Reid Health: Collaborating with expertise to develop and successfully launch the Program of All-Inclusive Care for the Elderly (PACE)
The Partner
Reid Health has provided the people of Richmond, Indiana, and surrounding communities with quality healthcare for more than 100 years. Reid is consistently recognized regionally and nationally for quality of both care and experience.
The Program of All-Inclusive Care for the Elderly (PACE) is designed to provide comprehensive medical and social services to frail, elderly individuals living in the community, most of whom are dually eligible for Medicare and Medicaid Financing for the program is capitated, which allows providers to deliver all services participants need rather than limit services to those reimbursable under Medicare and Medicaid fee-for-service plans.
Because the PACE model of care is established as a provider in the Medicare program, states can offer PACE services to Medicaid beneficiaries as a state option.
In 2018, Reid Health embarked on exploring PACE to expand its mission of working to achieve “wholeness-in body, mind, and spirit … in fulfillment of human potential for those they serve Reid Health PACE opened on November 1, 2020, with the capacity to serve over 300 seniors in select ZIP codes of Fayette, Franklin, Henry, Randolph, Union, and Wayne counties.
The Challenge
PACE exploration requires a deep understanding of the potential market, along with targeted demographics, a business plan, and financial projections based on opportunity. Organizations embarking on PACE often find the development process, which typically takes a minimum of 12 to 18 months, to be daunting Many factors contribute to this complexity, including the alignment of federal and state application submissions and response timelines, site construction, licensing, surveys, document compliance, hiring of key personnel, provider network development, Part D application submission, and pharmacy provider contracting. PACE was a new venture for Reid Health, and the hospital system needed guidance
“One significant challenge we encountered was specific to the Part D application process and meeting requirements for the Request for Additional Information (RAI). We could not have met the deficiency without the support of CareVention HealthCare Consulting and the resources they connected us with.” -Ashley Werner, Director of Reid PACE
Reid PACE’s development process took over 18 months and coincided with the COVID-19 pandemic. “One significant challenge we encountered was specific to the Part D application process and meeting requirements for the Request for Additional Information (RAI). We could not have met the deficiency without the support of CareVention HealthCare Consulting and the resources they connected us with,” said Ashley Werner, Director of Reid PACE.
The Solution
In 2018, Reid Health partnered with CareVention HealthCare Consulting, a service line of CareVention HealthCare (a division of Tabula Rasa HealthCare), which is deeply linked to the PACE community CareVention HealthCare Consulting has a team of operational, regulatory, marketing, and financial experts as well as physician-consultants with more than 100 years of combined PACE experience. The CareVention HealthCare Consulting Team was able to provide customized guidance, training, and support throughout the development process to help Reid Health PACE open its doors in November 2020.
In addition to guiding Reid Health through its PACE development process, CareVention HealthCare Consulting identified additional CareVention HealthCare services to ensure ideal participant care and operating efficiency, including Medicare risk adjustment (Capstone), PACE-specific medication management and pharmacy home delivery (CareKinesis), third-party administration (PeakTPA), and EHR/integrated technology solutions (PACElogic).
The Results
One element of complexity during the PACE development process is the Part D application and submission process, which requires crosswalks and often poses challenges for prospective PACE providers. When the Part D requirement challenge surfaced, “CareVention and our consultant put us in contact with other consultants who had additional experience with the process, connected us with CareKinesis administration to extensively review collateral, and then ultimately connected us with a Pharmacy Benefit Manager (PBM) with which we have contracted to ensure proper Part D oversight is maintained, said Werner. “CareVention and our consultants were behind us every step of the way in trying to think of creative solutions to meet the requirement”.
The Conclusion
Werner credits the team of CareVention HealthCare Consulting for leading Reid Health in developing and operationalizing PACE. “CareVention HealthCare Consulting’s operational and marketing consultants provide our team with support and an abundance of resources that are beneficial to our operations,” she stated. “Resources include collateral, policies, first hand insight, experience, and a contact network along with other materials aimed at equipping us with the tools for success.”
To learn more about the services CareVention HealthCare Consulting provides, call 844-683-5302, visit careventionhc.com or email info@cpstn.com.
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