Palliative care is becoming an increasingly prevalent component of Programs for All-Inclusive Care of the Elderly (PACE) programs.
PACE programs offer a comprehensive approach to care for participants who meet certain eligibility criteria, mainly to seniors who have significant medical and non-medical needs to help them age in place and avoid the hospital or nursing homes. PACE allows hospices to offer services to address social determinants of health, such as homemaking, transportation, home modification and others.
While some PACE programs are run by companies that have their own in-house palliative services, others who may lack that infrastructure are looking to partner with other providers, according to Ted Ferris, vice president of care innovations at Silverado Hospice.
“PACE programs are definitely open to capitated arrangements — per-participant, per-month. These are palliative care contracts where they really don’t want them to be on hospice, because they have to foot the bill. But they can pay us a portion of that,” Ferris told Palliative Care News. ”We’re getting a lot of referrals for patients, because they need these extra services at home to keep them independent, and to keep them out of the hospital, which is super expensive for these programs.”
Currently, 155 PACE programs serve more than 70,000 participants in 32 states and the District of Columbia, according to the most recent data from the National PACE Association. However, new programs continue to crop up around the country.
Most PACE participants are dually eligible for both Medicare and Medicaid, the U.S. Centers for Medicare & Medicaid Services (CMS) reported.
PACE providers receive monthly Medicare and Medicaid capitated payments for each enrollee. PACE programs are also Part D providers that are responsible for their patients’ medications and pharmacy services.
By integrating palliative care into their suite of services, PACE programs can help improve their participants’ quality of life, including clinical outcomes, while generating cost savings through reduced higher-acuity care, according to Ferris.
Such contracts also bring financial benefits to PACE programs’ palliative care partners.
“PACE programs go way outside the scope of just clinical care to cover the expenses of the participants to keep them out of the hospital,” Ferris said. “Getting into these arrangements, where we’re doing the per-participant per-month, has really helped boost our palliative programs, because we’re able to have a mix of contracted arrangements, and that helps balance out the [Medicare] Part B palliative reimbursement, which nobody gets into for fame and fortune.”