October 27, 2020 – A CMS program that provides long-term care for seniors in need of support services used telehealth to keep those connections going during the coronavirus pandemic.
The success was charted in a recent study that could serve as a blueprint for new programs that use connected health to improve home-based care and remote patient monitoring, thus keeping seniors out of nursing homes and assisted living facilities.
The study focuses on the 30-year-old PACE (Program for All-inclusive Care for the Elderly) program, created by the Centers for Medicare & Medicaid Services for seniors who need long-term support services (LTSS), or a nursing home level of care. Developed as a capitated model of care for dual-eligible beneficiaries (ninety percent are dual eligible), it provides all necessary medical care, therapies, long term care and services, meals, socialization, transportation, day center services and activities.
There are currently 135 PACE programs in 31 states, enrolling between 50 and 3,000 patients, for a total of more than 54,000 seniors served. The programs are based in a care center and feature an interdisciplinary care team (IDT) of primary care physicians, nurses, therapists, social workers, dieticians, home care professionals and others and offers a variety of services on-site and in the home.
PACE programs have traditionally shied away from telehealth and mHealth because of the in-person, hands-on approach of the care provided, but some programs have recently started using tools and platforms aimed at improving remote patient monitoring and giving patients and providers and opportunity to connect at any time.
That interest was sparked by the coronavirus pandemic.
The study, conducted by the National PACE Association, Altarum and Fallon Health, found that many PACE programs faced a crisis earlier this year when the pandemic curbed in-person care, and that many used telehealth to keep the program going.
“Early in the pandemic, faced with COVID-infected and COVID-suspected participants – and operating with very little direct guidance from the federal and state governments – quick-thinking PACE programs took advantage of their flexibility to redesign service delivery rapidly,” the report stated. “Information gathered by NPA indicated that most programs quickly adopted a greater use of telehealth, though use of video technology was limited to some degree by the capabilities and income level of participants and families. Others made a variety of rapid, effective adaptations to their care and support protocols to serve and protect their frail elders that are described here.”
One example is Piedmont Health Seniorcare in Raleigh-Durham, NC, which coordinated care via Zoom meetings and conducted some visits by phone. They also used wireless mHealth devices like blood pressure cuffs and scales to keep tabs on patients at home, deployed tablets at the PACE center to remote consults and virtual visits, and even converted a van into a mobile health units to conduct exams at some homes.
The upshot is that PACE programs could use telehealth and mHealth to facilitate care when in-person sessions are not feasible.
“Like many other Medicare and Medicaid providers, PACE has also further embraced telehealth – a development that is likely to accelerate,” the report concludes. “Traditionally, PACE has relied heavily on face-to-face interactions and interventions with participants. Now, PACE organizations are quickly transforming to best meet the evolving needs of their participants, whose own circumstances have changed due to COVID-19 – both by figuring out how to field a more comprehensive array of services in participants’ homes more frequently, and by adapting the PACE center itself for different uses.”
These experiences could also serve as a model for care after the pandemic. In October of 2019, Congress passed the PACE Innovation Act, which allows for pilot programs to develop a “PACE 2.0” model that includes innovations to serve more seniors and a wider range of people with care needs. According to the NPA, “the project will support the development of strategies to scale PACE operations and spread the model to more communities.”
While the pandemic has affected those plans, those programs who are using telehealth could help shape the PACE 2.0 program of the future.
“Providing services successfully now and in the future will require thinking creatively about how to field innovative, flexible, highly coordinated care as circumstances change, emphasizing the use of existing resources and assets,” the study concludes. “Such systems must be cost-effective, integrated with medical and social supports, and readily accessible to large numbers of older adults living in the community. In short, the US is being challenged to create on-ramps to comprehensive, safe community care that is scaled to handle the US ‘age wave’ – which has now arrived. PACE can be an important part of the answer.”