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Missed a session or want to pass along to colleagues?

Missed a session or want to pass along to colleagues?.

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Missed a session or want to pass along to colleagues?

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  1. Missed a session or want to pass along to colleagues? Purchase the VALUE PACK:Full access to 200+ education session audio recordings and PowerPoints (as released by speakers for inclusion) – so you can gain access to many more sessions than you can attend.Pricing: $300 for 200+ sessions, $75/track or $25/session Stop by Registration and ask for a Value Pack order formor visit www.leadingage.org/livelearningcenter

  2. PACE: A New Line of BusinessHow PACE Works Session 211-P October 15, 2011 Dan Gray

  3. Agenda • Participant Net Growth Rate • Rates and Participant Payer Mix • Capital Costs • Operating Practices • Contracted Services • Financial Performance

  4. Participant Net Growth Most critical and difficult to predict Many factors interrelated (access, approval process, eligibility, community perceptions) Death rates (increase in years 3-5)

  5. Participant Net Growth • Competition—real or perceived • Marketing—reaching potential participants • Gatekeepers—Division of Aging, AAA • Financial Eligibility—100% to 300% of poverty level

  6. Participant Net Growth Greater initial enrollment (accelerate break even) Staffing for growth (assessment and timely additions of staff) Timely expansion of adult day health center capacity

  7. The Numbers

  8. Rates Medicaid rate—negotiated with the state and usually has a rate for dually capitated participants and a separate rate for Medicaid only Medicare rate based on participant’s medical history and frailty Pharmacy (Part D) requires actuarial determined rate

  9. Payor Mix Higher capitation for ESRD Lower rate for Medicaid only Documentation dramatically affects Medicare rate

  10. Medicare Payment • Based on diagnosis plus frailty factor • Medicare risk scores ranged from 1.672 to 3.424 based on January 2010 PDAC data • Average risk score=2.44 • Improvement of .10 in risk score equals approximately $100 PMPM

  11. Medicaid

  12. Medicare

  13. Capital Costs *Range due to relationship between building condition and capital requirements

  14. Capital Costs • Reserves based on 30 days capitation revenue and contractual costs (approximately 12% of net revenues) • Adequate Reserves • Cash • Guarantee • LOC

  15. Operating Factors/Practices • Participants living alone—5 to 40% (dramatically affects costs) • Prevalence of specific chronic diseases • ESRD • COPD • Behavioral

  16. Operating Factors/Practices Primary care effectiveness Team Performance Day center attendance Day center expansion—mitosis or start from scratch

  17. Operating Factors/Practices End of life care Caregiver support Participant noncompliance management Review all hospital discharges and readmits within 30 days

  18. Contractual Services Hospital—rates and utilization significantly affect financial performance Nursing Home—utilization Assisted Living Home health/home care Specialists

  19. Financial Performance

  20. Total Income

  21. Total Expenses

  22. Operating Margin

  23. Questions 1501 Greer Lane Signal Mountain, TN 37377 423.517.0567 ▪ 423.517.0568 Fax dan.gray@consulting-cds.com www.consulting-cds.com

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