CEO DIALOGUE ON PACE GROWTH · NPA Annual Meeting October 22, 2018 1 CEO DIALOGUE ON PACE GROWTH...
Transcript of CEO DIALOGUE ON PACE GROWTH · NPA Annual Meeting October 22, 2018 1 CEO DIALOGUE ON PACE GROWTH...
NPA Annual Meeting October 22, 2018
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CEO DIALOGUE ON PACE GROWTH
OCTOBER 22, 2018
AGENDA
Jade Gong, Moderator
Peter Fitzgerald
PACE 2.0 Overview
Eric Gurley
Immanuel Growth Story
Scott La Rue
ArchCare Growth Story
DIALOGUE
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“When it comes to innovation, an ounce of execution is worth more than a ton of theory”
Phil McKinney, Syndicated Talk Show Host of Killer Innovations and Businessman
PACE LEADERS PURSUING GROWTH NOW
Incremental Growth Exponential Growth
Enrollment
Revenues
More Capacity
More Capacity
Enrollment
Revenues
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GROWTH STRATEGIES IN PLAY
Community Physician Waiver
State IDD PilotContiguous Rural
Markets
Risk Sharing Partnership
Creative Flexibility on State
Requirements
Notable Policies Awaiting Action
• PACE Final Regulationo HR 6157 directs CMS to release the final PACE regulation
• Part D Waiver for Medicare-only Beneficiarieso Huron Valley PACE Expansion Project, funded by the
Michigan Health Endowment fund has requested a waiver to allow a Medicare-only beneficiary to obtain Part D plan on the marketplace
o Lower Part D premium will make private pay PACE moreaffordable
For Profit PACE Allowed by CMS as of June 2015
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Peter Fitzgerald
Executive Vice President, Strategy & Policy
NPA
Growth and Mission
• PACE results in better self-rated health status
• PACE results in fewer unmet needs
• PACE adds years of life
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Without PACE, Participants and their Families are Struggling
Frail Elders• Isolated
• Bored
• Dependent
• Difficulty accessing care
• Uncoordinated care
• Fear of nursing home placement
Family Caregivers
• Worried
• Tired
• Running around (to get to care)
• Hard to maintain work schedule
Source: NPA review of PACE participant and caregiver interviews
Only One in Ten Eligible Individuals are Enrolled
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Our PACE 2.0 Goal
Serve 200K participants by 2028!
-
50,000
100,000
150,000
200,000
250,000
Aug'18 Aug-19 Aug-20 Aug-21 Aug-22 Aug-23 Aug-24 Aug-25 Aug-26 Aug-27 Aug-28
Exponential Growth
GS1 - Current PACE Programs GS2 - New PACE Programs GS3 - New Populations Total Baseline Participants
Serve 100K Participants by 2021
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Scale and Spread
• Scale – serving more people through the growth of currently operating PACE organizations, serving our current target population (Growth Stream 1)
• Spread – serving more people through current and new PACE organizations expanding into new service areas, serving our current target population (Growth Stream 2)
• Scale and Spread – serving new populations (Growth Stream 3)
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How?
• Retain essential elements
• Identify bright spots achieving high growth• Net Monthly enrollment: 10-15
• Market penetration: 20% or more
• Develop Growth Model
• Field Test Model
• Support dissemination and implementation
Essential Elements
• High functioning IDT
• Effective, ongoing care coordination
• Clinical utilization management
• Presence in the home
• Efficient transportation system
• Socialization systems
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PACE Growth Mindset
Incremental Growth Exponential Growth
If they come, we’ll Build it! If we Build it, they’ll come
Enrollment
Revenues
More Capacity
More Capacity
Enrollment
Revenues
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Field Test – PACE of the Triad
3 Month Field Test
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West Coast PACE 2.0 Learning Collaborative
• Includes 10 PACE organizations from California (8), Washington, and Oregon
• Kicked-off with an in-person learning session on October 3rd
• Will continue for 12-months with bi-weekly all team calls and 3 more in-person learning sessions with coaches & Bright Spot faculty
• Participants will conduct rapid cycle tests of tactics, collect data, and share lessons learning
The Collaborative will help spread & refine growth tactics
Learnings will be incorporated in the driver diagram and shared with the broader NPA membership
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Growth Pledge
• Potential Service Populationo Census
oMedicare & Medicaid claims
• Managed Care Market Factorso Special Needs Plans
oMedicaid Managed Care
• State Policy Factors
• Organizational Factorso Capacity
o Financing
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How Will Sponsors View
Growth?
Eric Gurley
President & CEO
Immanuel
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Immanuel
• Omaha, Nebraska based – Established in 1887
• Original mission:o To meet the health needs of the communityo To meet the needs of orphaned and neglected childreno To meet the needs of older people
• Historically identified as a hospital provider
• 1996 partnered with Catholic Health Initiatives to create largest health system in Nebraska
• 2012 resigned co-sponsorship to pursue aggressive growth in senior care
• Currently serve through 15 locations: market rate and affordable communities; PACE; skilled nursing
Immanuel Pathways -- PACE
• First Site 2012 – Council Bluffs, Iowa
• Second Site 2013 – Omaha, Nebraska
• Third Site 2014 – Des Moines, Iowa (expansion application)
• Relatively smaller regional markets, border on rural service
• Only PACE provider in Nebraska, 2 of 3 providers in Iowa
• Growth limited by processes, risk management, market size
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Immanuel Pathways Enrollment by Site
Future of Immanuel Pathways -- PACE
• Key Performance Indicator – Source of revenues
35%
37%
28%
FY2018 @ 6-30-18
Private Pay Third Party Investments
40%
42%
18%
FY2018 @ 6-30-18
IL/AL/MS Pathways LTC
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Future of Immanuel Pathways -- PACE
• Adapt internal processes to more effectively use space and transportationo Use of Home Care and In-Home services
o Processes for participants in nursing homes and assisted living
o Use of clinic and clinical staff
• Adapt PACE skills to serve the non-dual eligible population
• Use market rate communities as central hub for expansion
Future of PACE
• Immanuel embraced the PACE concept as the future of health delivery and chronic population management
• Immanuel believes that it can capitalize on PACE skills to serve new populations; market rate and specialized needs
• Partnering with other ACO models to share clinical services and to extend ACO model of chronic care management
• Isolate financial risks through private pay markets and partnerships
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Scott LaRue
President and CEO
ArchCare
ArchCare, An Overview
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Service Area 2018
74%
9,000
HOME/COMMUNITY
4,400CARE MEMBERS
SERVED DAILY
9COUNTIES
MEDICAID92%
VULNERABLE95%
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ArchCare Senior Life
• Based in New York City
• Part of the ArchCare system, sponsored by the Archdiocese of New York
• Currently serving o750+ participants
o7 locations (4 centers and 3 alternate care sites)
o4 (Bronx, Manhattan, Staten Island, Westchester) of the 10 counties in the Archdiocese service area
Growth of ArchCare Senior Life over time
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
PACE Opens in Harlem
PACE Opens in Bronx
PACE Opens in Staten Island
PACE Opens ACS in Staten Island
PACE Opens ACS in Bronx
PACE Opens 2nd
ACS in Bronx
PACE Opens in Westchester
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Where we are today…
Where we could be tomorrow
754
1304
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Where we will be under PACE 2.0
754
1304
1844
500Additional Participants required in addition to traditional
growth to meet PACE 2.0 target.
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Growth Opportunities
• New PACE Centers and ACS in existing service areas and service area expansion
• Develop specialized programs (e.g. IDD)
• Non-traditional partners (e.g. NYS OMH)
• Leveraging the Community Physician Waiver
• Adult day medical center conversions
Growth Opportunities
• Partner with Hospitals for existing infrastructure
• State approval to allow Assisted Living Program residents to enroll in PACE
• Mobile Health Clinics for rural counties
• Positioning PACE as the Integrated Product in NYS (FIDA replacement)
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Requirements
• Capital
• Partnerships
• Financial model and risk arrangement flexibility
• Policy change (state and federal)
• Program awareness (patients, physicians, etc.)
LET’S DIALOGUE
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THANK YOU!!!
Jade Gong
Peter Fitzgerald
Scott LaRue
Eric Gurley