PACE Conversations - Interview #1: Questions with PACE Expert Tim McIntyre
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What is PACE?
“Program of All Inclusive Care for the Elderly” (PACE) has been providing comprehensive care for nearly fifty years. PACE programs specifically serve populations 55 years or older and meet their state’s requirement for nursing homes — but they offer a home-first approach. PACE provides healthcare alternatives that help keep people in the comfort and convenience of their homes, offering an outpatient clinical setting — with transportation support — when needed. One of the hallmarks of PACE is their interdisciplinary teams of caregivers made up of physicians, nurse practitioners, therapists, and other providers. These teams take a holistic approach to care, addressing non-clinical factors that impact care and quality of life, such as social work services. The PACE clinical center includes a medical clinic, urgent care, and therapeutic facilities to serve patients who need evaluation and treatment in person but allow patients to stay in their homes a majority of the time.
Who is Tim McIntyre?
Tim is the Interim Director of a PACE program in Newaygo, Michigan. Tim is a PACE expert who has devoted most of his professional career providing service exclusively to the frail and elderly. Since getting his masters degree in Social Gerontology, the study of aging, he’s focused on working with the state of Michigan and various care programs to help keep the elderly population out of institutions. Working initially as a consultant to the then President and CEO of United Methodist Retirement Communities, John Thorhauer, Tim quickly found himself leading the development of PACE programs in cities like Ypsilanti, Jackson, and Lansing. Out of the 5 PACE programs Tim has developed during his time in the field, he has held the Executive Director position in 3 of them.
Q: Did you always want to work in elderly care? And if so, why?
A: Yes, for the most part. A couple personal experiences led me to this. When I was in college, my future father-in-law, who was pretty well off and retired early, had suffered a stroke. Insurance programs could not cover the around the clock care that he needed following his stroke and because he wanted to stay out of a nursing home, we turned to hiring individuals to help him from home with what he needed. After his resources were depleted, he ended up on Medicaid, and eventually in a nursing home with no other options. This gave me insight into the failure of the traditional healthcare system and showed me that additional means of high-level care are essential. Timing was everything. I then received a scholarship to pursue a gerontology degree free of charge which I accepted. My personal experience with the failure of the current healthcare system combined with the opportunity of higher education propelled me to wanting to make a difference.
Q: Why PACE?
A: One thing led to another. Prior to PACE, I developed some community-based programs for the elderly that I piloted with the state of Michigan. This resulted in the development of “Care Management for the frail elderly”, which was a research project at Western Michigan University. After two and a half years, the results of the care management research cheaper medical expenses. Medicaid actually came knocking and asked if I could put a similar pilot together for them, specifically targeting those with lower incomes. Eventually, I was offered an opportunity to develop this into a complete PACE Program, and I jumped at the chance. I dove into federal regulations, learning as much as possible, observing teams across the country, and eventually developing my own programming.
Q: What do you think is so special about PACE? What separates it from other models?
A: I think it’s the comprehensive scope of care that’s available and managed through one entity and comprehensive team. I think outside of PACE, people still have a pretty fragmented system which entails having to go to other organizations and professionals to get the care required which can be an incredible challenge to this given population. I would say there are two things that separate PACE: exclusive focus on a population in need of care more than any other, and care being all under one roofmaking it a lot easier to manage one's complications. We have a very well-coordinated and managed healthcare system within PACE.
Q: As an overall assessment, would you say the PACE model is better than most current models in healthcare?
A: I think it absolutely is the premier model of healthcare. As CMS has wanted the elderly population to be in some form of managed care, it has been made clear that they really like the PACE model. It is relatively small because it focuses on one population, so with that being said for the population we are serving I haven’t seen any model that could compare to PACE.
Q: What do you think the future of data in PACE looks like?
A: PACE organizations collect tremendous amounts of data, with each professional on the team doing their own specialized assessment, and interventions being recorded within EHRs (electronic health records), however there have not been any effective mechanisms that enable the organization to leverage this data and make decisions. As someone who has run PACE programs, there is always a constant need for information on facility performance, why people are frequently going to the hospital, and things like that. The kind of work Intus Care is doing has been much needed for some time now. Such analytics help executives and their teams manage care by data, rather than educated guessing.
Q: Why did you move forward with Intus Care? What makes Intus stand out?
A: I wasn’t really aware of Intus Care, but I was contacted by John Thorhauer who asked if I was willing to have a conversation with their CEO, Robbie Felton. John briefed me on what Intus was trying to do with predicting hospitalizations through the management of data. For a PACE organization to be successful they must have an accurate and steady flow of referrals for enrollments, allowing for needed revenue to cover expenses. Apart from enrollment, their other concern is managing utilization, which means keeping people out of hospitals and nursing homes. I had not heard of a group before that was focusing on how to manage risk and utilization through data. I was very impressed. I went into the call thinking I’d just do it because John asked, but once I talked with Robbie I was pretty excited about what they were doing at Intus.
Q: How are you thinking about the use of Intus Care’s software now & the potential impact it’ll have on your facility?
A: I think that it's having a tremendous impact now. There are 5 different groups working with Intus Care in Michigan and I’ve heard nothing but excitement about it. We’ve already introduced the software in team meetings, so we’re able to identify the people at highest risk of hospital admissions, as well as why they are placed at high risk. The ability to get into people’s care plans is quick which is helpful in evaluating which adjustments might best reduce those risks. In addition, we are able to look at financial information which allows us to see how we are spending and managing our limited resources and if what we are spending is too expensive compared to benchmarks. The information is seamlessly brought into operations and facilitates the identification of people who are most at risk not only for hospital admissions but chronic diseases too. The preventive care aspect is huge.
Q: If you were to tell a fellow ED about Intus what would you say? How should they be thinking about the use of Intus Care?
A: My message to Executive Directors is that I’ve never seen any product as useful for managing a PACE organization, or as meaningful for a professional healthcare team, because of the powerful information they have at their fingertips when making decisions about care. It’s really taken the guesswork out of who we should be focusing on. I just haven’t seen a more meaningful product for both managing utilization and managing the onset of different diseases. In addition, the clinical and demographic dashboards are used for board reports, informing the team how we are doing.
It is a very powerful tool for management as well as education. Through all of my experience with PACE I have not seen a tool based on data as effective in helping me as an executive manage the organization and the team itself. Having this type of tool allows for the anticipation of issues and the management of any situation.
Q: Looking back at your accomplished career, what is your most rewarding achievement?
A: II would say the experience I had that led up to the opportunity to put together a PACE organization. I think PACE certainly has been the highlight of my career. But, like I said, everything I did before that led me here are the reasons I am in PACE in the first place.
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