Katie White [00:00:11]:
Welcome to Pretend I Know Nothing About. I'm Katie White, your host, Administrator of COAAA. On today's episode, we're joined by Heidi Webster and Jeremy Diaz with BoldAge PACE. They'll be explaining the program of all inclusive care for the elderly coming to Franklin County in early 2025. Let's get into it. Well, welcome to the podcast. Today, I'm joined by some external partners that we're so excited to learn more about. We are joined by Heidi Webster, the national director of business development for BoldAge PACE, and Jeremy Diaz, executive director for the Columbus BoldAge PACE.
Katie White [00:00:50]:
Welcome.
Heidi Webster [00:00:51]:
Thank you for having us.
Jeremy Diaz [00:00:52]:
Good morning.
Katie White [00:00:53]:
Good morning. Am I saying your last name right?
Jeremy Diaz [00:00:56]:
Yes.
Katie White [00:00:57]:
Is it? I'll do it again.
Jeremy Diaz [00:00:58]:
It's Dias.
Katie White [00:00:59]:
Dias? Okay. Let me try it again. So after Heidi, then what's okay? And Jeremy Dias, executive director of Columbus Bold Age PACE. Welcome.
Heidi Webster [00:01:09]:
Thank you for having us. Katie.
Katie White [00:01:11]:
Being here. Well, we've been busy the last couple of weeks getting ready. We had this big event yesterday, where we talked all about PACE to the advisory council for COAAA and brought in a bunch of external partners. But today, I'm excited to really dig in with you both about the history of PACE, what it is, and really get some of those nuts and bolts into the podcast episodes. So I'd like to start off a little bit, I'd like to start off with learning a little bit about both of you. So, Heidi, get what's your background? Tell us
Heidi Webster [00:01:42]:
a little bit about yourself. I actually got into health care about 13 or 14 years ago in hospice. So I decided to, get a master's degree in music therapy. I did that at ASU, and I wasn't sure what population I wanted to work with. And I found myself doing, a a clinical day round in hospice care, and I I fell in love with it. I didn't think that I was going to like it. I'd had no idea that I was gonna be good at it. I ended up doing my internship at, an organization called Seasons Hospice.
Katie White [00:02:24]:
Okay.
Heidi Webster [00:02:24]:
And so as a music therapist, I spent a lot of time with nurses and social workers and chaplains and and really spending time with, individuals that were just on their last days, and most of those folks were in the older generation. Okay. You know? Some, of course, were not, which was awful, but most of the time, just individuals that were, as we call seniors, older adults. So I grew to love that that, age group so, so, so much, and it really changed my life. So I spent about 10 years in hospice. I became an educator in music therapy and how music therapy really works in end of life care. And we have an we had a really incredible team at Seasons Hospice. It's now called AccentCare.
Heidi Webster [00:03:10]:
Okay. They they merged with Accent Care, which is a home health organization. Seasons Hospice was really sorry. Bump the table. Seasons Hospice was really about, focusing on hospice care. So the 2 organizations merged, and, a lot of our leadership team ended up moving over to Bold Age PACE, which is the same owners as Seasons Hospice.
Katie White [00:03:35]:
Interesting.
Heidi Webster [00:03:35]:
So I was I was working as a consultant for for bold age for a little while. I have a lot of, experience working on certificate of needs, which is for states who, don't have hospice, hospice organizations. They they require that you apply. The state will control, what hospice programs can open. Only certain states require, certificate of needs. So my team and I got really embedded into applying for hospice in different states. And then, eventually, I was, hired as a consultant for a PACE organization, which is bold h PACE to apply for an RFP, which stands for request for proposal, which is the same as certificate of need. So basically applying with the state to have that, new provider brought in.
Heidi Webster [00:04:26]:
Some states don't have those restrictions. Like in Arizona, you can just open up a hospice on any corner and there are there's hospice programs everywhere, but certain states do restrict that. And so that's kind of where my expertise comes in. And that's how I ended up at bold age pace, which is, a program that I've felt fallen in love with and, of course, stays in that same genre of the older population that I grew to love and the people who just need it the most. That's a little bit my background in health care and how I got to where I am now.
Katie White [00:04:55]:
That's a great one of my favorite parts of this is just learning why everyone's why and why they love older adults or people with disabilities, and there's all kinds of great stories for that. So, Jeremy, how about you? Tell us a little bit about yourself.
Jeremy Diaz [00:05:08]:
Awesome. Well, I am Boston based, and I lived across the country at this point between San Diego and soon to be Columbus. I started as a registered nurse. I actually still practice nursing today as a case manager nurse in home health, and I went right into home health, and, you know, certainly you go through your clinical rotations, and for me, you know, you enter the hospital sick and you leave the hospital sick, and in home health, it's different. You usually see your patients when they're at their worst, coming right out of a nursing home, coming right out of a hospital, but by the time they discharge, usually they're doing a whole lot better, and that's what was satisfying for me in health care. I wanted to see people actually get better. I moved, from Boston to Southern California, went into home health operations for a little bit, but then I found PACE. I was part of a large PACE organization down in San Ysidro, very different population than Boston.
Jeremy Diaz [00:06:05]:
San Ysidro is a border city to Tijuana, Mexico. We had a lot of patients and families that would be going between Southern California and Tijuana and down in Mexico, and really just enjoyed the culture and people. It was a great program and model. It was attached to a large FQHC. About 93% of our population was, Spanish speaking only.
Katie White [00:06:28]:
Okay.
Jeremy Diaz [00:06:30]:
And then also, was introduced to the, Middle Eastern, Chaldean population, that's also there. Moved back to the East Coast, to take care of an older father who could've definitely, benefited from PACE and fortunately wasn't in our service area, and went into the ACO world. Saw over a lot of value based different programs, population health. I filled a national role. I was across 9 different states, over 60 communities, and was one of part of one of the largest, most successful Medicare Shared Savings Programs ACOs in the country, during the middle of a pandemic. So lots of challenges around there. Did a lot of that work and then, was introduced to our CEO, Mary Austin, through networking and everything else and ended up finding out that, you know, old age pace was growing, and that there was a need and with my skill set and background and not everyone can speak PACE, not everyone who can speak PACE is also clinical, so tying both of them together, there was this opportunity, for Columbus as one of their new sites to open and I was like, sure. Why not? Let's do it.
Jeremy Diaz [00:07:45]:
Let's create access, for a new community into a new market that hasn't had that experience before and let's really, you know, run into the ground and, you know, again, just creating that access so that participants can enjoy the program and all the benefits it comes with.
Katie White [00:08:02]:
That's great. So you mentioned that you wished, that PACE had been available for your father. So that brings me perfectly to my next question around the history of PACE. So the PACE program, first of all, is an acronym, and it stands for program of all inclusive care for the elderly, but it's not available everywhere. So that's why we're having all these events and education because it's new to Ohio, and specifically new to Franklin County in our case, but it's it's not a universal program. So give me a little bit of the history on, PACE.
Jeremy Diaz [00:08:40]:
No. Absolutely. So the PACE model has been around for, at this point, going on 55 years or so. So back in the early seventies, the On Lok community, based in the San Francisco market, recognized the need to care, and coordinated care for the elders that they service. This was a frail population, and, you know, they ended up doing that for over 20 years until really, the late nineties under the Clinton administration, passed under their legislation with the Balanced Budget Act, and that's when it was recognized as a federal program, and under the Medicare, Medicaid programs with CMS really was able to kinda skyrocket, in the late nineties. Of course, as you know over the years and into the 2000s, has continued to expand, but certainly not a new model or concept, although new for the Ohio market. Bold Age PACE will is not the first, PACE organization in Ohio. There's also McGregor PACE, that has already been active and seen participants in other counties, but it wasn't really until, this previous year in 2023 where Ohio really wanted to go statewide, and that's when Bold H PACE ended up coming in and looking at some of that RFP stuff that Heidi was mentioning.
Katie White [00:10:02]:
Okay. So before we get into the process of Ohio's, RFP, you mentioned that it's a Medicare program. So, essentially, participants can opt into the PACE program, but they have to be, a certain age and meet certain requirements, which we'll get into. But tell me a little bit about how the program operates financially. So an individual opts in. It is a I'm sorry. It's a capped program. So can you explain that a little bit, just kind of the high level, how that works?
Jeremy Diaz [00:10:41]:
Yeah. So most of our patients are dual eligible. They would be Medicare and Medicaid, and what ends up happening is that, both the federal government and the state government Medicaid, they will give a certain amount of money to the PACE organization, which we consider like a per participant per month. So PACE would receive that payment, and then all of the benefits of PACE, would be, all the benefits or health care benefits, would then revert to the PACE organization to have to be financially, at risk for, and we're a 100% at risk. There's no, risk to participants in regards to, like, co pays and things to that, but that's how financially we get funded to be able to take care of those, you know, within our program.
Katie White [00:11:26]:
So because it's it's essentially another nursing home, diversion program. So in Franklin County and on the podcast, we've talked about our passport program. We've talked about our MyCare program, which is Aetna and Molina here. But this is another option for folks that want to have that integrated care stay in their home, except it also offers another benefit of having a location to go to. Mhmm. So instead of, going into a nursing home, Medicare and Medicaid invest in this per member per month with essentially the thought that it is better for the member and more cost savings to provide this PACE program. Am I getting that
Jeremy Diaz [00:12:06]:
right? Exactly. And there's been some studies around PACE organizations and how it compares to other types of programs and and health waivers as well. You know, PACE compared to other Medicaid managed products cost the state about 13% less in comparison with some of the same population. So from a state perspective, the financials are also favorable for them, as well as patient experience and things to that aspect of, you know, again, maybe a little bias being part of the home health community, but most people want to remain in their home. They don't necessarily wanna go to institutionalized post acute care or custodial care, so this is a great option for those that, you know, are able to reap that benefit.
Katie White [00:12:49]:
Absolutely. Okay. So, Heidi, talk to us about the timeline, how this came about in Ohio, how the Ohio Department of Aging put out an RFP, and what that whole process is.
Heidi Webster [00:13:00]:
Well, I believe in the PACE world in general, Ohio had been in the conversation for a long time as far as talking about PACE, learning about PACE, passing legislative bills that allow PACE. And LeadingAge here in Ohio, which is headed by Susan Wallace, had a big part in that conversation and really spearheading that to make that happen. And so, on the on the front end, I guess I did know for a while that the conversation around PACE in Ohio was buzzing because there is a growing aging population here that really just needs a lot of care. And there were a certain amount of counties that they decided to open this the RFPs for. So not only one RFP, but 7. I think there were 7 r Oh, there's 7. Okay.
Katie White [00:13:51]:
I didn't realize it was that many. There was a lot.
Heidi Webster [00:13:53]:
And I was trying to pull up the list, but I'll see if I can find it. There so as as a pace as different pace organizations were discussing, there were also opportunities for other folks to get involved in pace. And the conversation around what pace can offer is amazing. So not only organizations here in Ohio, but also PACE providers around the country were all looking at Ohio. All eyes were on Ohio. It was a very exciting time. So the RFP actually did come out in March of 2023. I believe the applications went in in August of that year, and then a decision was finalized in, I wanna say, November or December of that same year.
Heidi Webster [00:14:40]:
So That's fast. It was fast, and we thought it was gonna take forever. And and, you know, it can it can because there's a lot to review. And those applications, I wanna say, Katie, are like 200 pages. They're so lengthy, and there's a lot that goes into it, including the ins and outs of the organization that's applying, the needs that are discovered in the community and what each program plans to put forth, what they think are is gonna be the location of the PACE Center, what they discovered about where PACE eligibles reside in Ohio and in each county. So a lot of detail goes into the application and, really explaining to the state, you know, why we why each PACE program feels like they're going to be the one for that job. So, yeah, there were 7 awards. And as Jeremy mentioned earlier, McGregor PACE, has been in Cleveland, Ohio for quite some time.
Heidi Webster [00:15:41]:
And so they've they've established that it works there and it does well and it has a good reputation. So I think this I think at the state level, they understood the cost savings and that it was really gonna be important for this all inclusive model. So the process around the RFP for, our experience at bold age, I was involved here on the ground working on the RFP. And part of that process includes a community oriented needs assessment, and that really involves just digging into the community, having conversations about the area, what the needs are, and what is going well, and what's and what are the programs that are serving that community, and what's missing.
Jeremy Diaz [00:16:25]:
Mhmm.
Heidi Webster [00:16:26]:
And in every state, there are similar issues. There's always issues of housing insecurity, food insecurity, and transportation. Those are the biggest things that we always hear. And as a community partner, we have to look at everything that's being said and say, how can we help best serve? What can we do to be a good community partner? And how can we tailor our program to meet those needs? So here in Columbus, well, let me just back up and I'll say, we were awarded the licenses, in Dayton, Toledo, and Columbus. Mhmm. And I will say because of the competitive nature around the RFP, we were just hoping to maybe get one. We were really, really shocked and surprised that we got all 3 that we applied for.
Katie White [00:17:11]:
Oh, good.
Heidi Webster [00:17:12]:
We were stunned. Yes. And and, of course, thrilled. And the state, has had so much support around this whole effort that I feel like that trickled down into the community too. And we could feel it with everybody that we talked to in terms of, learning around what the program can offer. And then once people know, it's sounds too good to be true, doesn't it? It does a little bit. It's really amazing. And and the truth is, is that it's not too good to be true.
Heidi Webster [00:17:38]:
And it's here and it's coming and it's very exciting. But the things that we discovered here in Columbus, specifically, are really for individuals who maybe are falling through the cracks. And there are great managed care programs and waiver programs that you are all involved with. But the thing that makes PACE different from those programs is one team, one case management team, 1 IDT team. We are the insurance plan, and we are the provider. And then we contract out with other specialty providers in the community. But we're the ones organizing everything, and we own our own transportation. So we'll pick that person up.
Heidi Webster [00:18:21]:
And I know we're gonna get into the the more details about what a PACE program does and the ins and outs. But the program is different because it's having all eyes and ears on this individual, which creates a more holistic sense of care. And the idea is to create quality of life because people want want to live independently. I don't think anybody imagines their dream would be to end up in a facility and spend their days there. Although there are really important aspects to those skilled nursing facilities, what they do long term, how they help rehab people, but being able to stay where you are and where you call home, I think, is really important. But the increased quality of life, therefore, creates opportunities to help with other health issues that may be involved. Anything between diet, your mental health, your community, the family, or chosen family, or lack of that that you have around you plays a part in your daily life. So PACE looks at all of those things, creates a sense of belonging and community, and really allows people to have, a full team surrounding them and supporting them in all those ways.
Katie White [00:19:32]:
So the RFP came out in March of 23, but you knew ahead of that. It sounds like that it would be coming out, so you could kind of be watching for it. You said, you know, things were a buzz every all eyes on Ohio kinda thing. Okay. So you do this really intensive, fast turnaround in terms of the application and coming here and doing that needs assessment. I wanna just ask, what groups did you meet with when you were here? I know you did a ton of outreach with nonprofits, and, obviously, we had meetings with you to kinda tell you some other folks. But I'm always so proud of Franklin County and our collaborative nature and really in the region. So we'd love for you to shout out, some of those agencies that you were able to meet with while here.
Heidi Webster [00:20:15]:
Oh, absolutely. And that's my favorite part about this discussion is the collaborative feeling and spirit that there is in Franklin County and Columbus. Some of the things that we look at immediately when we're looking at a community are those organizations that are that have their finger on the pulse in terms of the aging population. A lot of the, individuals that we serve as participants in the PACE program will come from independent housing, a lot of low income senior housing. So we had a lot of collaborative discussions with National Church Residences. One of our biggest, partners or collaborators in the beginning besides, of course, the CO triple a's, which are our number one collaborators, was the Mid Ohio Food Collective. They're they're so tapped into what the needs are in terms of food insecurity, food as medicine. They have the a food pharmacy program, their market, and the way that they do senior boxes was very impressive to us.
Heidi Webster [00:21:13]:
And so we did a tour of their facility, and they we immediately started to come up with ideas on how we could collaborate with them and have their programs integrated into our programs. Great. So that was one of our biggest collaborators in the beginning. And of course, the food bank association. And the food banks across the state were incredibly, responsive and supportive of the the PACE model and the PACE program. Another organization that we identified as a really fabulous partner is Stonewall Columbus. And there is a real need and a real gap in the way that we serve and affirm aging LGBTQ plus older adults and elders. They have a program called the trailblazers program, and they do continuing education on how to serve and affirm those those elders.
Heidi Webster [00:22:02]:
And a lot of the language and, care provided for those older adults are different than the young generation. The words that you use are different. And so there needs to be training around that and making sure that that we, as an organization, it's very important for us at Bold Age, to know that not only the participants, but also our staff know that we are a very safe and welcoming and affirming organization for anyone in that community. So we are a Sage Platinum certified, organization, which means we've all been trained to know and understand how to care for our LGBTQ plus elders. But in our partnership with Stonewall, we've asked them to continue our training, be part of our community advisory council, and be a local partner with us so that our staff and our participants feel like that culture is welcoming and embedded into our programming day in and day out. Excellent.
Katie White [00:22:55]:
And I think just a couple of the others you met with Age Friendly. Did you meet with the county office on aging?
Heidi Webster [00:23:01]:
We didn't get to meet with the county office on aging. Another one I would like to mention is the Urban Aging Residents Coalition, also known as UARC, which was founded and headed by Pamela Shields. She is just a force in the community and
Katie White [00:23:15]:
We're so lucky to have her.
Heidi Webster [00:23:17]:
She really is amazing. And every person that I spoke with when I first got here said, have you met with Pamela Shields yet? So I was very happy to, get in front of Pamela when she is such a champion for seniors and really has a strong voice. And not only that, but the black and African American community and those health care disparities and and understanding cultural sensitivity. And so she was imperative in getting a letter of support for our application, and we are partnering with her and UARC as well, and she will sit on our community advisory council to help us, understand and and support that community as best as possible. So that was another one of our really important partners. Also, the veterans organizations, the, Somali Association Mhmm. Signed a letter of support for us. And That's great.
Heidi Webster [00:24:07]:
And, we learned that in our community oriented needs assessment, there is one of the largest Somali populations in Columbus in the United States. So we wanna make sure that we are bringing everything to the table, understanding who we need to hire to look and sound like the community that we are gonna be a part of. Because we are PACE experts, but we are not Columbus, Ohio experts. So that's what we wanted to make sure we did all of our research and understood the community we're about to come into. Yeah.
Katie White [00:24:36]:
So we had this community event, and a a number of the organizations were there, the Veterans Association or Veterans Administration, our settlement houses. We had hospitals in the room. We had elected officials in the room. A really great group yesterday that came in to learn about PACE. And one of the things that you focused on, I'm gonna turn to Jeremy for this, is PACE eligibility. So who is eligible to participate in this? And then tell us a little bit about what a day in the life of, a PACE program client is like.
Jeremy Diaz [00:25:09]:
Oh, absolutely. In terms of eligibility, there's really 4 main requirements, that need to be gone through for what we consider a potential enrollee. First, a hard, stop is that you have to be 55 years or older. So that is one of them. The second one is in regards to you have to reside in a state approved county or zip code. So for Ohio, they ended up going by county, so certainly, Franklin County, you must reside in, at least for a bold age base as well as Montgomery or Lucas as we look to, those sites as well. 3rd, you need to meet a state approved nursing home level of care. So during, as we receive a applicant or a potential enrollee, there is a evaluation by usually the home health RN that's part of our IDT team that Heidi mentioned, and they'll do an assessment and review the record of the, potential enrollee, and then that goes to a state approved agency, to review that in what we consider our level of care decision.
Jeremy Diaz [00:26:18]:
And then at that point, we would be able to, you know, extend an an offer or an opportunity to enroll. And then the 4th part is is that they must have safe housing, in the community. That's one of the benefits that we're not able to provide is housing, so that is something that, needs to be determined, during that enrollment process. So with those four main requirements, you can, there is open enrollment throughout the entire year. So it's not like you have to wait for a certain period of time. Right now it's if you were to, meet all 4 of those requirements, then most likely you would be able to enroll for the following month on 1st. So there's no delay in in time and and months and having to wait, potentially to, gain that benefit. In terms of the day in life of a participant, and certainly on day 1 of their 1st month, they're gonna be having their assessments with the full IDT and there's really 11 core IDT members, that sit at the table and they all do their assessment.
Jeremy Diaz [00:27:26]:
So from the primary care provider to physical therapy, occupational therapy, recreational therapist, social worker, transportation coordinator, day center manager, and the entire team really comes together to evaluate what are your needs, what are you going to need as a participant to have the wrap around services that we can provide so that again you can continue to live at home. So a lot of our participants will, engage in our day center and, work with our recreational therapist in determining what their social needs are going to be, if they need transportation on one of our buses, and vans, as Heidi mentioned, coming to our site, how many days a week would they like to join us, as well as having hot meal at our day center. The nice thing about, with the day center and our participants is that our clinic is right attached to our building or embedded in our buildings. So if you're not feeling well that day, we can literally bring you from day center right into the clinic, to see your primary care provider, as well. So that's a little bit in data life as a PACE program. We provide, as I said, everything before. So from medical, dental, vision, pharmacy, transportation, durable medical equipment, if you end up in an emergency room and you're hospitalized, you get discharged and you need a skilled nursing facility, everything would be covered by Bold Age Base. There is no other payer, that, you know, that you have to work with, and really it's no cost to copay for participants.
Jeremy Diaz [00:29:10]:
So in terms of their expensive medications, in regards to their specialty appointments, there is no cost for a participant, and that's huge, especially for those, that do have you know, are already receiving financial burden, and they're trying to determine, do I pay for my medications, or do I pay for food on the table? That's really that burden's removed, at least from a, cost in regards to their health care.
Katie White [00:29:36]:
So that, individuals that are on a fixed income aren't going to have an unexpected medical bill related to an unexpected medical need. So PACE is both the provider and the payer. So you enroll in this, and it truly is that all inclusive, what you might need in the home, plus this added benefit of the center and the clinic, all of it wrapped into 1.
Jeremy Diaz [00:30:02]:
Exactly. And as, you know, I was making mention, if, you know, a participant is, you know, being discharged from the hospital, we can certainly have our transportation go to pick them up, and we can bring them right to our clinic. We can review the discharge paperwork as well as what was happening, especially with our health systems that we contract and coordinate with in trying to obtain EMR access so that we can review in real time what is going on with the participant during that hospitalization, what medications are being ordered post discharge, ensuring that they actually receive the medications that they need, post discharge, and really trying to prevent, you know, that rehospitalization and, you know, seeing transitions of care across the country in my previous role, I it is very rare to see someone discharged from a hospital and land in a primary care provider's office. It's almost unheard of and I would say that is a common trend, that we see in in PACE organizations. We really try, to ensure that our participants are getting the best care that they can receive, because it's confusing and a lot of the times it's scary, being discharged. You're not sure what to expect, and really our team does a stand up job, you know, not only with Bold H PACE, but PACE organizations across the country ensuring that, you know, participants get the care they need. And the research shows, we have fewer readmissions, we have fewer hospitalizations, we see better outcomes around depression, and we certainly see that in the geriatric community, right, in terms of loneliness and things to that aspect and the services that we can provide. So it's a really special program.
Katie White [00:31:49]:
It's not easy to navigate getting older or, to navigate having a disability. The the insurance aspect, the coordination of care aspect, we don't we don't make it easy for folks. And, so when you think about adding this additional program to services available in Franklin County, it's really exciting. And I think about individuals that live alone, that might not have any family members, and just that advocacy in that continuum of care to have a program, whether it's your waiver service case manager or if it's a PACE program, but someone to help keep the eyes and ears.
Heidi Webster [00:32:25]:
Yes.
Katie White [00:32:26]:
So tell me about the demographics of those that you're serving. Like, is there sort of a is there a breakdown of sort of a a common some common denominators that you're seeing for individuals that are enrolling in PACE?
Heidi Webster [00:32:40]:
A lot of the individuals that enroll in the PACE program are well, it it really it goes across lots of different demographics really. But the the people who are, having to deal with trying to make rent Mhmm. Or paying for their medical bills, and it could be across so many different demographics. In our New Jersey program, specifically, we've got, a large Hispanic population there, and so there's a lot of, celebrations around different Hispanic rituals and and celebrations for holidays there and culturally sensitive meals. So we wanna make sure that there's that. There's also a partnership that we have in New Jersey with, Orthodox Jewish community. There's a very large population there. And so we made a partnership with an adult day program that serves that community in their neighborhood.
Katie White [00:33:31]:
Wow. So they're a part of
Heidi Webster [00:33:32]:
the PACE program, and they get all the benefits as us as an insurer and taking care of them. But they're going to a day center that has the activities that work for them, the meals that are sensitive to their religious needs and their cultural needs, and they're surrounded by people who are like them. So, there's so many different ways to partner and meet the the needs of all the different demographics. We also do have a partnership in our Fresno, California program with an adult day program called Guardian Angels that serves predominantly the Hmong community that speak Hmong and Lao. And so we've partnered with them, and now Bold Age is part of their program, and they can enroll in the PACE program, but the staff and the participants are all from that community. So it's really amazing that what you can do Yeah. In terms of, helping people with all of their different needs. But individuals who are on Medicaid are going to be eligible for the PACE program.
Heidi Webster [00:34:30]:
So we're looking at folks who have very little, and we are going to give them a lot more than they had. So back to the day in a life, you know, keeping all eyes and ears on somebody, they will be picked up by our transportation driver who's part of our IDT team and a home health aide who are going in, we like to call it couch to couch service. They go in, they see everything, they know what's happening. They take that individual to the center, they'll get breakfast Activities start. They have different groups. They have women's groups, veterans groups, music, and movement. So many different things that they can be involved in. So as Jeremy mentioned, depression rates go down down.
Heidi Webster [00:35:13]:
Depression rates go down, and people are no longer suffering from isolation. They have a lunch together as a group. The physical therapist goes into the day room, pulls them out, says it's time for us to do your appointment today. Let's do some walking. If they're unsure that they wanna do that that day, the music therapist can say, come on. Let's go do it. And they get them active. They get them moving.
Heidi Webster [00:35:34]:
So it really is a community. And then at the end of the day, transportation takes them right back home. If they're alone, look at how that person's day was changed. And if that person lives with their adult children, then you can imagine the burden that was lifted from that family as well, knowing that their their loved one is safe and taken care of that day.
Katie White [00:35:53]:
And they can go to work, and we're not having to worry about, missing work or missing income. And so, when I think about my own self, some days I really wanna be social, and some days I don't. So if I'm in the PACE program, I can go to the center, but it sounds like I don't have to. And if I don't want to go to the center, what does that mean for services in my home?
Jeremy Diaz [00:36:21]:
Right. So, certainly, we have, personal care aids as well as our home health nurses that, go out into the home and see participants. Our providers can go out into the home as well to see them if needed, especially for those that might be suffering from mental health issues around anxiety, trying to get to a clinic, being on a, you know, transportation bus or van. We'll try and meet the, you know, the clinical needs wherever the patient, wants them.
Katie White [00:36:48]:
Okay.
Jeremy Diaz [00:36:49]:
In terms of the social aspect of not coming to the day center, Bold Age PACE certainly has invested in some technology and we've invested in GRANDPAD. Mhmm. Certainly pre COVID, very hands on, high touch program, and still is. But during COVID, we had to change a little bit in terms of how do we get to the participants. GrandPad is a a great option. It is a telehealth, opportunity, but it's really geared towards seniors. It's very friendly, user friendly. We can receive a whole bunch of vitals in terms of their weight, clinically how they're doing, but there's also the social aspect.
Jeremy Diaz [00:37:31]:
They're able to communicate directly with their provider and their IDT team. We can put on, certain games, certain podcasts, you know, if a participant really loves, British comedy and, you know, that's what, they receive joy out of. We can work with our recreational therapists to ensure that that is on the grand pad, for our participants, and again it's that interaction. It's, you know, moving forward, looking towards, you know how can we care for our participants in a wholesome manner and really meeting them with what they consider healthcare, right? My definition of healthcare is gonna be different than yours, gonna be different than Heidi's and really meeting them on where do they see health care for them and and meeting them there, so that we can provide as much care, as they need or desire to have.
Katie White [00:38:29]:
It's a lot around protecting choice, which I think is something we all value and potentially take for granted. And sometimes when you are in the aging community or disability community or low income or maybe you don't speak the language, you lose a lot of your choice and your autonomy. And so this is another program that offers full choice. So before we get to our closing thoughts, my last question is sort of around logistics. So do individuals in the program, schedule out what days they go into the center? How do you know who's coming in and when they're coming in and and how often and all how does that work? Good question.
Jeremy Diaz [00:39:07]:
Yeah. So we create, as I may have mentioned a little bit earlier, during the beginning of the enrollment, they will meet with the 11 IDT members, at the table, and they will create their care plan. We will reevaluate that care plan, every 6 months at a minimum. Certainly, there could be what we consider a participant with a service delivery request or SDR if they want a service that wasn't initially brought upon, during their care plan, and that could be to add or withdraw. Okay. Maybe at first they wanted 3 days a week, to come to our day center and because maybe there was a hospitalization, something ended up occurring in their healthcare, or maybe they're just declining, right, because we, hope that they will come on with us and they will be with us, you know, to their final days. You know, as time goes on, you kinda slow down a little bit more, so maybe it's only 2 days a week. Maybe they need more caregiver hours in the home to be able to be supported at home versus when they first enter the program.
Jeremy Diaz [00:40:08]:
So we'll continue to evaluate and again, adjust their care plan, as time goes on as they're with us. And as they get to learn us, we'll also get to learn them. Right? And and trying to, give recommendations, but ultimately knowing that it's it's their choice. Right? And and meeting them where they are in their healthcare and at that time.
Katie White [00:40:30]:
So and I said that was my last question. And, of course, now it's not. But when you talk about, an individual being with you, you know, till their till their last days, are you able to bring in hospice on top of PACE services, or do you yes. Okay. Yes.
Heidi Webster [00:40:47]:
I I think that there's, the way doctor Glenn Myers, our chief medical officer, talks about PACE as being very palliative, and he comes from that world. And so it is a very palliative model. Like, we we do want to serve and be with that participant until the end of their life.
Katie White [00:41:02]:
Mhmm.
Heidi Webster [00:41:03]:
And I think a lot of PACE programs do serve participants until the end of their lives. But when it comes to hospice care, we absolutely can contract with the hospice provider to bring in an end of life as adding that extra level of touch, extra level of expertise when it comes to end of life care. So we look at it the same as if we were, getting any other specialists involved. And so it's very important that we collaborate, and we can identify actually participants that maybe or a patient that would yo yo in and out of hospice care because sometimes they don't recertify.
Jeremy Diaz [00:41:36]:
Yeah.
Heidi Webster [00:41:37]:
And so who's gonna be watching that person and that individual when they go in and out of hospice services? And this is where we found to be a great collaboration
Katie White [00:41:45]:
Oh, good.
Heidi Webster [00:41:45]:
Because they can be part of that IDT team as well.
Katie White [00:41:48]:
So it's sometimes you're the provider and the payer. Sometimes you're just the payer. But no matter what the challenge or obstacle is, you're tying people to the best suited resource for their needs. Am I getting that right? Love that. Okay.
Jeremy Diaz [00:42:05]:
That's correct. And even on a, you know, a hospice benefit where we think of, you know, traditional Medicare hospice, we would still continue to, you know, have provide oversight, with them. So it's not like they go to the hospice agency and, you know, we fall to the wayside. We're still very active and, you know, a lot of our participants that have been with us for years are receiving those services to a hospice organization. A lot of the times our IDT team is going to the bed side and really getting to see them in their last days, which is a very special moment, not only for the team, but also patient and family. I mean, you see the same nurse that's been coming to your home for 4 years and doing assessments, you know, it's it's truly a special bond and something that, is very unique in, you know, our our healthcare industry.
Katie White [00:42:54]:
Yeah. Become part of their social network.
Heidi Webster [00:42:57]:
Yeah. Yeah.
Katie White [00:42:58]:
So closing thoughts, what do you want listeners to know about old age PACE or PACE in general?
Heidi Webster [00:43:07]:
I would say that this program and all PACE programs are designed to really help individuals live the fullest life possible that they can on their terms. And so our promise to all folks who come onto our program at bold age pace is we want to help you live a meaningful and independent life full of grace and dignity. And at home, wherever that that may be, wherever they call home, we want people to feel like they have a purpose, that they have a community, and we want to wrap our arms around them and care for them as long as they wanna be a part of our program. And and so we're so happy to be a part of now the Columbus community, and we just can't wait to see how this is gonna change people's lives because we know that it does. It really does.
Katie White [00:43:55]:
Thank you. Jeremy?
Jeremy Diaz [00:43:57]:
So what I would like to say is that PACE is one of those models that, again, it's so hard to wrap your mind around because it's so, underutilized compared to other health plans, that are out there, and and really, it's a model that, you know, is certainly, one that should be tapped into. I feel a whole lot more, maybe I'm a little bit biased, but from a bold age pace perspective, you know, we really strive in regards to our mission and vision. Our mission statement is going to be in all of our clinics and day centers as a forward reminder of who we are as an organization. We're a people first organization, not only to our participants, but also our employees who take care of one another. We really seek to understand as well as being bold in the community, and how do we, be part of the landscape of Columbus and those that we serve across the country. So that's what I'm really excited about, and to bring that here right into Franklin.
Katie White [00:45:06]:
Wonderful. Well, thank you both for being here. Thank you for bringing this wonderful resource to our community.
Heidi Webster [00:45:11]:
Thank you for having us, Katie. Thank you.
Katie White [00:45:16]:
I hope now you know something about PACE.
Welcome to Pretend I Know Nothing About. I'm Katie White, your host, Administrator of COAAA. On today's episode, we're joined by Heidi Webster and Jeremy Diaz with BoldAge PACE. They'll be explaining the program of all inclusive care for the elderly coming to Franklin County in early 2025. Let's get into it. Well, welcome to the podcast. Today, I'm joined by some external partners that we're so excited to learn more about. We are joined by Heidi Webster, the national director of business development for BoldAge PACE, and Jeremy Diaz, executive director for the Columbus BoldAge PACE.
Katie White [00:00:50]:
Welcome.
Heidi Webster [00:00:51]:
Thank you for having us.
Jeremy Diaz [00:00:52]:
Good morning.
Katie White [00:00:53]:
Good morning. Am I saying your last name right?
Jeremy Diaz [00:00:56]:
Yes.
Katie White [00:00:57]:
Is it? I'll do it again.
Jeremy Diaz [00:00:58]:
It's Dias.
Katie White [00:00:59]:
Dias? Okay. Let me try it again. So after Heidi, then what's okay? And Jeremy Dias, executive director of Columbus Bold Age PACE. Welcome.
Heidi Webster [00:01:09]:
Thank you for having us. Katie.
Katie White [00:01:11]:
Being here. Well, we've been busy the last couple of weeks getting ready. We had this big event yesterday, where we talked all about PACE to the advisory council for COAAA and brought in a bunch of external partners. But today, I'm excited to really dig in with you both about the history of PACE, what it is, and really get some of those nuts and bolts into the podcast episodes. So I'd like to start off a little bit, I'd like to start off with learning a little bit about both of you. So, Heidi, get what's your background? Tell us
Heidi Webster [00:01:42]:
a little bit about yourself. I actually got into health care about 13 or 14 years ago in hospice. So I decided to, get a master's degree in music therapy. I did that at ASU, and I wasn't sure what population I wanted to work with. And I found myself doing, a a clinical day round in hospice care, and I I fell in love with it. I didn't think that I was going to like it. I'd had no idea that I was gonna be good at it. I ended up doing my internship at, an organization called Seasons Hospice.
Katie White [00:02:24]:
Okay.
Heidi Webster [00:02:24]:
And so as a music therapist, I spent a lot of time with nurses and social workers and chaplains and and really spending time with, individuals that were just on their last days, and most of those folks were in the older generation. Okay. You know? Some, of course, were not, which was awful, but most of the time, just individuals that were, as we call seniors, older adults. So I grew to love that that, age group so, so, so much, and it really changed my life. So I spent about 10 years in hospice. I became an educator in music therapy and how music therapy really works in end of life care. And we have an we had a really incredible team at Seasons Hospice. It's now called AccentCare.
Heidi Webster [00:03:10]:
Okay. They they merged with Accent Care, which is a home health organization. Seasons Hospice was really sorry. Bump the table. Seasons Hospice was really about, focusing on hospice care. So the 2 organizations merged, and, a lot of our leadership team ended up moving over to Bold Age PACE, which is the same owners as Seasons Hospice.
Katie White [00:03:35]:
Interesting.
Heidi Webster [00:03:35]:
So I was I was working as a consultant for for bold age for a little while. I have a lot of, experience working on certificate of needs, which is for states who, don't have hospice, hospice organizations. They they require that you apply. The state will control, what hospice programs can open. Only certain states require, certificate of needs. So my team and I got really embedded into applying for hospice in different states. And then, eventually, I was, hired as a consultant for a PACE organization, which is bold h PACE to apply for an RFP, which stands for request for proposal, which is the same as certificate of need. So basically applying with the state to have that, new provider brought in.
Heidi Webster [00:04:26]:
Some states don't have those restrictions. Like in Arizona, you can just open up a hospice on any corner and there are there's hospice programs everywhere, but certain states do restrict that. And so that's kind of where my expertise comes in. And that's how I ended up at bold age pace, which is, a program that I've felt fallen in love with and, of course, stays in that same genre of the older population that I grew to love and the people who just need it the most. That's a little bit my background in health care and how I got to where I am now.
Katie White [00:04:55]:
That's a great one of my favorite parts of this is just learning why everyone's why and why they love older adults or people with disabilities, and there's all kinds of great stories for that. So, Jeremy, how about you? Tell us a little bit about yourself.
Jeremy Diaz [00:05:08]:
Awesome. Well, I am Boston based, and I lived across the country at this point between San Diego and soon to be Columbus. I started as a registered nurse. I actually still practice nursing today as a case manager nurse in home health, and I went right into home health, and, you know, certainly you go through your clinical rotations, and for me, you know, you enter the hospital sick and you leave the hospital sick, and in home health, it's different. You usually see your patients when they're at their worst, coming right out of a nursing home, coming right out of a hospital, but by the time they discharge, usually they're doing a whole lot better, and that's what was satisfying for me in health care. I wanted to see people actually get better. I moved, from Boston to Southern California, went into home health operations for a little bit, but then I found PACE. I was part of a large PACE organization down in San Ysidro, very different population than Boston.
Jeremy Diaz [00:06:05]:
San Ysidro is a border city to Tijuana, Mexico. We had a lot of patients and families that would be going between Southern California and Tijuana and down in Mexico, and really just enjoyed the culture and people. It was a great program and model. It was attached to a large FQHC. About 93% of our population was, Spanish speaking only.
Katie White [00:06:28]:
Okay.
Jeremy Diaz [00:06:30]:
And then also, was introduced to the, Middle Eastern, Chaldean population, that's also there. Moved back to the East Coast, to take care of an older father who could've definitely, benefited from PACE and fortunately wasn't in our service area, and went into the ACO world. Saw over a lot of value based different programs, population health. I filled a national role. I was across 9 different states, over 60 communities, and was one of part of one of the largest, most successful Medicare Shared Savings Programs ACOs in the country, during the middle of a pandemic. So lots of challenges around there. Did a lot of that work and then, was introduced to our CEO, Mary Austin, through networking and everything else and ended up finding out that, you know, old age pace was growing, and that there was a need and with my skill set and background and not everyone can speak PACE, not everyone who can speak PACE is also clinical, so tying both of them together, there was this opportunity, for Columbus as one of their new sites to open and I was like, sure. Why not? Let's do it.
Jeremy Diaz [00:07:45]:
Let's create access, for a new community into a new market that hasn't had that experience before and let's really, you know, run into the ground and, you know, again, just creating that access so that participants can enjoy the program and all the benefits it comes with.
Katie White [00:08:02]:
That's great. So you mentioned that you wished, that PACE had been available for your father. So that brings me perfectly to my next question around the history of PACE. So the PACE program, first of all, is an acronym, and it stands for program of all inclusive care for the elderly, but it's not available everywhere. So that's why we're having all these events and education because it's new to Ohio, and specifically new to Franklin County in our case, but it's it's not a universal program. So give me a little bit of the history on, PACE.
Jeremy Diaz [00:08:40]:
No. Absolutely. So the PACE model has been around for, at this point, going on 55 years or so. So back in the early seventies, the On Lok community, based in the San Francisco market, recognized the need to care, and coordinated care for the elders that they service. This was a frail population, and, you know, they ended up doing that for over 20 years until really, the late nineties under the Clinton administration, passed under their legislation with the Balanced Budget Act, and that's when it was recognized as a federal program, and under the Medicare, Medicaid programs with CMS really was able to kinda skyrocket, in the late nineties. Of course, as you know over the years and into the 2000s, has continued to expand, but certainly not a new model or concept, although new for the Ohio market. Bold Age PACE will is not the first, PACE organization in Ohio. There's also McGregor PACE, that has already been active and seen participants in other counties, but it wasn't really until, this previous year in 2023 where Ohio really wanted to go statewide, and that's when Bold H PACE ended up coming in and looking at some of that RFP stuff that Heidi was mentioning.
Katie White [00:10:02]:
Okay. So before we get into the process of Ohio's, RFP, you mentioned that it's a Medicare program. So, essentially, participants can opt into the PACE program, but they have to be, a certain age and meet certain requirements, which we'll get into. But tell me a little bit about how the program operates financially. So an individual opts in. It is a I'm sorry. It's a capped program. So can you explain that a little bit, just kind of the high level, how that works?
Jeremy Diaz [00:10:41]:
Yeah. So most of our patients are dual eligible. They would be Medicare and Medicaid, and what ends up happening is that, both the federal government and the state government Medicaid, they will give a certain amount of money to the PACE organization, which we consider like a per participant per month. So PACE would receive that payment, and then all of the benefits of PACE, would be, all the benefits or health care benefits, would then revert to the PACE organization to have to be financially, at risk for, and we're a 100% at risk. There's no, risk to participants in regards to, like, co pays and things to that, but that's how financially we get funded to be able to take care of those, you know, within our program.
Katie White [00:11:26]:
So because it's it's essentially another nursing home, diversion program. So in Franklin County and on the podcast, we've talked about our passport program. We've talked about our MyCare program, which is Aetna and Molina here. But this is another option for folks that want to have that integrated care stay in their home, except it also offers another benefit of having a location to go to. Mhmm. So instead of, going into a nursing home, Medicare and Medicaid invest in this per member per month with essentially the thought that it is better for the member and more cost savings to provide this PACE program. Am I getting that
Jeremy Diaz [00:12:06]:
right? Exactly. And there's been some studies around PACE organizations and how it compares to other types of programs and and health waivers as well. You know, PACE compared to other Medicaid managed products cost the state about 13% less in comparison with some of the same population. So from a state perspective, the financials are also favorable for them, as well as patient experience and things to that aspect of, you know, again, maybe a little bias being part of the home health community, but most people want to remain in their home. They don't necessarily wanna go to institutionalized post acute care or custodial care, so this is a great option for those that, you know, are able to reap that benefit.
Katie White [00:12:49]:
Absolutely. Okay. So, Heidi, talk to us about the timeline, how this came about in Ohio, how the Ohio Department of Aging put out an RFP, and what that whole process is.
Heidi Webster [00:13:00]:
Well, I believe in the PACE world in general, Ohio had been in the conversation for a long time as far as talking about PACE, learning about PACE, passing legislative bills that allow PACE. And LeadingAge here in Ohio, which is headed by Susan Wallace, had a big part in that conversation and really spearheading that to make that happen. And so, on the on the front end, I guess I did know for a while that the conversation around PACE in Ohio was buzzing because there is a growing aging population here that really just needs a lot of care. And there were a certain amount of counties that they decided to open this the RFPs for. So not only one RFP, but 7. I think there were 7 r Oh, there's 7. Okay.
Katie White [00:13:51]:
I didn't realize it was that many. There was a lot.
Heidi Webster [00:13:53]:
And I was trying to pull up the list, but I'll see if I can find it. There so as as a pace as different pace organizations were discussing, there were also opportunities for other folks to get involved in pace. And the conversation around what pace can offer is amazing. So not only organizations here in Ohio, but also PACE providers around the country were all looking at Ohio. All eyes were on Ohio. It was a very exciting time. So the RFP actually did come out in March of 2023. I believe the applications went in in August of that year, and then a decision was finalized in, I wanna say, November or December of that same year.
Heidi Webster [00:14:40]:
So That's fast. It was fast, and we thought it was gonna take forever. And and, you know, it can it can because there's a lot to review. And those applications, I wanna say, Katie, are like 200 pages. They're so lengthy, and there's a lot that goes into it, including the ins and outs of the organization that's applying, the needs that are discovered in the community and what each program plans to put forth, what they think are is gonna be the location of the PACE Center, what they discovered about where PACE eligibles reside in Ohio and in each county. So a lot of detail goes into the application and, really explaining to the state, you know, why we why each PACE program feels like they're going to be the one for that job. So, yeah, there were 7 awards. And as Jeremy mentioned earlier, McGregor PACE, has been in Cleveland, Ohio for quite some time.
Heidi Webster [00:15:41]:
And so they've they've established that it works there and it does well and it has a good reputation. So I think this I think at the state level, they understood the cost savings and that it was really gonna be important for this all inclusive model. So the process around the RFP for, our experience at bold age, I was involved here on the ground working on the RFP. And part of that process includes a community oriented needs assessment, and that really involves just digging into the community, having conversations about the area, what the needs are, and what is going well, and what's and what are the programs that are serving that community, and what's missing.
Jeremy Diaz [00:16:25]:
Mhmm.
Heidi Webster [00:16:26]:
And in every state, there are similar issues. There's always issues of housing insecurity, food insecurity, and transportation. Those are the biggest things that we always hear. And as a community partner, we have to look at everything that's being said and say, how can we help best serve? What can we do to be a good community partner? And how can we tailor our program to meet those needs? So here in Columbus, well, let me just back up and I'll say, we were awarded the licenses, in Dayton, Toledo, and Columbus. Mhmm. And I will say because of the competitive nature around the RFP, we were just hoping to maybe get one. We were really, really shocked and surprised that we got all 3 that we applied for.
Katie White [00:17:11]:
Oh, good.
Heidi Webster [00:17:12]:
We were stunned. Yes. And and, of course, thrilled. And the state, has had so much support around this whole effort that I feel like that trickled down into the community too. And we could feel it with everybody that we talked to in terms of, learning around what the program can offer. And then once people know, it's sounds too good to be true, doesn't it? It does a little bit. It's really amazing. And and the truth is, is that it's not too good to be true.
Heidi Webster [00:17:38]:
And it's here and it's coming and it's very exciting. But the things that we discovered here in Columbus, specifically, are really for individuals who maybe are falling through the cracks. And there are great managed care programs and waiver programs that you are all involved with. But the thing that makes PACE different from those programs is one team, one case management team, 1 IDT team. We are the insurance plan, and we are the provider. And then we contract out with other specialty providers in the community. But we're the ones organizing everything, and we own our own transportation. So we'll pick that person up.
Heidi Webster [00:18:21]:
And I know we're gonna get into the the more details about what a PACE program does and the ins and outs. But the program is different because it's having all eyes and ears on this individual, which creates a more holistic sense of care. And the idea is to create quality of life because people want want to live independently. I don't think anybody imagines their dream would be to end up in a facility and spend their days there. Although there are really important aspects to those skilled nursing facilities, what they do long term, how they help rehab people, but being able to stay where you are and where you call home, I think, is really important. But the increased quality of life, therefore, creates opportunities to help with other health issues that may be involved. Anything between diet, your mental health, your community, the family, or chosen family, or lack of that that you have around you plays a part in your daily life. So PACE looks at all of those things, creates a sense of belonging and community, and really allows people to have, a full team surrounding them and supporting them in all those ways.
Katie White [00:19:32]:
So the RFP came out in March of 23, but you knew ahead of that. It sounds like that it would be coming out, so you could kind of be watching for it. You said, you know, things were a buzz every all eyes on Ohio kinda thing. Okay. So you do this really intensive, fast turnaround in terms of the application and coming here and doing that needs assessment. I wanna just ask, what groups did you meet with when you were here? I know you did a ton of outreach with nonprofits, and, obviously, we had meetings with you to kinda tell you some other folks. But I'm always so proud of Franklin County and our collaborative nature and really in the region. So we'd love for you to shout out, some of those agencies that you were able to meet with while here.
Heidi Webster [00:20:15]:
Oh, absolutely. And that's my favorite part about this discussion is the collaborative feeling and spirit that there is in Franklin County and Columbus. Some of the things that we look at immediately when we're looking at a community are those organizations that are that have their finger on the pulse in terms of the aging population. A lot of the, individuals that we serve as participants in the PACE program will come from independent housing, a lot of low income senior housing. So we had a lot of collaborative discussions with National Church Residences. One of our biggest, partners or collaborators in the beginning besides, of course, the CO triple a's, which are our number one collaborators, was the Mid Ohio Food Collective. They're they're so tapped into what the needs are in terms of food insecurity, food as medicine. They have the a food pharmacy program, their market, and the way that they do senior boxes was very impressive to us.
Heidi Webster [00:21:13]:
And so we did a tour of their facility, and they we immediately started to come up with ideas on how we could collaborate with them and have their programs integrated into our programs. Great. So that was one of our biggest collaborators in the beginning. And of course, the food bank association. And the food banks across the state were incredibly, responsive and supportive of the the PACE model and the PACE program. Another organization that we identified as a really fabulous partner is Stonewall Columbus. And there is a real need and a real gap in the way that we serve and affirm aging LGBTQ plus older adults and elders. They have a program called the trailblazers program, and they do continuing education on how to serve and affirm those those elders.
Heidi Webster [00:22:02]:
And a lot of the language and, care provided for those older adults are different than the young generation. The words that you use are different. And so there needs to be training around that and making sure that that we, as an organization, it's very important for us at Bold Age, to know that not only the participants, but also our staff know that we are a very safe and welcoming and affirming organization for anyone in that community. So we are a Sage Platinum certified, organization, which means we've all been trained to know and understand how to care for our LGBTQ plus elders. But in our partnership with Stonewall, we've asked them to continue our training, be part of our community advisory council, and be a local partner with us so that our staff and our participants feel like that culture is welcoming and embedded into our programming day in and day out. Excellent.
Katie White [00:22:55]:
And I think just a couple of the others you met with Age Friendly. Did you meet with the county office on aging?
Heidi Webster [00:23:01]:
We didn't get to meet with the county office on aging. Another one I would like to mention is the Urban Aging Residents Coalition, also known as UARC, which was founded and headed by Pamela Shields. She is just a force in the community and
Katie White [00:23:15]:
We're so lucky to have her.
Heidi Webster [00:23:17]:
She really is amazing. And every person that I spoke with when I first got here said, have you met with Pamela Shields yet? So I was very happy to, get in front of Pamela when she is such a champion for seniors and really has a strong voice. And not only that, but the black and African American community and those health care disparities and and understanding cultural sensitivity. And so she was imperative in getting a letter of support for our application, and we are partnering with her and UARC as well, and she will sit on our community advisory council to help us, understand and and support that community as best as possible. So that was another one of our really important partners. Also, the veterans organizations, the, Somali Association Mhmm. Signed a letter of support for us. And That's great.
Heidi Webster [00:24:07]:
And, we learned that in our community oriented needs assessment, there is one of the largest Somali populations in Columbus in the United States. So we wanna make sure that we are bringing everything to the table, understanding who we need to hire to look and sound like the community that we are gonna be a part of. Because we are PACE experts, but we are not Columbus, Ohio experts. So that's what we wanted to make sure we did all of our research and understood the community we're about to come into. Yeah.
Katie White [00:24:36]:
So we had this community event, and a a number of the organizations were there, the Veterans Association or Veterans Administration, our settlement houses. We had hospitals in the room. We had elected officials in the room. A really great group yesterday that came in to learn about PACE. And one of the things that you focused on, I'm gonna turn to Jeremy for this, is PACE eligibility. So who is eligible to participate in this? And then tell us a little bit about what a day in the life of, a PACE program client is like.
Jeremy Diaz [00:25:09]:
Oh, absolutely. In terms of eligibility, there's really 4 main requirements, that need to be gone through for what we consider a potential enrollee. First, a hard, stop is that you have to be 55 years or older. So that is one of them. The second one is in regards to you have to reside in a state approved county or zip code. So for Ohio, they ended up going by county, so certainly, Franklin County, you must reside in, at least for a bold age base as well as Montgomery or Lucas as we look to, those sites as well. 3rd, you need to meet a state approved nursing home level of care. So during, as we receive a applicant or a potential enrollee, there is a evaluation by usually the home health RN that's part of our IDT team that Heidi mentioned, and they'll do an assessment and review the record of the, potential enrollee, and then that goes to a state approved agency, to review that in what we consider our level of care decision.
Jeremy Diaz [00:26:18]:
And then at that point, we would be able to, you know, extend an an offer or an opportunity to enroll. And then the 4th part is is that they must have safe housing, in the community. That's one of the benefits that we're not able to provide is housing, so that is something that, needs to be determined, during that enrollment process. So with those four main requirements, you can, there is open enrollment throughout the entire year. So it's not like you have to wait for a certain period of time. Right now it's if you were to, meet all 4 of those requirements, then most likely you would be able to enroll for the following month on 1st. So there's no delay in in time and and months and having to wait, potentially to, gain that benefit. In terms of the day in life of a participant, and certainly on day 1 of their 1st month, they're gonna be having their assessments with the full IDT and there's really 11 core IDT members, that sit at the table and they all do their assessment.
Jeremy Diaz [00:27:26]:
So from the primary care provider to physical therapy, occupational therapy, recreational therapist, social worker, transportation coordinator, day center manager, and the entire team really comes together to evaluate what are your needs, what are you going to need as a participant to have the wrap around services that we can provide so that again you can continue to live at home. So a lot of our participants will, engage in our day center and, work with our recreational therapist in determining what their social needs are going to be, if they need transportation on one of our buses, and vans, as Heidi mentioned, coming to our site, how many days a week would they like to join us, as well as having hot meal at our day center. The nice thing about, with the day center and our participants is that our clinic is right attached to our building or embedded in our buildings. So if you're not feeling well that day, we can literally bring you from day center right into the clinic, to see your primary care provider, as well. So that's a little bit in data life as a PACE program. We provide, as I said, everything before. So from medical, dental, vision, pharmacy, transportation, durable medical equipment, if you end up in an emergency room and you're hospitalized, you get discharged and you need a skilled nursing facility, everything would be covered by Bold Age Base. There is no other payer, that, you know, that you have to work with, and really it's no cost to copay for participants.
Jeremy Diaz [00:29:10]:
So in terms of their expensive medications, in regards to their specialty appointments, there is no cost for a participant, and that's huge, especially for those, that do have you know, are already receiving financial burden, and they're trying to determine, do I pay for my medications, or do I pay for food on the table? That's really that burden's removed, at least from a, cost in regards to their health care.
Katie White [00:29:36]:
So that, individuals that are on a fixed income aren't going to have an unexpected medical bill related to an unexpected medical need. So PACE is both the provider and the payer. So you enroll in this, and it truly is that all inclusive, what you might need in the home, plus this added benefit of the center and the clinic, all of it wrapped into 1.
Jeremy Diaz [00:30:02]:
Exactly. And as, you know, I was making mention, if, you know, a participant is, you know, being discharged from the hospital, we can certainly have our transportation go to pick them up, and we can bring them right to our clinic. We can review the discharge paperwork as well as what was happening, especially with our health systems that we contract and coordinate with in trying to obtain EMR access so that we can review in real time what is going on with the participant during that hospitalization, what medications are being ordered post discharge, ensuring that they actually receive the medications that they need, post discharge, and really trying to prevent, you know, that rehospitalization and, you know, seeing transitions of care across the country in my previous role, I it is very rare to see someone discharged from a hospital and land in a primary care provider's office. It's almost unheard of and I would say that is a common trend, that we see in in PACE organizations. We really try, to ensure that our participants are getting the best care that they can receive, because it's confusing and a lot of the times it's scary, being discharged. You're not sure what to expect, and really our team does a stand up job, you know, not only with Bold H PACE, but PACE organizations across the country ensuring that, you know, participants get the care they need. And the research shows, we have fewer readmissions, we have fewer hospitalizations, we see better outcomes around depression, and we certainly see that in the geriatric community, right, in terms of loneliness and things to that aspect and the services that we can provide. So it's a really special program.
Katie White [00:31:49]:
It's not easy to navigate getting older or, to navigate having a disability. The the insurance aspect, the coordination of care aspect, we don't we don't make it easy for folks. And, so when you think about adding this additional program to services available in Franklin County, it's really exciting. And I think about individuals that live alone, that might not have any family members, and just that advocacy in that continuum of care to have a program, whether it's your waiver service case manager or if it's a PACE program, but someone to help keep the eyes and ears.
Heidi Webster [00:32:25]:
Yes.
Katie White [00:32:26]:
So tell me about the demographics of those that you're serving. Like, is there sort of a is there a breakdown of sort of a a common some common denominators that you're seeing for individuals that are enrolling in PACE?
Heidi Webster [00:32:40]:
A lot of the individuals that enroll in the PACE program are well, it it really it goes across lots of different demographics really. But the the people who are, having to deal with trying to make rent Mhmm. Or paying for their medical bills, and it could be across so many different demographics. In our New Jersey program, specifically, we've got, a large Hispanic population there, and so there's a lot of, celebrations around different Hispanic rituals and and celebrations for holidays there and culturally sensitive meals. So we wanna make sure that there's that. There's also a partnership that we have in New Jersey with, Orthodox Jewish community. There's a very large population there. And so we made a partnership with an adult day program that serves that community in their neighborhood.
Katie White [00:33:31]:
Wow. So they're a part of
Heidi Webster [00:33:32]:
the PACE program, and they get all the benefits as us as an insurer and taking care of them. But they're going to a day center that has the activities that work for them, the meals that are sensitive to their religious needs and their cultural needs, and they're surrounded by people who are like them. So, there's so many different ways to partner and meet the the needs of all the different demographics. We also do have a partnership in our Fresno, California program with an adult day program called Guardian Angels that serves predominantly the Hmong community that speak Hmong and Lao. And so we've partnered with them, and now Bold Age is part of their program, and they can enroll in the PACE program, but the staff and the participants are all from that community. So it's really amazing that what you can do Yeah. In terms of, helping people with all of their different needs. But individuals who are on Medicaid are going to be eligible for the PACE program.
Heidi Webster [00:34:30]:
So we're looking at folks who have very little, and we are going to give them a lot more than they had. So back to the day in a life, you know, keeping all eyes and ears on somebody, they will be picked up by our transportation driver who's part of our IDT team and a home health aide who are going in, we like to call it couch to couch service. They go in, they see everything, they know what's happening. They take that individual to the center, they'll get breakfast Activities start. They have different groups. They have women's groups, veterans groups, music, and movement. So many different things that they can be involved in. So as Jeremy mentioned, depression rates go down down.
Heidi Webster [00:35:13]:
Depression rates go down, and people are no longer suffering from isolation. They have a lunch together as a group. The physical therapist goes into the day room, pulls them out, says it's time for us to do your appointment today. Let's do some walking. If they're unsure that they wanna do that that day, the music therapist can say, come on. Let's go do it. And they get them active. They get them moving.
Heidi Webster [00:35:34]:
So it really is a community. And then at the end of the day, transportation takes them right back home. If they're alone, look at how that person's day was changed. And if that person lives with their adult children, then you can imagine the burden that was lifted from that family as well, knowing that their their loved one is safe and taken care of that day.
Katie White [00:35:53]:
And they can go to work, and we're not having to worry about, missing work or missing income. And so, when I think about my own self, some days I really wanna be social, and some days I don't. So if I'm in the PACE program, I can go to the center, but it sounds like I don't have to. And if I don't want to go to the center, what does that mean for services in my home?
Jeremy Diaz [00:36:21]:
Right. So, certainly, we have, personal care aids as well as our home health nurses that, go out into the home and see participants. Our providers can go out into the home as well to see them if needed, especially for those that might be suffering from mental health issues around anxiety, trying to get to a clinic, being on a, you know, transportation bus or van. We'll try and meet the, you know, the clinical needs wherever the patient, wants them.
Katie White [00:36:48]:
Okay.
Jeremy Diaz [00:36:49]:
In terms of the social aspect of not coming to the day center, Bold Age PACE certainly has invested in some technology and we've invested in GRANDPAD. Mhmm. Certainly pre COVID, very hands on, high touch program, and still is. But during COVID, we had to change a little bit in terms of how do we get to the participants. GrandPad is a a great option. It is a telehealth, opportunity, but it's really geared towards seniors. It's very friendly, user friendly. We can receive a whole bunch of vitals in terms of their weight, clinically how they're doing, but there's also the social aspect.
Jeremy Diaz [00:37:31]:
They're able to communicate directly with their provider and their IDT team. We can put on, certain games, certain podcasts, you know, if a participant really loves, British comedy and, you know, that's what, they receive joy out of. We can work with our recreational therapists to ensure that that is on the grand pad, for our participants, and again it's that interaction. It's, you know, moving forward, looking towards, you know how can we care for our participants in a wholesome manner and really meeting them with what they consider healthcare, right? My definition of healthcare is gonna be different than yours, gonna be different than Heidi's and really meeting them on where do they see health care for them and and meeting them there, so that we can provide as much care, as they need or desire to have.
Katie White [00:38:29]:
It's a lot around protecting choice, which I think is something we all value and potentially take for granted. And sometimes when you are in the aging community or disability community or low income or maybe you don't speak the language, you lose a lot of your choice and your autonomy. And so this is another program that offers full choice. So before we get to our closing thoughts, my last question is sort of around logistics. So do individuals in the program, schedule out what days they go into the center? How do you know who's coming in and when they're coming in and and how often and all how does that work? Good question.
Jeremy Diaz [00:39:07]:
Yeah. So we create, as I may have mentioned a little bit earlier, during the beginning of the enrollment, they will meet with the 11 IDT members, at the table, and they will create their care plan. We will reevaluate that care plan, every 6 months at a minimum. Certainly, there could be what we consider a participant with a service delivery request or SDR if they want a service that wasn't initially brought upon, during their care plan, and that could be to add or withdraw. Okay. Maybe at first they wanted 3 days a week, to come to our day center and because maybe there was a hospitalization, something ended up occurring in their healthcare, or maybe they're just declining, right, because we, hope that they will come on with us and they will be with us, you know, to their final days. You know, as time goes on, you kinda slow down a little bit more, so maybe it's only 2 days a week. Maybe they need more caregiver hours in the home to be able to be supported at home versus when they first enter the program.
Jeremy Diaz [00:40:08]:
So we'll continue to evaluate and again, adjust their care plan, as time goes on as they're with us. And as they get to learn us, we'll also get to learn them. Right? And and trying to, give recommendations, but ultimately knowing that it's it's their choice. Right? And and meeting them where they are in their healthcare and at that time.
Katie White [00:40:30]:
So and I said that was my last question. And, of course, now it's not. But when you talk about, an individual being with you, you know, till their till their last days, are you able to bring in hospice on top of PACE services, or do you yes. Okay. Yes.
Heidi Webster [00:40:47]:
I I think that there's, the way doctor Glenn Myers, our chief medical officer, talks about PACE as being very palliative, and he comes from that world. And so it is a very palliative model. Like, we we do want to serve and be with that participant until the end of their life.
Katie White [00:41:02]:
Mhmm.
Heidi Webster [00:41:03]:
And I think a lot of PACE programs do serve participants until the end of their lives. But when it comes to hospice care, we absolutely can contract with the hospice provider to bring in an end of life as adding that extra level of touch, extra level of expertise when it comes to end of life care. So we look at it the same as if we were, getting any other specialists involved. And so it's very important that we collaborate, and we can identify actually participants that maybe or a patient that would yo yo in and out of hospice care because sometimes they don't recertify.
Jeremy Diaz [00:41:36]:
Yeah.
Heidi Webster [00:41:37]:
And so who's gonna be watching that person and that individual when they go in and out of hospice services? And this is where we found to be a great collaboration
Katie White [00:41:45]:
Oh, good.
Heidi Webster [00:41:45]:
Because they can be part of that IDT team as well.
Katie White [00:41:48]:
So it's sometimes you're the provider and the payer. Sometimes you're just the payer. But no matter what the challenge or obstacle is, you're tying people to the best suited resource for their needs. Am I getting that right? Love that. Okay.
Jeremy Diaz [00:42:05]:
That's correct. And even on a, you know, a hospice benefit where we think of, you know, traditional Medicare hospice, we would still continue to, you know, have provide oversight, with them. So it's not like they go to the hospice agency and, you know, we fall to the wayside. We're still very active and, you know, a lot of our participants that have been with us for years are receiving those services to a hospice organization. A lot of the times our IDT team is going to the bed side and really getting to see them in their last days, which is a very special moment, not only for the team, but also patient and family. I mean, you see the same nurse that's been coming to your home for 4 years and doing assessments, you know, it's it's truly a special bond and something that, is very unique in, you know, our our healthcare industry.
Katie White [00:42:54]:
Yeah. Become part of their social network.
Heidi Webster [00:42:57]:
Yeah. Yeah.
Katie White [00:42:58]:
So closing thoughts, what do you want listeners to know about old age PACE or PACE in general?
Heidi Webster [00:43:07]:
I would say that this program and all PACE programs are designed to really help individuals live the fullest life possible that they can on their terms. And so our promise to all folks who come onto our program at bold age pace is we want to help you live a meaningful and independent life full of grace and dignity. And at home, wherever that that may be, wherever they call home, we want people to feel like they have a purpose, that they have a community, and we want to wrap our arms around them and care for them as long as they wanna be a part of our program. And and so we're so happy to be a part of now the Columbus community, and we just can't wait to see how this is gonna change people's lives because we know that it does. It really does.
Katie White [00:43:55]:
Thank you. Jeremy?
Jeremy Diaz [00:43:57]:
So what I would like to say is that PACE is one of those models that, again, it's so hard to wrap your mind around because it's so, underutilized compared to other health plans, that are out there, and and really, it's a model that, you know, is certainly, one that should be tapped into. I feel a whole lot more, maybe I'm a little bit biased, but from a bold age pace perspective, you know, we really strive in regards to our mission and vision. Our mission statement is going to be in all of our clinics and day centers as a forward reminder of who we are as an organization. We're a people first organization, not only to our participants, but also our employees who take care of one another. We really seek to understand as well as being bold in the community, and how do we, be part of the landscape of Columbus and those that we serve across the country. So that's what I'm really excited about, and to bring that here right into Franklin.
Katie White [00:45:06]:
Wonderful. Well, thank you both for being here. Thank you for bringing this wonderful resource to our community.
Heidi Webster [00:45:11]:
Thank you for having us, Katie. Thank you.
Katie White [00:45:16]:
I hope now you know something about PACE.
