ArchCare CEO: Operational Flexibility Key to PACE Model’s Long-Term Success
There are plenty of Program of All-Inclusive Care for the Elderly (PACE) operators that embody the model’s success and recent momentum, but perhaps none greater than the New York-based ArchCare.
With just under $1 billion in annual revenues, ArchCare is part of the Archdiocese of New York’s large health care system. Its PACE operations began as a single site in Harlem in 2009, but have since expanded to multiple centers and seven overall locations in four counties.
Today, ArchCare’s PACE segment cares for roughly 750 members, making it one of the bigger programs in the U.S. The health care organization also operates skilled nursing facilities, two hospitals, a home care agency and a number of ancillary programs, employing over 4,000 people in total.
Since the public health emergency, the PACE model — and ArchCare — has been able to further prove its value by treating COVID-19 patients. In fact, the national PACE COVID-19 death rate was 3.8%, compared to 11.8% in nursing homes.
“PACE was well-positioned to serve individuals during the pandemic because the model already had the structure in place to provide home-based care,” Scott LaRue, president and CEO of ArchCare, told Home Health Care News.
Prior to the pandemic, ArchCare’s PACE enrollment was steadily growing, almost reaching 1,000 members. Once COVID-19 hit, ArchCare had to close its physical centers and shift more of its services into the home, using technology to fill any potential gaps.
Several other PACE operators took that approach as well.
“We put in place a telehealth platform that allowed us to interact with our members,” LaRue said. “As an example, the recreation staff could get 10 members together and play bingo [virtually], or use that same technology for one-on-one interactions with the different disciplines of the care planning team. It was a bit of a transition to a full home-based model, but PACE lent itself to be very successful.”
Nationally, there are 140 PACE organizations operating 272 PACE centers in 30 states, serving over 56,000 participants, according to the National PACE Association.
LaRue believes that this moment is an opportune time for PACE operators, as the COVID-19 emergency has played a major role in increasing the demand for care services delivered in the home setting.
“They don’t want to go into institutions for a variety of reasons, and the pandemic helped people realize that you could provide high-quality, high-acuity care in a home-based environment,” he said. “I think the pandemic accelerated the transition, the consumer understanding and demand for home- and community-based services by at least 10 years.”
PACE has been around for years, but it’s growth has been partly slowed because policymakers had often overlooked the model in the past, making it more difficult for operators to get started.
“You hear policymakers and they’re like, ‘Jeez, I wish we had a program that could take care of the social determinants of health, provide the necessary clinical services, evaluate their home situation and coordinate all of that under one umbrella,’” LaRue said. “That’s what PACE does.”
It’s often difficult for would-be operators to get started, as initial operating costs can be high when opening new brick-and-mortar facilities.
Instead of building new centers from scratch, LaRue wants policymakers to give PACE programs more flexibility, especially in terms of forming partnerships across the continuum of care.
“We’ve got to continue the effort to provide more flexibility to the rigidity of some of the PACE requirements,” he said,
Sen. Bob Casey, a Democrat from Pennsylvania and chairman of the Senate Special Committee on Aging, introduced the “PACE Plus Act” in April. The aim of the legislation is to drive PACE growth by rolling out federal grants that would fund the creation of new programs and the expansion of existing ones.
LaRue and ArchCare have been advocating on behalf of New York-specific PACE changes as well.
“Here in New York, we’re trying to convince the Office of CMMI to allow us to offer a Medicare-only option for PACE,” he said. “Right now, PACE is for individuals who are either 100% Medicaid, or Medicaid and Medicare. What we want to be able to do is have people enroll and privately pay for the Medicaid portion of the PACE program, and to do that at a tiered level based on their needs.”
Additional reporting by Robert Holly.