A Medicare advisory panel issued recommendations that would allow Medicare to strengthen Program of All-Inclusive Care for the Elderly (PACE) for dual eligibles. A dual eligible is a person who is receiving both Medicaid and Medicare.
The changes are intended to boost enrollment in the PACE program and "to pay all integrated programs for dual eligible beneficiaries from the same payment system," MedPAC analyst Christina Aguiar said, according to a Healthcare Finance News report.
Medicare will spend 17% more on PACE dual-eligible enrollees if these individuals stayed in tradition fee-for-service programs. These adjustments to the program would reduce payments to PACE providers by $1 billion over five years, but offset that reduction by offering similar-sized payment increases for specific components of care.
The Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive care delivery system that allows those who would be traditionally thought of as nursing home residents to continue living at home while receiving services. It provides an alternative to nursing homes. This model of care will become increasingly important as the concept of medical homes evolves and the emphasis for care continues to shift away from more acute settings. In fact one could make the case that PACE is pioneering the medical home in many respects.
The ability to coordinate the care of each participant enrolled in PACE is key to the model. PACE programs coordinate and provide all needed preventive, primary, acute and long-term care services so that its participants can continue living in the community.
The Center for Medicare Education gives this succinct example. A Medicare beneficiary shows up at the emergency room every month to be treated for skin infections caused by flea bites. The traditional, care delivery system would have trouble addressing the root cause of her condition and might just keep admitting the patient and treating her. For a PACE enrollee, the team, with input from social workers, home health aides and drivers who have been in her home, may decide to fumigate her home and provide a flea dip for her pet. This flexibility can produce more cost-effective solutions and a higher quality of life than prescribing costly medications or continually hospitalizing an individual.
Look for PACE programs to expand. More providers might want to get on board.
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