As CEO of PACE Organization of Rhode Island – the only fully integrated, Medicare- and Medicaid-funded health plan in the state, I feel a strong affinity for the work being done at the Executive Office of Health & Human Services with respect to the Integrated Care Initiative. We founded PACE (Program of All-inclusive Care for the Elderly) in 2005 in response to a growing need among the state’s aging population – many of whom had a strong desire to remain at home in their communities despite having complex health care needs.
This is one of the basic tenets of the ICI – creating the possibility of at-home care for elderly individuals for whom it is appropriate. As a result, many folks who would prefer to stay out of nursing homes now have access to alternatives, such as living at home with family and the added support of home-care nurses, for example.
Coordinating health care for the elderly not only makes life better for this vulnerable part of the population, it frees up federal Medicaid funds – a disproportionate amount of which are currently being funneled into nursing homes (about 70 percent, as noted in the Dec. 2, 2013, Providence Business News story, “Cuts feared from coordinated care”).
In Rhode Island, the U.S. Census Bureau estimates the population of those 62 and older was about 204,152 as of 2013. By 2030 that number is expected to increase to 246,507, about 21 percent growth.
We need to be ready to care for this segment of the population as it ages. Long-term-care facilities are a necessary part of the solution, but they cannot be the only solution. We need other systems in place to provide the right care for each individual, depending on their health care needs. The Integrative Care Initiative is the first step in preparing for this.
The ICI offers a model of care that encourages agencies, providers, patients and their advocates to work together to ensure that the right services are delivered in a timely manner. When we establish more effective and accessible lines of communication, we can avoid the unnecessary services and costs that so often arise in the absence of meaningful dialogue. In short, we need a coordinated health care system, and a reimbursement system that incentivizes providers to work together to keep people healthy, to avoid costly hospital stays and to do so regardless of a patient’s ability to pay.
Under this new model of care, the role of nursing homes will change. There will be those that provide highly skilled, specialty short-term care, and those that continue the tradition of providing a caring home for long-term, high-need individuals.
Coordinated care is not every client having multiple case managers, nor is it every provider keeping a client all to themselves. Coordinated care is agencies respecting clients’ needs and choices; facilitating smooth handoffs when their job is done; communicating effectively with a client’s team of health care professionals; and recognizing that when we keep the client’s needs a priority, the right care and services more easily fall into place. That is our focus at PACE.