors safe and living in their own homes and communities. PACE aims to keep this elderly population out of hospitals and nursing homes while incentivizing a flexible, creative, team-based approach to care. On average, states pay PACE programs 13% less than the cost of other Medicaid services.

“The nature of payment provides significant flexibility, as well as really strong incentives for PACE organizations to really proactively monitor and get out in front and address existing and emerging health needs,” says Shawn Bloom, president, and CEO of the National PACE Association.

Data collected during the pandemic show that seniors enrolled in PACE contracted COVD-19 at just one-third the rate of those in nursing homes, according to the National PACE Association.

The push for greater government funding for programs like PACE is growing. President Biden’s proposal to spend $400 billion on home care over the next 4 years could pave the way toward boosting access to more Americans. And proposed legislation in California, Assembly BILL (AB) 540, would allow eligible seniors to be automatically informed about PACE right along with other Medicaid and Medicare options.

Click on the logo to go to the full story.

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

June 7, 2021

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

May 27, 2021 – 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.”