88. Keeping Seniors at Home: How Bluestem PACE is Changing Care

In this episode of Raising Tech, host Amber Bardon welcomes Emilie Rains, Executive Director of Bluestem PACE, to discuss the innovative PACE (Program of All-Inclusive Care for the Elderly) model. Emilie shares insights into how PACE enables seniors aged 55 and better to remain living independently at home while receiving comprehensive medical and supportive care.

Key Takeaways:

• What is PACE? A CMS-regulated program that integrates federal, state, and private provider resources to deliver holistic care for seniors at risk of institutionalization.
• The Benefits of PACE: Reduces ER visits and hospital readmissions by up to 80%, provides preventative care, and supports individuals through a coordinated care approach.
• How Providers Can Get Involved: The process of establishing a PACE program, regulatory requirements, and its financial and operational structure.
• Technology’s Role in PACE: Opportunities for telehealth, home monitoring, and software development tailored to the unique needs of PACE participants.
• Future of PACE: The program's rapid expansion and potential for continued growth as a cost-effective, high-quality care solution.

Resources Mentioned:

• Learn more about Bluestem PACE: bluestempace.org
• Find a PACE program in your state: npaonline.org

🔊 Listen Now: Available on Apple Podcasts, Spotify, and all major podcast platforms.

Find us online:
Website
Facebook
Instagram
LinkedIn

Transcript

Amber Bardon: [00:00:00] Welcome to Raising Tech podcast. I'm your host Amber Bardon, and today our guest is Emilie Rains. I met Emilie when I was working with one of our clients, Bluestem communities in Kansas, . Emilie is the Executive Director of Bluestem Pace, which is a program of all inclusive care for the elderly, which is a comprehensive medical care and supportive service program that aims to keep seniors 55 and better living well at home for as long as possible.

Welcome to the show, Emilie. 

Thank you for having me. 

[00:01:00] So I met you when I was working with Bluestem on their strategic assessment, and I'd heard of pace, but I didn't really know a lot about the program and I'd heard about it mostly from the transportation side. So when I met you and we, I interviewed you for your assessment and learned more about the program, I was just really impressed with the PACE program and I don't know if people really know a lot about it.

I know it's a newer program so I was really excited to get you on the show and have you educate our listeners about it. So can you start off by just introducing yourself and how did you get involved in this program in the first place? 

Emilie Rains: Yeah, so I'm Emilie Rains. I'm the executive director of Bluestem Pace. PACE is a program of all inclusive care for the elderly, which we help people, stay at home. But I became involved back in 2016 when Bluestem was opening the PACE program and the original position I held was intake coordinator, so my background is in social work, and so it really met my goal of helping connect seniors to a program that could help them stay at home where they wanna be with their dogs and their family and all their [00:02:00] memories.

Amber Bardon: How long have you worked in senior living? Was this your first role in senior living or were you in senior living before? 

Emilie Rains: Yes, it's my first role in senior living. Yeah. So before my history is really working in child services and so this was a big transition from one end of the age spectrum to another.

But it has been the joy of my life, honestly, certainly my career, to be able to work with seniors to help them live at home. 

Amber Bardon: Yeah. Great. So tell us a little bit about the PACE program. What is it? How does it work? 

Emilie Rains: Absolutely. So a PACE program is one that is supported and regulated through CMS or Medicare and Medicaid.

So it's a unique program and that it's a partnership between state and federal in addition to a private provider. So that's Bluestem communities. Our goal is to help people stay at home who have complex medical conditions. As well as are at risk for potential early placement in an assisted living or a nursing home.

So we are providing folks with comprehensive [00:03:00] care, which includes primary care, specialty care, home care, all the therapies that they need. We have a dietician on our team as well as social workers. When seniors are working to stay at home and access care, it's a big job to put all those parts and pieces together.

And so the PACE Program being an integrative model, when they access our program, they're accessing all the resources that they need now and that they could need in the future. When they enroll in our program, they may not need home care. They may not need assistance like that, but in the future they may.

And they can remain in our program for long term and their care can change and bend and mold to their current care needs, whatever those might be. So 

Amber Bardon: I know when we met before, I had a lot of questions for you about how does PACE differ from a traditional private duty home care model can you talk a little bit about the differences between the way the programs are administered, but also what are some of the clinical or outcomes that are different between the different types of approaches? 

Emilie Rains: Absolutely. PACE [00:04:00] is for, mostly for dual eligibles. So we do have some folks that would privately pay for our services, but it gives a high level of service available to Medicaid beneficiaries, which is pretty unique.

And again, in the private duty setting the family is doing the coordinating of care and connecting all the pieces where in the PACE program we're doing that for them. As we see and anticipate needs, which is a huge thing in pace, we're able to have care ready and going at the very first site of need rather than waiting until we're responding to a need.

So in best case scenario, our participants are enrolling when they're as healthy as they can be. While still qualifying for our program. And then it's our goal to help them, stay there as much as we can. PACE programs are huge in relationship to reducing hospitalizations and emergency room visits.

Our goal to help seniors live well at home also means that we're really trying to keep them home as opposed to being in the [00:05:00] hospital often or having ER visits. So we reduce those by, 80% in our readmissions our slim to none, so that's really helpful not only for our participants, but our community partners who are measured on readmissions and ER visits and things like that.

Amber Bardon: Can you talk a little bit about how a provider can get into the PACE program? Are there requirements to be able to offer this service? Again, it's not really that common, so I'm curious, if someone was interested in offering these types of services, how would they get more information about it or start to roll out a program like this?

Emilie Rains: Yeah, in order to get into pace, the state that their organization operates from has to have PACE as a part of their legislation, as a part of their Medicaid program. And what happens is the states put out a request for proposal and then, private organizations will respond to that RFP with a proposal of starting a PACE program.

It's not [00:06:00] possible for just anyone who wants to pop up a pace to be able to do that. It's a definite collaboration with the state that they're in. And also, they do have a lot of requirements to meet with regards to provider networks partner facilities when we need for respite.

And then also PACE programs have to open their doors with a full interdisciplinary team ready. Employed planning to go. So it's a little bit of a front end investment. As far as, you're employing a physician, maybe a nurse practitioner a pt, ot, social workers, all these clinically specified services, which are also, costly.

There's a front end commitment to the PACE program, but once you have it running, it's much more economical than like opening a long-term care facility, which we know Bluestem communities, we have two of the best in the nation. But we also know there's not enough beds for the, for the folks that are coming into the need of care.

So being able to serve folks in the community. [00:07:00] For bluestem was a great fit to really expand our options for folks who need care and really do wanna stay at home. 

Amber Bardon: Yeah. And that's why I was so impressed with learning about the program because I feel like we've been stagnant for a long time with the types of services and care and payer options that we've had in this country.

And what's interesting is we are more advanced in the US and other countries with that regard because we actually have federal funding and federal regulations. And that's why I think PACE is such an interesting program to talk about because it is a different way of delivering care and more importantly, preventative care.

Do you have any like specific outcomes that you could speak to, that you've seen through the PACE program?   

Emilie Rains: Absolutely. So One of our very first participants that we enrolled was having four to five ER visits monthly. She had very unmanaged diabetes and also had lack.

Select support really to manage her own condition at home. And so by bringing her into the PACE program and really monitoring her medication [00:08:00] administration as well as really working with her to address her nutrition. To work with her to address her sedentary lifestyle. So we've, we're able to offer a lot of therapy and exercise and things like that.

Her first er visit with us wasn't until 14 months into our program, and it was for a broken arm, so not related to anything that she'd ever been hospitalized before. So truly we can take a situation that is spiraling quickly out of control and bring the unity through integrated care to help a person be more successful at home through not only primary care.

Through having the connection to home through our, our CNAs and our weekly nursing visits. And when a person's in a regular clinical environment, they're going to see their physician. It's a 15 minute visit. The physician's gonna learn what they tell them in 15 minutes.

Our participants, because we see them often, we have a real long-term relationship with these individuals. We are really able to identify early before they even tell us [00:09:00] that there may be a sign of decline. And so that's been really helpful. 

Amber Bardon: Yeah. That's such an incredible outcome. Can you imagine the money we would save in healthcare costs if we could have that kind of outcome more often?

Absolutely. 

Emilie Rains: You figure that, an ER visit is at the minimum five grand, and if a person's doing that five times a month, we're looking at $25,000. And for us to save that monthly, if you will. And that first visit being so far out is huge. And it's not just the cost, but it's really, for the participant, what the trauma and the challenge that it is to be in and out of a hospital setting.

I. 

Amber Bardon: Absolutely. Where do you see the future of this program going? I don't know if you can feel like you can comment on that, you are, like I said, it's not that common yet. So you probably have a lot of knowledge in how you think that this could be potentially expanded or used in other scenarios.

So what are your thoughts on that? 

Emilie Rains: Yeah, so certainly the very first PACE program was started in the late [00:10:00] 1970s in San Francisco by an organization called On Lock. Back in 1997, there was legislation that made it a permanent care provider, and that was because they had done a waiver in the eighties to, see is this a viable option for healthcare?

Is this replicatable? Those types of things. So about. Five or six years ago, there were only a hundred and, 20 programs nationally and it was not offered in every state. It still remains to not be offered. But in the last five years, the PACE program has grown exponentially.

We're the best kept secret in healthcare, but really bursting that bubble. We don't wanna be a secret. We are a capitated payment structure and we see healthcare going that way in general with bundled payments for surgeries and things like that. And this program has grown and will continue.

It is an economical opportunity for states with so many of our participants being Medicaid beneficiaries. The state is [00:11:00] paying a defined finite amount of money when a person's in pace. When a person's in a fee for service model, that can charge Medicare and Medicaid thousands and thousands because it's not defined.

Within the PACE program, we have not only accountability to our participants to keep them outta the hospital and be as preventative as we can. We also have the accountability on the backside to say, if we're not taking care of people in a preventative and anticipatory way, we are paying for it on the back end.

So it's just that per perfect model of care where, participants' needs are first, not only because ethically they need should be, but because financially if we, if we're sleeping on the job we're gonna pay, we're gonna pay the price. On the backside of that. 

Amber Bardon: Absolutely. I hope to see the program grow and expand.

It's exciting to think about different types of care models that might emerge in the next few years. Yeah. Let's talk a little bit about the technology side. So I know when we did your interview and worked on your part of the strategic assessment, I. We talked about [00:12:00] some of the challenges that come with being a program that's not as universal and the types of software and technology out there to support what you need.

So yeah, I'd like to talk a little bit about that, but also on the other side of that, I'm curious to see your I'm curious to hear your thoughts on if technology could be used to serve the participants in the program in any way, and what, how you might see that happening. I. 

Emilie Rains: Absolutely.

So this is such a great question and such a great question. Post pandemic. If the, even in hard situations, good things come from it. And one of those good things from the pandemic is really pushing us towards equipping our participants with more technology in their homes. Our program offers tablets that are customized and prepared for seniors to be able to access not just telehealth options, which we do provide through the tablets, but also, social opportunities to connect to our day center.

Maybe they're not. Scheduled to come to our day center on a particular day, but they're feeling [00:13:00] lonely. They would love to be in an activity and they can join us through that option. Technology has such a huge place. We think about, we're helping seniors well at home for as long as we can.

There's even a lot of home technology options. Which have helped us extend the time a person can remain at home through a variety of monitoring services, whether it be motion, whether it be, actual physical check-in. Those types of things. And really, I think the largest opportunity in pace is on the software side of creating pace specific software that meets the changing needs and regulations of pace.

So the market is small on options that we have. Even fewer options are PACE specific and the PACE regulations are ongoing. They're changing in my almost nine years in pace, the last two years of pace. The regulatory changes have. [00:14:00] Rapidly increased. And so it makes it challenging for our software providers to keep up with those challenges.

And I think there's certainly innovative opportunities for software to be more I. All encompassing for what PACE needs. Right now PACE providers have a software for their EHR and then we're bolting on different softwares to that. And I think it'd be really a great opportunity for a vendor to really jump in, learn pace and provide something that's more comprehensive so that the technology side of pace isn't so bulky.

Every PACE program I know has, real concerns about, where the technology side of things is going, especially in the software realm. But technology related to keeping seniors at home is almost unlimited. As well as, in the innovation side of things, because our regulations.

Are strict and stringent. We also, within those regulations, have [00:15:00] some room for exploration. So specifically within the physical therapy side of things, we're using a technique called blood flow restriction therapy that isolates certain muscle types for higher production and exercise with lower impact.

And so typically this blood flow restriction therapy is only used with professional athletes, right? College level athletes. But because within pace we can really be innovative our. Physical therapist Chris Deck has done extensive work as well as training in learning this technique. And we have seen just such significant improvements for our participants from maybe a sit to stand of.

20, they're able to sit and stand 20 times within, 45 seconds or 60 seconds to where they're, doubling those to 40. As well as just really additional technologies which are helping us use therapy as medicine versus therapy just as [00:16:00] rehabilitation. 

Amber Bardon: So it's really 

Emilie Rains: exciting. 

Amber Bardon: Yeah, it is.

And I always say senior living technology is one of the most exciting areas and I think the application in home care there, there's a lot. Options like you said. All the things you said are really exciting. I know that there's portable VR headsets for gait assessments and falls prevention.

There's a lot coming up with in-home sensors and monitors. Yes. And the ability to detect changes and have preventative cares sooner rather than later through these tools. So it's interesting to see how the regulations can keep pace with funding for these types of services, because I think we're gonna definitely see a huge increase in outcomes with these.

And I think earlier what you said about the software to manage the PACE program, this is a call to action for any vendors listening. Yes. Who are looking for an opportunity to get into something new and get ahead of the curve as this program pro, potentially expands across the country.

Emilie Rains: Absolutely. If there's ever a time to get into pace, it's now, having been in it again for almost nine years, it just continues to get more and more [00:17:00] exciting. We at Bluestem PACE keep 98% of our enrollees are participants at home through the end of life. That's an outcome that. No other program can really, stand up to seniors in our program sometimes are cantankerous to deal with and you know why they're committed.

They're strong-willed to stay at home, and so allowing them to do that, partnering with them to do that is just an awesome gift and really something that's a win-win situation, not only for the participants and their families and our organization, but for the funding sources that do have limited resources.

Like the federal and state governments. 

Amber Bardon: Yeah. Emilie, thank you so much for coming on our show. I really hope our listeners enjoyed learning more about the PACE program.

If they want to learn more, where can they find information about you? Absolutely. 

Emilie Rains: We're at bluestempace.org and if they're interested in whether PACE isn't their state they can go to npaonline.org. [00:18:00] Thank you so much. Thank you.