The health system is poised to reach more patients looking to age in place comfortably.
OSF HealthCare, based in Peoria, Illinois, has begun the application process to bring the Program of All-Inclusive Care for the Elderly (PACE) to its patient population.
The program is anticipated to begin mid-2024, upon completion of the application process.
HealthLeaders spoke with Nathan Pritzker, the system's director of PACE strategy and operations, about the extensive application process, goals for the program, and how they plan to integrate the current resources within the system into the program.
The following transcript has been edited for brevity and clarity.
HealthLeaders: What types of resources and services does PACE offer?
Nathan Pritzker: Since we're programmed for all-inclusive care of the elderly, we cover all required care for elderly populations that is reimbursable by Medicare or Medicaid or that could be reasonably expected to keep a PACE participant healthy and aging in place with dignity.
We cover everything from drugs to assistive care in the home, to hospitalizations and surgeries, all the way to transportation and meals, if that's what the individual requires.
HL: What does the application process consist of?
Pritzker: The PACE application is very rigorous. We need, among other things, to complete a relatively significant listing of our policies, procedures, and protocols that surround the care and protection of elderly populations.
We needed to submit a detailed financial analysis and plan indicating our ability to support a pay center during a startup period, which can be relatively costly. We will undergo an extensive facility assessment to ensure our PACE center and supporting assets can facilitate the program.
We are working through the required process to put together a bid to administer the pharmaceutical needs of the PACE population. We are also working through a contracting and networking process to make sure that all major types of care, including specialists, are in network for our participants just like an insurance program would need to do so that we can refer any PACE participant and make sure that they can get the service they need in a timely fashion.
HL: How will the PACE Program benefit the area for which the OSF provides care?
Prtizker: We have been in the application process for a geography that coincides with the central Illinois area around the tri-county area around Peoria. It's a mix of rural, urban, and suburban areas, and it coincides well with our major areas of operation.
We'll have resources either employed directly by our PACE department or through our contracts internally with our own home health and home care divisions to make sure that we can deliver the full suite of in-home services that PACE participants need, leveraging as much of our existing infrastructure as possible.
HL: What are OSF's goals for the PACE program, upon the application's approval?
Pritzker: Our vision and our aspiration for PACE is to better care for our aging population in the homes and communities they're in. We as an organization have a mission to serve with the greatest care and love and meet people where they are. PACE allows us to do that without concern for the walls of our hospitals and with a much greater degree of flexibility in the modalities of care that we use.
The PACE program is quite beautiful in that it allows program participants or PACE organizations to have significant flexibilities in how they deliver care and how we're no longer bound by the same fee-for-service constraints.
We are able to take a much more proactive population health approach for an often-high-needs group of people that tends to slip through the cracks.
HL: The program will also include the establishment of an adult day center. What will the facility's role be?
Prtizker: All PACE programs revolve around a PACE Adult Day Center that acts as the hub of care for PACE participants.
Partipants can come to the center and experience social activities, group events, entertainment, and receive care they need. Attached to our proposed site is a clinic and rehab facility, and PACE programs are also required to provide transportation and meals for their participants, at least in the adult day center setting.
OSF is very fortunate to have a longstanding adult day center in the Peoria community, which we are retrofitting to become our PACE center. We plan on building on to that model to better serve and provide more services to that population and any members of our adult day center population that may want to enroll in PACE once our application is completed.
Jasmyne Ray is the revenue cycle editor at HealthLeaders.