Mastering Medicare

E25: Deep dive into the PACE program with Dr Rob Schreiber and Eric Patzelt from myPlace Health.

• PACE Overview: Program of All-Inclusive Care for the Elderly provides comprehensive care for seniors, allowing them to live in the community rather than nursing homes.


• Eligibility: Seniors must be 55+, certifiable for nursing home care, and safe in the community with PACE services.


• Funding: PACE is funded by Medicare, Medicaid, and individual contributions, with high startup costs and a long-term recovery period.


• Revenue: PACE receives ~$9,500–11,000 PMPM for dual-eligible members and ~$7,000–8,000 for Medicaid-only members, higher than Medicare Advantage.


• Services Provided: Includes adult day care, primary care, home care, dental, therapy, nutrition, social work, and transportation.


• Target Demographic: Serves high-need populations with complex health issues and short life expectancy, helping to manage costs and reduce hospitalizations.


• Coverage: PACE covers all care aspects except direct housing costs unless in a nursing home, where it covers the non-Social Security portion.


• Handling Health Declines: Provides immediate care and support, including home visits and temporary nursing home placements.


• Technology Integration: Uses technology for communication, remote monitoring, and data analysis, especially accelerated by COVID-19.


• Financial Implications: PACE can save money in the long run by reducing hospitalizations and emergency visits, though initial costs are high.


• Enrollment: Participants can leave voluntarily or be involuntarily disenrolled due to death, loss of coverage, or moving out of the service area.


• Comparison to Medicare Models: PACE offers an integrated care model distinct from Medicare Parts A, B, C, and D, operating on a capitated model.


• Hospice Care: PACE provides comprehensive end-of-life care, but participants must disenroll from PACE to fully access hospice services.


• Social Work Role: Social workers in PACE advocate for participants, addressing needs and enhancing care through personal connections.


• Healthcare Innovation: Models like PACE demonstrate potential for improved care and outcomes, with ongoing support and adaptation crucial for success.