Medicare Advantage and managed care organizations could be the secret to growing Programs of All-Inclusive Care for the Elderly (PACE), according to InnovAge CEO Patrick Blair.
Blair told investors at the JP Morgan Healthcare Conference Thursday that growth in PACE, which caters to dual eligible Medicare and Medicaid beneficiaries, has been stymied because states have been focused on other programs, such as dual-eligible special needs plans (D-SNPs). However, Blair thinks that is beginning to change.
“I think states are now starting to say what’s next,” Blair told the audience. “What is the next natural extension of value-based care within a state long-term care program? Should PACE sit alongside a long-term care program? I think that is the sort of thing that could really unlock the growth opportunity.”
PACE provides comprehensive medical and social services to frail, older adults who qualify for skilled nursing care, but can still live at home. The 30-year-old program provides services both at home and at PACE centers. While the program is available in 32 states, it has been slow to expand because start-up costs are high and only nonprofits were able to operate PACE programs until about six years ago.
InnovAge is the largest and only publicly held PACE program. It operates in five states and serves approximately 6,500 participants. The company’s efforts to grow further were hindered last year after enforcement action from the Centers for Medicare & Medicaid Services and state regulators froze enrollment at InnovAge centers in Colorado and Sacramento, CA. Regulators found the company was not adequately providing services covered under PACE. Last month, CMS cleared InnovAge to begin enrollment again in Sacramento of Medicare-eligible participants. It is still waiting for clearance by California to enroll Medicaid-eligible patients and state and federal approval to begin enrolling members again in Colorado.
Following the enrollment freeze, Blair said the company has strengthened its compliance program and operations system, helping to tee it up for growth. Future expansion for InnovAge could include a potential deal with MA plans.
“I think it fits very well with health plans and we would love to figure out a way to partner with one,” Blair said.
