4 Reasons You Should Hire a PACE Consultant

Blogs | 5 Minute Read

You’re on a great mission. You want to start a Program of All-Inclusive Care for the Elderly, commonly known as PACE. The need is strong. Americans are looking for alternatives to long-term care and see a better, happier life by aging in place. Opening a PACE Center is an altruistic way to serve communities and provide the comprehensive, value-based care that everyone deserves.

But to get from zero to a fully operational program, you’ll face state, financial, operational, regulatory, technical, and clinical care challenges. There are complex market and financial feasibility studies, a complicated state and Centers for Medicare and Medicaid Services (CMS) application process, tight timelines and deadlines, present and future business plans, and more.

To overcome the challenges, you need a smart solution. Here are the top 4 reasons you should hire an experienced PACE consultant.

1. State regulations are stringent

By the latest estimate, 60,000 participants are served by 273 PACE centers across the country. And it’s projected that the number of individuals enrolled in PACE programs will rise to 200,000 by 2028. But not all states are open to PACE, while other states may restrict PACE to only a few geographical areas. Experienced PACE consultants have existing and ongoing relationships with state administrators, which provides insight into which states are open to new PACE development and expansion and which are not.

With the right contacts, consultants can get accurate information faster and more efficiently than a new PACE owner. Consultants will have first-hand knowledge of the state’s application process and any licensing requirements that may be unique to that state. Most importantly, PACE consultants will be familiar with applicable timelines and will help you navigate the process, so you don’t miss critical deadlines.

It’s challenging to get started, know who to contact at the state level, and stay on track. A PACE consultant will guide you on a successful journey.

2. Feasibility studies are complex and labor intensive

Before you open a PACE center, you should know answers to a few key questions. Are there enough potential participants in your target market to sustain the business? Are there other PACE centers in your zip code? Do you have the necessary financial answers to launch and manage the business toward the long-term breakeven?

A PACE consultant will address these questions through comprehensive market and financial feasibility studies that will model the likely scenarios that can impact your business. Through a highly collaborative process with a PACE consultant, you’ll learn key considerations for your center, understand the demographics within the community, realize potential competition in your area, and develop projections of costs to launch your program. The data collected for financial feasibility will also help you meet a complex but integral part of your state and CMS applications: the five-year financial proforma.

3. The CMS application is arduous

While CMS has streamlined the online process of submitting your PACE application, the work required to create and gather the necessary documentation is still complex and time consuming. A PACE consultant eases the burden on you and your team by creating the policies and completing the documentation required as part of the application. The consultant will review all documents before final submission including the Part D application, quality assurance plan, attestations, potential program waivers, enrollment and disenrollment policies, termination policies, and more.  

A consultant ensures your application is complete and accurate, and submitted on time. And should the state or CMS request additional information, your PACE consultant will guide you through the process of accurately and efficiently managing the response.

4. A consultant has the strong expertise you need to build a solid interdisciplinary team

Your PACE interdisciplinary team (IDT) is at the center of your program’s success. A PACE consultant can help you establish the critical framework needed to make your team successful—including policies and procedures, participant care plans, team workflows, and the onboarding and training they need to work inside the PACE model.

Some of your new team members may have never worked within an IDT. A PACE consultant can coach your team in the hiring process and development of your team.

With an expert PACE consultant by your side, you’ll have the guidance, support, and expertise needed to help improve your participants’ lives.

Partnerships for PACE success

Clearly, establishing a PACE program is a massive undertaking. Having a partner that not only lessens the load, but provides first-hand experience, is essential.

The right PACE consultant can be instrumental in establishing and sustaining your PACE program. They have expertise in all elements of the PACE model of care from understanding your market and financial feasibility to enrolling your first participant, coaching your team through regulatory and audit expectations along the way. As you consider your future with PACE, it is critical to choose a consultant that matches your needs — setting the best foundation for your program and the best outcomes for your participants.

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