The development and implementation of a new PACE program typically takes between 12 and 24 months. Implementation of a PACE program requires a significant investment of time and capital resources to evaluate and demonstrate community need for a program, develop a plan and funding for the infrastructure to provide comprehensive services, and complete an application. Specifically, a prospective PACE sponsoring organization needs to complete the following steps:
- Discussions with state representatives
- Market analysis and feasibility study
- Site selection and design
- Development of comprehensive provider network
- Community education
- Application development and review by state and federal agencies
In addition, a prospective PACE sponsoring organization will need to work with state and federal agencies, internal and external funding sources, community organizations and healthcare providers to assemble an operational PACE program.
Resources to help evaluate PACE are available from the National PACE Association. http://www.npaonline.org/website/article.asp?id=65
PACE has national guidelines for required staff credentials, competencies, and roles. In addition to seeking these basic requirements, LIFE looks for individuals who have educational, professional, or substantial personal experience with the aged population and experience functioning on an interdisciplinary team.
Medicare requires orientation and training for all staff and contracted staff involved with all PACE programs. At LIFE, training is provided by the Director of Education and Training, an MSN and the founding clinical director of the program. In addition to using training materials develop by the National PACE Association, LIFE also employs an internally-developed training and orientation program.
LIFE provides behavioral health training to all direct service providers—nurse, caregivers and drivers.
In 2007, LIFE oriented 22 new staff members and provided 50 on-site educational programs. In addition, LIFE complied with annual training requirements for 95 staff.
Since LIFE serves as a dually-capitated Medicare and Medicaid health plan, the enrollment process involves multiple steps and assessments that are presented below.
- Telephone screening to determine eligibility. If not eligible, the enrollment team will offer information and referrals
- Within 24 hours of the telephone screening, a LIFE Penn enrollment specialist will conduct a face-to-face meeting in the patient’s home to assess home environment, caregiver, and patient needs, financial eligibility, and discuss services provided by the program.
- Complete home and community needs assessment by Area Agency of Aging (AAA)
- Financial assessment done by County Assistant’s Office
- LIFE nursing, social work, and home care assessments of potential member in adult day center or in individual’s home.
For every ten referrals, LIFE Penn enrolls three to four new members.
LIFE is a replication of the PACE model. Currently, there are 43 PACE programs operational in 23 states. By the end of 2008, the National PACE Association expects a total of approximately 60 PACE programs operating in 32 states. A significant portion of this growth will come from rural PACE sites that have received financial support from Congress, in large part as a response to significant concerns about the insufficient supply of health care professionals and providers in rural areas.
Since LIFE and PACE require the development of a comprehensive care model plus state and federal approval, replication of this model is difficult. One particular challenge of developing a new PACE program is working with the relevant state as each state approaches the programs differently. States in which PACE programs already operate are likely to be easier to work with.
