COVID 19 and Chronic Condition Management

Deborah Keller

CEO TCS Healthcare Technologies

For the past few months, healthcare has been like a song with one note. The government, the media, healthcare professionals, health plans and all the rest of us have been heavily focused all COVID-19 all the time.

That’s understandable. Global pandemics have a way of sucking up all the attention in the room.

But the problem is all those other life-threatening chronic health conditions Americans already had or were in danger of acquiring before COVID-19 didn’t suddenly go away because there was a new coronavirus in town. Instead, they continued to do what they have always done, and the damage they’re doing now will still be around long after COVID is under control.

That is why it’s so critical for healthcare providers and health plans to shake off the tunnel vision of the past few months and focus once again on preventive screenings and wellness visits.  Including safely bringing non-COVID-19 patients into the office where hands-on care is required and continuing to expand the use of telemedicine.  Case managers must stay focused on ensuring that their patients/members are following their plans of care closely.

For example, given the fear surrounding COVID-19 (not to mention forced shut-downs), it’s possible a large number of patients/members with diabetes are behind on their HbA1c lab tests and/or diabetic eye and foot examinations.

As a result, health plans and providers will want to focus their initial efforts on the patients/members who are most in danger of requiring an emergency department (ED) visit or a hospital inpatient stay due to their lack of attention to their conditions. They are the ones most likely to deteriorate quickly and require urgent or emergent care.

This is where population health management analytics can be invaluable. It can parse through an entire patient panel and not only identify patients/members who are overdue for care, but also how many gaps in care they have and how far behind they are.  Analytics can also be used to identify people who are most at risk of COVID and engage them to be tested. 

With more sophisticated analytics, the provider or health plan can dig deeper, incorporating additional factors such as age, number of co-morbidities, demographics, social determinants of health (SDOH) etc. This information will help score patients/members on the severity of their overall conditions and needs to ensure those with the highest priority – the one with the greatest care needs – surface to the top of the list for routine chronic care as well as COVID testing.

Once this list is generated, care managers or care coordinators can begin contacting patients/members to schedule an appointment for the care they need. Of course, they may meet some unusual resistance to these types of care due to lingering fears; after all, the pandemic is far from over and in some geographies is now starting to heat up.

Providers and health plans may want to develop conversation tools to help care managers and care coordinators not only explain the importance of coming in for these tests and procedures but also the steps that are being taken to ensure a patient/member who visits their physician for their regular care doesn’t acquire the virus in the process.

Primary care providers getting patients in for wellness visits and preventive screenings will help get patients back in the habit of visiting their physicians again even it is virtually. For those providers in value-based arrangements, securing these visits is essential to ensuring patients achieve better health outcomes on a sustained basis so providers can meet their cost containment commitments.

While the COVID-19 pandemic has been capturing all the attention, other health conditions and the need for preventive care have not stopped. They’ve just been pushed to the background.

It’s important to ensure that these other forms of care continue to be delivered, pandemic or not. Otherwise, the price we have to pay in lives and dollars down the road could be enormous.


COVID-19 and Health Disparities

Deborah Keller

CEO TCS Healthcare Technologies

I was privileged to attend the “Mostly Medicaid 2020 Summer Virtual Conference” which was led by Clay Farris, Practice Lead of Mostly Medicaid.  The conference was held over four days and included a variety of speakers from various health plans, state officials in the Medicaid space, and other experts.  The focus of the conference was how health plans, vendors and Medicaid were responding to the COVID-19 pandemic.

The focus was primarily on the COVID-19 pandemic and what was being done to support their members, but they also spoke a lot about health disparities and how they were working to identify and assist their members in overcoming barriers to medication access, affordable housing, and even day care.

There was a lot of discussion around telemedicine and its newly found place in the healthcare world.  Although telemedicine has been around for several years, it hasn’t really taken its place in the healthcare arena until recently.  Some of the health plans said they have no limits on how telemedicine is used and are reimbursing their providers at office visit rates.  There was also a lot of talk around mail order pharmacies and how some health plans were now allowing 90-day prescription refills rather than the normal 30-day refill.  And, of course there was a lot of talk around COVID-19 testing and admissions to hospital and skilled nursing, and how many health plans had responded to the crisis by authorizing no pre-certifications for such services. 

There was a tremendous focus also on our more vulnerable citizens and many plans were placing check-in calls to these members to see how they were fairing with the effects of social isolation and to check on food supplies in the home.  Also, some health plans discussed how they are now deeming behavioral health services to not require a pre-certification. 

Shortly after attending this seminar, I also listened to a podcast put out by NCQA (the National Committee for Quality Assurance) entitled Inside Health Care #40, Standing with the Black Community.  It featured Peggy O’Kane, NCQA President, and discussed the murders, racism, and the role of race in health disparities.  Here is a quote from Ms. O’Kane: “These terrible losses in succession, followed by violence against peaceful protestors, are unfortunately part of a larger picture of law enforcement aggression and racial profiling of Black Americans dating back generations. Advances in technology, such as cell phones, have brought awareness of these practices to the public eye, and we witness the unfolding events in horror and shame.  We say to our Black fellow Americans, ”We stand with you. We demand change with you.”  In the podcast she touches on NCQA’s planned steps to improve ourselves and our communities, inside and outside of health care.

It was the combination of my attendance at these two events that prompted the development of TCS Healthcare Technologies’ newest assessment, “COVID-19 and Health Disparities”, and the care plan that accompanies it.  It focuses on COVID-19, measures you can do to protect yourself from it, and the financial impacts on members of the pandemic.  Like our current “Health Risk Assessment”, it also concentrates on social determinants of health, such as housing, food insecurity, and social isolation; and it also has questions surrounding a member’s race and health disparities.  This will help capture the data that is needed to assess the effects of COVID-19 and health disparities on your membership and empower your case managers to help and better educate your members.


The Impacts of Blindness on Overall Health

Deborah Keller

CEO TCS Healthcare Technologies

 

How often is one alerted to a potential health concern by “seeing” a change in their body? A mole, new bruise, strange bump, change in color of skin, mucous membranes, or even the visual of the different outputs from the body such as blood, urine and others? It’s challenging enough that many health issues occur without symptoms or actually “feeling” anything, but imagine if you also couldn’t visualize when things go wrong or change in your body? Impairment doesn’t even need to be full blindness to hinder one’s health– even the loss of vision from aging eyes can make it very difficult to notice outward changes in one’s health.

Vision impairment itself is a chronic condition and major public health problem. A publication by the Centers For Disease Control and Prevention (CDC) Improving the Nation’s Vision Health notes visual disability to be “one of the top 10 disabilities amongst adults 18 years and older and the single most prevalent disabling condition among children.” Its prevalence is expected to double over the next 30 years.

Effects of visual impairment include significant restrictions to independence, mobility, and ability to perform household and personal tasks.  From a health maintenance perspective, reading and understanding instructions such as medication labels, physician treatment plans and discharge instructions can significantly hinder adherence to recommended care plans.

Being visually impaired often negatively impacts other chronic conditions by making it challenging for people to engage in self-care and attend medical appointments. Administering medications can be especially difficult particularly if it involves dosing and administration of things such as insulin or other injectable medications, putting the visually impaired at further risk of complications from medication errors.

Quality of life can suffer in the visually impaired, bringing on both physically and mentally unhealthy days that can lead to overall dissatisfaction with life. Difficulty getting around can lead to inactivity and in some cases put one at higher risk for obesity or activity related injuries. Falls, fractures, injuries, and social isolation can negatively impact a blind person’s health and put them at increased risk for comorbidities. These complicating factors can lead to both indirect and direct rises in the healthcare costs for the visually impaired.

While there have been no significant studies on the economic impact of vision loss or the cost benefit of promoting eye and vision health, it is safe to say that a population health approach targeted in these areas, can not only decrease costs, but improve the quality of life and health outcomes for the visually impaired.

CDC recommendations include “engaging key national partners, collaborating with state and local health departments, implementing vision  surveillance and evaluation systems, focusing on at risk populations, integrating vision health interventions into existing public health programs, addressing the role of behavior in protecting and optimizing vision health, professional workforce development and establishing an applied public health research agenda for vision health.”

Thus, promoting and sustaining vision health and the quality of life for all will require a clear public and population health vision!


clinical and technical consulting

The Importance of Men's Health Week

India B. Carson, RN, MSN

Clinical Product Specialist

 

It’s almost Father’s Day and it is time to observe National Men’s Health Week.  This week is a reminder for men to take the steps they need to be healthier!  But men don’t need to do this alone.  Whether it is your husband, partner, dad, brother, son, or friend, you can help support the health and safety of the men in your life.

Remind Men to Get their Checkups – Let’s advocate that the men in your life see a doctor or healthcare provider regularly for checkups and talk about their own personal family health history.  During their regular checkups, men should review their existing health problems:  have there been any body changes, including lumps or skin changes; any pain, dizziness, fatigue, or problems with urine or bowels; have eating habits changed; any depression, anxiety, trauma, distress, or sleeping problems?  If they notice any of these changes, they should make a note of when the change began and any other observation that a healthcare provider would want to be aware of.  They need to be honest with their provider.  For instance, if they are not taking their medications as directed, they need to let their healthcare provider know this and why.  If it is due to side effects or the co-payments associated with the cost of the medication, the provider may be able to order something else.  If it is due to forgetfulness, their provider should know that, too.  They may be able to provide the member with reminder tools.

Get General Screenings or Vaccinations – Men should check with their healthcare provider to see if it is time for any vaccinations or tests, like a prostate cancer screening, colon cancer screening, tetanus shot, or other screening.

Encourage Men to Seek Help for Depression – About one of every six adults will have depression at some time in their life.  Depression affects around 16 million American adults every year.  These feelings can interfere with daily activities and may last for a long time.  So why not get help with it?  Men should tell their healthcare provider if they are experiencing feelings of sadness or anxiety often or all of the time.  Men should let the provider know if they no longer want to do activities that used to be fun, if they are feeling irritable, easily frustrated, or restless.  Men should tell their provider if they are having trouble falling asleep or staying asleep, or if they are eating more or less than usual.  Depression is one of the leading causes of disease or injury worldwide for both men and women.  Learn to recognize the signs and how to help the men in your life.

Know the Signs and Symptoms of a Heart Attack – A heart attack happens when a part of the heart muscle doesn’t get enough blood.  The more time that passes without treatment, the greater the damage to the heart muscle. The five major symptoms of a heart attack are:

  • Chest pain or discomfort
  • Feeling weak, light-headed, or faint
  • Pain or discomfort in the jaw, neck, or back
  • Pain or discomfort in one or both arms, or in the shoulders
  • Shortness of breath

We know that you love the men in your life!  Let’s help to keep them all safe![1]

[1] Centers for Disease Control and Prevention.  National Men’s Health Week.  Retrieved on March 11, 2020 from: https://www.cdc.gov/features/healthymen/index.html

 

 

[1] Centers for Disease Control and Prevention.  National Men’s Health Week.  Retrieved on March 11, 2020 from: https://www.cdc.gov/features/healthymen/index.html


Prior Authorization - Capturing Turnaround Times

India B. Carson, RN, MSN

Clinical Product Specialist

 

Do you need to capture turnaround times for your prior authorizations?  Assuming this is the case, I have a few proposals for you to follow when you are searching for a new software application.  These tips can make your life much easier!

Ensure sure your application captures the prior authorization type.  Is the request for a concurrent review, a prior to service review, or a retro review?  Is the prior to service request for a standard vs. expedited request?  These are just a few of the distinct differences that your application will need to address.

Look for a software application that allows for additional time when there is insufficient documentation submitted with the authorization request.  In many cases, a request is received but does not have enough documentation to make a decision, necessitating a phone call or an email to the provider asking for more detailed information.  Your software should allow for such variances and it should also allow for an extension of time.

Something else you should look for is the ability to enter the turnaround time requirements by company.  It is important that you be able to capture a variety of turnaround times by company, because the various companies that you contract with may have different requirements for authorization timeliness.

Additionally, you need a software application that allows you to document the dates and times in the appropriate format.  Does your software allow you to document the time you provided written notification to the member recorded down to the time in seconds?  Does your regulated entity require this?  You will want to investigate this further.

You will also want an application in which you can document the turnaround time requirements in either business days, calendar days, or hours.  And, you also want an application in which you can document the notification date and time for the member and the provider.

Examples of what you might need in a software application to document turnaround time by company:

Company XYZ

Rule Type Turnaround Time- Due Extension Time
Concurrent 24 hours 48 hours
Prior to Service- Standard 15 business days 15 business days
Prior to Service- Expedited 72 hours 48 hours
Retro 30 calendar days 15 calendar days

 

These are just some examples of what you may want to capture for your turnaround times.  Consult with your regulatory agency’s specific requirements for the appropriate values to capture.  Make sure the software you select can accommodate custom fields too, so you can define what values you need for your specific regulatory agency.


TCS Healthcare Expands Team and Opens East Coast Office

WILMINGTON, N.C.May 27, 2020 /PRNewswire/ — TCS Healthcare Technologies (TCS) is delighted to announce the opening of their new office in Wilmington, NC.

Opening an east coast office represents an important expansion step for TCS.  Having an additional office in North Carolina will allow the company to execute on their strategic growth plans while also better serving their existing east coast clients.  The new office will house new employees in the Sales and Project Management areas.  TCS will maintain their corporate headquarters in Auburn, CA.

Deborah Keller, RN, CEO, TCS HealthcareTechnologies

TCS CEO, Deborah Keller, states, “When selecting an east coast location, we looked at available talent, quality of life, cost of living, and atmosphere; Wilmington stood out in these areas.  Being an HCAP Partners portfolio company we were committed to finding an area where we not only can be successful in our goals but where we can also make a difference. We are going into our second year implementing the HCAP Partners Gainful Jobs ApproachTM and we are excited to bring North Carolina employees on board. We look forward to being a great local employer and community partner”

While TCS was able to complete the project on time and within budget, opening a new office during the COVID 19 pandemic created unique obstacles. “While the logistics had to change a bit, during our opening we have been met with friendliness and tremendous support from local vendors. The team on the ground kept things moving and our new office is ready to go,” says Matt Fahner, Vice President of Engineering for TCS.

To request a demo, email us at info@tcshealthcare.com.

About TCS Healthcare Technologies:

TCS Healthcare Technologies (TCS) is a leading provider of software designed to support health plans, TPAs, ACOs and other risk-bearing organizations. The TCS team of US-based clinicians and developers are recognized for their best-in-class managed care expertise and customer support.

TCS Healthcare Technologies is an HCAP Partners portfolio company.


Alcohol Screening Tools

India B. Carson, RN, MSN
Clinical Product Specialist

Primary care providers often screen their patients for a variety of conditions, including alcohol use.  Screening is not the same as diagnostic testing, which can establish a definite diagnosis.  Instead, screening is used to identify people who are likely to have a disorder, as determined by their answers to certain questions.  Evidence suggests that even if patients are not meeting the requirements for alcohol dependence or abuse, they may be consuming alcohol at levels which place them at risk for increased problems.[1]  A variety of screening tools are available to identify these at-risk patients to ensure that they can be helped through the necessary interventions.

The Alcohol Use Disorders Identification Test (AUDIT) is a screening tool that was developed in 1982 by the World Health Organization.  This screening tool accurately classifies 95% of people as either alcoholic or non-alcoholics by asking ten questions related to alcohol use.  A resulting score of eight or more indicates harmful drinking behavior[2].  This tool offers a simple way to screen and identify patients who may be at risk for developing problems related to their alcohol consumption and can be found here:  https://www.integration.samhsa.gov/AUDIT_screener_for_alcohol.pdf[3].

The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) is a very simple three-question screening tool for harmful drinking which can be administered alone or as part of a lengthier survey or assessment.  At TCS, this tool is utilized as part of our Health Risk Assessment (HRA), as it is only three questions in length and can be easily incorporated into a longer assessment.  A copy of the AUDIT-C can be found here:  https://cde.drugabuse.gov/sites/nida_cde/files/Audit-C_2014Mar24.pdf[4].

The CAGE AID is a commonly used screening tool for both drug and alcohol use.  However, it can be used to determine whether a more comprehensive alcohol assessment is needed.  A copy of this tool can be found at:  https://www.integration.samhsa.gov/images/res/CAGEAID.pdf[5].  These questions can also be adapted to include drug use.

As previously mentioned, there are quite a variety of screening tools available.  If you are searching for one, please consider reviewing the Substance Abuse and Mental Health Service Administration (SAMHSA) website and look for specific recommendations.  Lastly, you can find additional reference material at the National Institutes of Health section on National Institute on Alcohol Abuse and Alcoholism.

[1] National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert. Retrieved from: https://www.niaaa.nih.gov/alcohols-effects-health  Retrieved on March 4, 2020.

2 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retried from: https://www.integration.samhsa.gov/AUDIT_screener_for_alcohol.pdf on March 4, 2020.

3 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retrieved from: https://cde.drugabuse.gov/sites/nida_cde/files/Audit-C_2014Mar24.pdf on March 4, 2020.

4 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retrieved from: https://www.integration.samhsa.gov/images/res/CAGEAID.pdf on March 4, 2020.


PACE Programs Amid COVID-19

Audrey Ward, RN, MBA
Clinical Account Executive

As we roll into the third month of COVID-19, the world is becoming a very different place, and moving at a very different pace in all manner of speaking.  One area particularly affected by the Novel Coronavirus, is a program that serves the most vulnerable population, the Program of All-Inclusive Care for the Elderly (PACE).   Participants in the program are 55 years or older and are typically frail elderly still living in the community but needing comprehensive medical and social services that might otherwise be provided in a nursing home. This puts the population of program participants in the highest risk category for exposure and infection with COVID-19.

PACE programs across the country are striving to stay open and continuing to provide the necessary services amid quarantine, lack of resources, and risk of exposure and transmission for both the participants and the providers of care and services. Recognizing that these organizations are dependent upon up-to-date information to better serve and protect program participants, the National Pace Association (NPA) has established an information hub where community providers can access the tools and resources needed to serve the frail and vulnerable.

The information hub located at https://www.npaonline.org/coronavirus-disease-2019-covid-19 provides easy to find, valuable information including the following:

  • Summaries of CMS COVID-19 Communications
  • PACE Organizations’ Responses to COVID-19
  • COVID-19 Resource Links
  • Telehealth Resources
  • Personal Protective Equipment (PPE) Information
  • Emergency Preparedness e-Community
  • COVID-19 Clinical and Quality Resources
  • Webinars on COVID-19
  • COVID-19 Weekly Updates

The Emergency Preparedness e-Community is the designated location for NPA member PACE plans to exchange information related to COVID-19. If not already a member, PACE plans are encouraged to create an account to access this critical information. In addition, the NPA is monitoring regulatory and congressional activities and providing links to State Policy Updates, Federal Assistance Programs, and Federal Policy related to COVID-19.

In a publication by Health Dimensions Group (HDG) Skilled Nursing & Senior Living COVID-19 Response & Resource Guide, community providers will find additional guidance on communication, workforce planning and support, surveillance and preparedness plans, financial resources, policy changes, and rapid response teams.

Life for both participants and providers of PACE has changed. Technology such as tablets, tools and training are being leveraged for e-visits, and residents are experiencing more in-room and hallway activities with overhead speaker games and interaction rather than group interactions.

There are more than 260 PACE centers located in 31 states, and many ways that the community at large can aid and support. On a larger scale, consider starting a PACE Program, or financially supporting an existing program with a donation of any amount. Ask Congress to support PACE programs, especially during the COVID-19 pandemic, by contacting your U.S. Representative and U.S. Senators. The gesture need not be grand to make a big difference. Giving encouragement to participants and providers by sending cards, letters, puzzles, books, and other small gifts can bring a positive change of PACE, if even for a moment.


National Nurses Week Is Extra Meaningful This Year

Deborah Keller, RN, CMCN, CCM, CPHQ
Chief Executive Officer 

Each year, May 6-12 is designated as National Nurses Week, a time to recognize, celebrate and honor all
the dedicated caregivers who are the heart of healthcare. This year was already shaping up to be
something special since 2020 has been declared to be the Year of the Nurse and Midwife to coincide
with the 200 th birthday of Florence Nightingale.
Then the world changed, and suddenly we all found ourselves with a whole new appreciation for what
being a nurse is all about.
Consider that all that is being asked of most of us in the battle against COVID-19 is to wash our hands, sit
on our couches and eat our home-cooked meals while watching Netflix. And yet, we are frustrated, and
we complain. We want our “normal” back.
Nurses on the front line have a different perspective. They must deal with the ravages of COVID-19 in
strangers every single shift even stepping in to hold a dying patient’s hand while in their other hand they
are holding a mobile phone soothing a family member. Nurse case managers in the hardest hit areas
are seeing their patients who had been getting control of their chronic conditions suddenly die of a
virus. All the while, these nurses also worry about all the same things the rest of us worry about, such as
how to home school their kids, whether their aging parents are doing ok and if the products they’re
purchasing at the grocery store contain traces of the virus.
When most of us are done working from home we shut down our computers and spend time with our
families. When a 26-year-old nurse finishes her shift, she has to completely decontaminate, treat the
bleeding behind her ears and the bruising from 12 hours of wearing a mask. That nurse then has to
decide whether to go home to her baby and take a chance on exposing her family to any residual traces
of COVID-19 or stay away for the duration. Either way, it often feels like a no-win proposition.

Nurses in 2020 are rushing headlong into a virus where there are still many unknowns. Many don’t have
all the personal protective equipment (PPE) they need so they are improvising as best they can and
hoping for the best. Because stopping and waiting until more PPE arrives simply isn’t an option.
With all the social distancing rules in place nurses are being called upon to do even more. In normal
times they can count on families to shoulder some of the load for patient care, such as walking the
patient to the bathroom, pouring a cupt of water, or helping patients adjust their pillows. None of that
help is available now.

They are also going above and beyond in other ways. Here’s a personal example.
Recently my mother-in-law fell as she attempted to navigate some stairs in her home when a tornado
raged through her town. She broke her hip, requiring surgery. My husband and I weren’t able to come
to the room to find out what was going on, and when we called her a young nurse answered.

The nurse asked where we were and we told her we were in the parking lot. She told us to stay there
and she would came out totalk to us. , Still dressed in her PPE, she came to stand in the rain 6 feet from
our car to explain what was happening. Since then she consistently called us with updates and helped
my mother-in-law call us on her cell phone.
They don’t teach that level of compassion in nursing school. It’s just something that is inside of these
special people that proves nursing isn’t a job but a calling.
So yes, this year we have even more reasons than usual to honor these heroic caregivers – although
most of them will probably still be too deeply involved on the front lines of the COVID-19 fight to notice
when their special week occurs. But that shouldn’t stop us from honoring them more than ever this
year.
As someone who was a practicing nurse for many years here’s what I suggest. For us nurses who have
been away from clinical practice for a while, consider preparing yourself to step back in and offer
support. Many states are offering to cover the cost of clinical refresher courses and several nursing
schools are waiving fees. For others, during this National Nurses Week send a few boxes of chocolates
to the nurses at your local hospital. Order a few pizzas or a couple of those giant sandwiches for
everyone to share. Brighten up the nurse’s station with some flowers or colorful balloons.
Believe me, any gesture of kindness – especially one that reminds them that someone is thinking about
their welfare – will be greatly appreciated. It is the least we can do.


What is a PACE program?

India B. Carson, RN, MSN

Clinical Product Specialist

The PACE Model of Care began in the early 1970’s when the Chinatown-North Beach community of San Francisco saw a need for long-term care services by people.  The Balanced Budget Act of 1997 established the PACE model as a permanently recognized provider type under both the Medicare and Medicaid programs.  PACE, or the Program of All-Inclusive Care for the Elderly provides comprehensive care (both medical and social services) to certain frail, elderly participants still living in the community.  Many of the PACE participants are eligible for both Medicare and Medicaid.

Eligibility for PACE.  Participants must be 55 years or older and live in the service area of a PACE center.  They must require a nursing home level of care and be able to safely live in the PACE community.  PACE is not available in all states.  If you think you are eligible, you can call your local Medicaid office to determine your eligibility and to help you find a PACE plan in your area.[i]

What are the benefits?  The benefits of PACE include:  adult day care; dentistry; emergency services; home care; hospital care; laboratory/x-ray services; meals; medical specialty services; nursing home care; nutritional counseling; occupational therapy; physical therapy; prescription drugs; primary care; recreational therapy; social services; social work counseling; and transportation.  PACE also includes any other services deemed to be necessary to maintain a person’s health.  Services are provided mostly in adult day health centers and are often supplemented by in-home and referral services in accordance with the person’s needs.  Individuals who need end-of-life care will receive the appropriate services, however, if the person wants to elect the hospice benefit, they must voluntarily disenroll from the PACE program.

What services are provided?  An interdisciplinary team assesses an enrollee’s needs, develops care plans, and delivery all services.  Minimally the team consists of a:  dietician; driver; home care liaison; nurse; occupational therapist; PACE center supervisor; personal care attendants; physical therapist; primary care physician; recreational therapist or activity coordinator; and a social worker.

Application and Enrollment Process.  If someone meets the eligibility requirements and elects to have PACE, a voluntary enrollment agreement is signed.  Enrollment continues if desired by the person regardless of any changes in health status until they voluntarily disenroll.

Quality of Care.  The PACE organization is required to develop, implement, maintain, and evaluate an effective data-driven quality assessment and performance improvement (QAPI) program.  PACE organizations have the flexibility to develop to QAPI program that best matches their services so they may meet the needs of their members.  The desired outcome of the QAPI requirement is that the data-driven quality assessment serves as the engine that drives and prioritizes continuous improvements for all PACE organization services.

[i] Centers for Medicare & Medicaid Services.  Programs of All-Inclusive Care for the Elderly (PACE). Retrieved April 30, 2020 from: https://www.cms.gov/Medicare/Health-Plans/PACE/Overview.