Illinois launches PACE services to provide better care integration for elderly population

By

Maddie McCarthy

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The Program of All-Inclusive Care for the Elderly (PACE) officially launched in Illinois in June, and designated PACE centers have begun rolling out services to their members. 

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PACE is designed to keep older adults in their communities as long as possible by providing interdisciplinary services such as primary, dental, and in-home care, as well as physical (PT) and occupational (OT) therapy, meals, transportation, and additional services.

“PACE is an integrated model of care that provides all the care and services covered by Medicare and Medicaid, as authorized by the interdisciplinary team, as well as additional medically-necessary care and services not covered by Medicare and Medicaid,” said the Illinois Department of Healthcare and Family Services (HFS) in a statement sent to State of Reform.

Illinois has five regions offering PACE services: West Chicago, South Chicago, Southern Cook County, Peoria, and East St. Louis. HFS and the Centers for Medicare and Medicaid Services (CMS) awarded contracts to seven designated centers.

Nathan Pritzker, executive director of PACE at OSF Healthcare—Peoria’s PACE administrator—told State of Reform the exciting thing about the program is its closeness in care coordination. He said national PACE data suggests close care coordination drives better health outcomes.

“The blessing of PACE is its intimacy in comparison to other healthcare models … There are deep relationships formed between the participants and the caregivers, and that extra degree of, really, love and connection, drives so many extra intangible outcomes for both the satisfaction of our employees and also quality of life and quality of care for our participants. It’s a really unique element of PACE.”

— Pritzker

To qualify for PACE, adults must be 55 or older, live within a designated PACE area, and be eligible for nursing home care, but able to safely live in their communities. Many people who use PACE services are also dually-eligible for Medicare and Medicaid, though PACE can be covered by private insurers or paid through a monthly premium as well.

HFS said before a senior can enroll in PACE, they must be determined to meet the need for a nursing home level of care. Then, PACE staff conduct assessments to ensure a senior can live safely in their own homes based on their health and support network.

“Upon completion of those assessments, the senior and their caregivers are invited to the PACE center for a tour and to meet PACE staff and discuss the recommended plan of care, [and] the partnership between the senior and PACE staff needed to achieve the care plan; discuss Medicaid and Medicare eligibility; and answer any questions the senior and their family have,” HFS said.

Lawndale Christian Health Center (LCHC), a federally-qualified health center (FQHC), operates one of the PACE centers serving Chicago’s west side. Jonathan Wildt, chief operating officer at LCHC, told State of Reform that the FQHC was the first PACE center approved in Illinois, and it began offering PACE services on May 1. However, staff there began looking into PACE in 2014.

“At that time, we were finding older adults were leaving our neighborhood at a higher rate than other neighborhoods in Chicago,” Wildt wrote in an email. “With the belief that our community would be healthier with greater intergenerational connection, we began looking at models of care that would enable older adults to stay in their homes within our community longer.”

LCHC began offering adult day services, in-home care, and transportation services through the Illinois Department of Aging, Wildt said, and built a center in 2018 with PACE in mind.

HFS approved LCHC as a PACE center in August 2022, when Gov. JB Pritzker first announced the program. Wildt said LCHC then began to put systems in place to be compliant with CMS and HFS guidelines, build a provider network, and educate potential PACE members and their caregivers about the program.

“A number of patients for whom we have already been providing primary care, home health, and day center services were particularly interested to have access to the therapies (PT and OT) with no limits. Several participants are attracted to having their healthcare provider and ‘insurance company’ aligned to make navigating the healthcare system easier.” 

— Wildt

Pritzker said preparing for the launch required lots of preparation.

“PACE has a long runway to be developed,” Pritzker said. “There is both a state and federal application, and [a] series of survey reviews that need to take place before a PACE program can open.”

OSF also had an adult day center before PACE started there, and Pritzker said it served as the basis of its new PACE operations. He added that OSF’s PACE members have been excited to be some of the first people in the state to be enrolled in the program.

Wildt said many of LCHC’s members like PACE’s ability to give them access to both in-home care with activities of daily living (ADLs) and a day center for socialization opportunities. He said some care programs restrict members to choosing just one of those benefits with a limit on hours. They also like having access to the transportation benefit.

“As a team, we look forward to seeing the types of requests [we get] from participants as we work together with them on their individualized plans of care,” Wildt said.

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