Providence ElderPlace Celebrates 20 Years
By Susan Tuller
Executive Director
Providence ElderPlace
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Original Publish Date: Jul 10, 2015
Imagine a program that serves some of the most frail seniors - those with multiple chronic diseases, 85 percent of whom qualify for both Medicare and Medicaid, and most of whom are sick or frail enough to qualify to live in a skilled nursing home.
This program is Providence ElderPlace, which this year celebrates 20 years of serving this population at a cost that saves both the federal government and state of Washington millions of dollars. Operated by Providence Health & Services, Providence ElderPlace has grown to serve 527 participants in three stand-alone locations and two clinics located inside assisted living facilities. Participants receive wrap-around services that keep them healthy and in the community, whether that's in their homes alone, with family, in an adult family home, or assisted living facility. Providence ElderPlace provides them with all of their medical care, adult day health and social services, transportation to the Providence ElderPlace centers, and in some cases even covers housing.
Because Providence is paid a capitated rate, we're incentivized to keep our participants as healthy as possible. We closely monitor their health, their medications and their well-being to keep them out of the hospital and the nursing home.
Not only does Providence ElderPlace keep these individuals living in the community and saves the government money, its outcomes are impressive. At a time when healthcare systems are penalized for hospital re-admissions, Providence ElderPlace's numbers outperform the average population in many areas:
- While the hospital re-admission rate for the general Medicare population is 20 percent over a 30-day period, it's under 10 percent for Providence ElderPlace.
- Mortality of those who need help with more than six activities of daily living (ADLs) for the general Medicare population is 28 percent, compared to 16 percent for Providence ElderPlace participants.
- While 54 percent to 66 percent of Medicare patients die in a hospital or nursing facility, only 14 percent of Providence ElderPlace patients do.
- While only 10 percent to 30 percent of Medicare patients have an advanced directive or Physician Orders for Life-Sustaining Treatment (POLST), 96 percent of Providence ElderPlace patients do.
These numbers can be attributed to the intense managed care each participant receives: weekly visits to the clinic with free transportation, constant review of health conditions by the entire medical team, and immediate interventions, coupled in some cases with housing and supportive home care services to keep people in their homes.
Providence ElderPlace is part of the national Program of All-Inclusive Care for the Elderly (PACE), started in 1990 to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible. There are 113 PACE organizations in 33 states that serve about 30,000 participants.
Providence believes in this program and has worked over the past 20 years to expand it in Washington state. But we're still not making money on it - at least not in this state because of declining state reimbursement rates. In fact, our daily reimbursement rate today is less than it was when we opened the first Providence ElderPlace center 20 years ago. But because it fits with our Mission - and allows this frail population to live better lives - we continue to expand it with the hope that one day it will break even. We truly believe that if this program did not exist, a significant number of our participants would need nursing home care or would be at significant risk for hospitalization because they're not in settings providing all the care they need.
Carolyn Lewis-Carter, a Providence ElderPlace participant since 2011 who suffers from multiple health problems and gets around in a wheelchair, considers the program a lifesaver. Despite her health problems, she's able to live independently and carry on with her life as a result of the intense healthcare management she receives. "I didn't know which way to turn. It came at the best time," said Lewis-Carter, a former teacher whose father Randolph Carter was a Seattle civil rights leader and political activist. "It was easy to understand, transportation is provided, everything is under one roof. When I stepped in the building I couldn't believe it."
When it started, the program was ahead of its time. It continues to work to reduce costs of care to the sickest, most frail population and is now a great example of what the Affordable Care Act aims to do, said Assad Kazemi, M.D., who has been the Providence ElderPlace medical director nearly since the program's inception. "Providence ElderPlace does everything that ACOs want to do - efficient, coordinated, cost-effective chronic care management."
We expect to expand the program in the future and are seeing younger participants with different healthcare problems including multiple sclerosis, traumatic brain injury from a stroke or accident, and those who are developmentally delayed and aging out of the system that previously served them. In addition, Providence plans to leverage what it has learned about managing high-risk populations through the PACE program to manage Medicare patients elsewhere in the health system.
"People in this community get better care, better health outcomes, they live longer and they do better," said Robert Hellrigel, chief executive of Providence Senior and Community Services, which oversees Providence ElderPlace. "People come to us and their lives are spiraling out of control. They can't manage their chronic conditions. They don't understand their options. They fear going to a nursing home and don't know where to turn. Providence ElderPlace wraps you up in this big warm blanket, says `you're covered, we're going to get your symptoms under control.'"
Adds Dr. Kazemi: "I can't tell you how many times people have come to me to say this is the best thing that has happened to me. `Now I have a life of my own. I can focus on my kids and grandchildren because I know you're looking after me, or my father or grandfather or uncle.'"
Susan Tuller is executive director of Providence ElderPlace in Seattle. Reach her at 206-320-5325 or susan.tuller@providence.org.