During the pandemic, some senior care models succeeded, and some didn’t. The Program of All-Inclusive Care for the Elderly (PACE) was one that did.
In 2023, PACE enrollment exceeded 70,000 participants and has seen an over 40% growth in enrollment since 2019.
Many home-based care providers have already gotten into PACE. The Jacksonville-based Alivia Care – a home health and hospice provider – has even become a PACE administrator itself.
But, in order for providers to become PACE partners or participants, they have to be as prepared as possible prior to the enrollment process.
“We have really seen increasing competition for RFPs in recent years, which has required organizations to really think ahead and prepare ahead of an RFP release,” Tina Hansen Pickett, managing director of ATI Advisory’s Medicare innovation practice, said during a webinar Tuesday.
Generally, PACE participants live in their respective communities prior to enrollment, but are patents who would qualify for nursing home placement based upon their level of impairment and care needs.
PACE providers offer medical, physical, emotional and social need solutions — much of which is centered around a PACE center. A PACE center is a physical facility in which the program offers an adult day center, a medical clinic, dental and other services.
A PACE provider — like InnovAge, for example, one of the largest PACE providers — will enroll those participants and receive capitated payments from Medicare and Medicaid.
PACE organizations or agencies — including health care providers, insurers or community organizations — may issue an RFP to solicit proposals from potential partners interested in participating in or providing services for the PACE program.
These proposals outline how an organization intends to meet the requirements and objectives outlined in the RFP. The applications include details on the services they will provide, their qualifications and experience, their proposed budget and any other relevant information.
One of the strategies ATI Advisory experts recommend is being enthusiastic about each answer and doing the homework beforehand.
“You have to nail absolutely everything,” Jade Gong, senior advisor with ATI Advisory, said during the webinar. “It’s still very surprising when you look through the applications of those that did win and didn’t win, just the small differences in the applications.”
A provider’s bandwidth and capabilities is another key part of the equation.
“Especially if you’re new to PACE,” Gong said. “It’s very possible that PACE is feasible in your market but not feasible for you. This requires careful consideration. There are many unknowns in this process and there will be many unknowns as you construct your RFP. Especially if you’re new to this, you have to make sure you’re committed and have the appetite for the amount of risk that you’ll be taking on.”
Gong recommended organizations do their own internal pressure test. What would this mean for leadership? What is your risk tolerance as a company?
As PACE expands into more states, there isn’t a lot of concrete evidence that can ensure providers will get a certain reimbursement rate in any given state.
Certain capabilities vary from state to state as well.
“You’re going to have to bring in PACE operational knowledge if you don’t already have it in your organization,” Gong said. “All of the states require various month-by-month startup plans with a lot of detail. When it comes to the provision of services, they’re going to ask you how you would operationalize certain components like network development, transportation and other aspects of the program.”
After becoming an expert in these RFPs, Gong reiterated that the process will force organizations to truly understand their own strengths and — maybe more importantly — their weaknesses.
Companies featured in this article:
