Are there ways to simplify specialty care, like heart care, for PACE plans?
Scheduling an in-person visit with a cardiologist is downright difficult. Nationally, it takes upwards of 45 days to see one and the prospect of getting yourself there can be a challenge for many. For PACE plans (Program of All Inclusive Care for the Elderly) who manage care for thousands of individuals in their network – this reality is an incredible challenge and extends beyond one speciality area like heart care. The responsibility that falls under a program providing all inclusive healthcare for the elderly includes so much more than standard primary care. The all inclusive aspect of care in the PACE model is also one of the greatest assets to its participants, but what happens when specialty care becomes too complex for the participant to reap the benefits?
As background, PACE programs provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible. Services are all inclusive, a participant relies on the PACE organization to provide all care, inclusive of transportation and social services related to care. Programs receive a set amount monthly from Medicare and Medicaid to provide nearly everything for people over 55 whose needs qualify them for a nursing home but who don’t want to enter one. This includes doctors’ visits, tests, procedures, physical, occupational and speech therapy, social workers, home care, transportation, medication, dentistry and hearing aids. Participants typically visit a PACE center several times a week for meals and social activities as well as therapy and health monitoring.
So the question arises – are there ways to simplify specialty care, like heart care, for PACE plans?
At Heartbeat Health, we provide an opportunity for a primary care provider in a PACE facility to easily refer a patient directly to a Heartbeat virtual cardiologist. The participant can set up a virtual visit instantly or on another day that they will be back in the PACE facility, or even at home if they choose. This simplified workflow eliminates scheduling headaches, transportation coordination burdens and the visit itself is lower cost than an in person visit. Not to mention, this simplifies the experience and lowers stress barriers reduction for the participant as well.
Additionally, given the barriers that participants face, such as the need for translation services or access to a laptop or WiFi, there are concerns among some that Virtual-First care will exacerbate the digital divide. Fortunately in the PACE model, an interdisciplinary team of health professionals provides PACE participants with coordinated care and assistance. For most participants, this opens a door for simple virtual visits, with their care team in the facility to help if needed. Furthermore, Heartbeat’s virtual visit experience (televisits) takes those issues into account and as a result, systematically improves access to treatment.
Lastly, given the at-risk nature of the payment model for PACE, cost reduction also becomes a very important piece of the puzzle. With facility fee costs eliminated, the average savings can be ~$200 per visit across most markets. This coupled, with a reduction in costs in eliminating transportation costs, presents a great opportunity financially for a PACE program.
Additionally, Heartbeat can conduct cardiovascular risk assessment across the entire PACE population. This can be done either through chart review or in-person diagnostics or remote diagnostics, to identify participants with rising risk or existing CVD. This may allow the PACE plan to adjust risk scores and potentially increase reimbursement per participant.
PACE plans are responsible for some of the widest variety of services for any healthcare organization taking on risk. The complexity that each plan faces to ensure their participants receive high quality specialty care is just too much. The time is now to untangle the logistics, scheduling burden and cost for specialty care for PACE plans – and deliver better clinical outcomes for PACE participants at scale.