In this episode of The PACE Playbook Podcast, Dr. Ankur Patel sits down with Shawn Bloom, President and CEO of the National PACE Association, to examine where PACE stands today and where it is heading.
They discuss PACE's growth toward 100,000 participants, the role states play in expanding access, why PACE can reduce reliance on more expensive institutional care, and how Medicaid funding changes may affect programs. Shawn also shares insights on FQHC and health-system sponsorship, supportive housing, caregiver burden, workforce development, the PACE Access Improvement Act, and the leadership practices that distinguish high-performing organizations.
The conversation closes with Shawn's essential play for every PACE leader: understand where your organization is different, where it is better, and communicate that story clearly.
The PACE Playbook Podcast is proudly sponsored by our exclusive founding sponsor, ChorusRx, partnering with PACE organizations to improve patient outcomes, reduce medical costs, and streamline pharmacy workflows.
Shawn Bloom is the President and CEO of the National PACE Association (NPA). He has spent decades advancing the Program of All-Inclusive Care for the Elderly, supporting state and federal policy development, and expanding access to coordinated, community-based care for older adults.
Where are you different? Where are you better? And being able to tell that story. That's really it. I've come off 2 or 3, four weeks of a lot of road work with states, and you've got to meet people where they are. States are there to balance the budget, but they also want they want to buy the best product. Hello and Namaste to everybody. I am Dr. Ankur Patel, geriatrician, author of Age Is Just a Number and most importantly, a PACE fanatic. Welcome to The PACE Playbook where we bring together the people, ideas, strategies and innovation shaping the future of PACE. PACE playbook is proudly sponsored by our exclusive founding sponsor, ChorusRx, backed by innovative science and Technology ChorusRx partners with PACE organizations to improve patient outcomes, reduce medical costs, and streamline pharmacy workflows. I am grateful to ChorusRx for supporting our mission to grow and advance PACE across the country. I'm pleased to introduce our guest today, Shawn Bloom, president and CEO, National PACE Association. Namaste, Shawn, and welcome to The PACE Playbook. Thank you very much. It's really a pleasure to be here again. I look forward to the discussion. Thank you. Like because you actually wear my first guest on my previous podcast. And thank you again for being my guest for this podcast as well. So I hope you bring the same luck that you brought me last time. I will do my best. I will do my best. Okay, so this feels like a full circle for me. We talked few years ago, and that time when we talked about there were nearly 134 PACE programs across 31 state and just shy of 60,000 participants where we are today. Yeah, no, this is a really good moment and a good milestone, I think. You know, thinking back two years, what I to know then, what I know now, I would have been much more excited than I even was then. But we are sitting today with over 200 programs in 33 states and were very quickly nearing in terms of individual impact, to 100,000 enrollees. So it's been a while to that period of time we've grown considerably. That that's awesome. 100,000 participants. And I'm like, not to, but I don't know if you remember. But even when you started PACE in 2000 and I ask you and you, you're the guesstimate was 2 to 3000 in 2000 when you started. We are talking about that 2021, 20, 22 ish with, you know, sight of 60,000. And now we are almost 100,000 to do you think by end of the year we'll hit 100,000 participants? Yeah, I think I think that's our projection, our forecast at this point. You know, when it's worth saying clearly we wish we had more impact. But we are enormously encouraged by what is nearly exponential growth that we've experienced over the last 12 to 24 months. You know, that's what I was. Thinking to like. It sounds like, okay, 60,000 or now almost 100,000. And when you look at this big pool of participants that could benefit from PACE, could be a lot larger. But what. I. Always think about it, it sounds like let's say 100,000 are currently in PACE, but how many participants life might have touched over this many years? Because we all know what one fourth to one third of the PACE participant. Also decent role and most of the descent rule is from death. So even if it's 100,000 participants we serve today, we might have touch million patient possibly or whatever that number will. I'm really glad you raised that because, you know, it's not something we want to celebrate, but the average PACE participant lives in PACE for typically under three years. So if you think about that in the context of our enrollment each year, we're losing almost a third of our population. So you make a very good point to put it in a positive context about the impact we have on, on, PACE participants and their families and their lives. So we do touch a lot more people and have a much broader impact than a snapshot of current enrollment on any given day. Correct. And I always say in PACE, rather than talking about quantity of life, it's more focus on the quality of life, what kind of life we gave them in the last four or 5 or 6 years of their life. But so this is exciting. I'm very excited. I can't wait to see that email before holiday season that we hit 100,000 participants. But you mentioned like 100,000 is great from 134 PACE program to 200. Amazing. But why is 31 state to only 33 states? And what are the barriers for other states to get into PACE? Yeah. So, you know, it's worth noting right out of the gates that, for listeners, I think PACE the PACE is really it's a permanent Medicare benefit, but it were an optional Medicaid service option. So we really do exist at the pleasure of the states. So to that extent, if you understand that, I think it's important to note that, you know, it states really are the determiner determining entity of whether we exist. And even even if they say yes to we do support PACE. They also control and have told me about to what degree people have access within the state to PACE. Correct. I remember you saying that before that certain PACE state has a cap. So even technically, do they have a PACE program? Yes, but they can only enroll X number of participants in any given year. Yeah. Like I recently did. You know in Louisiana I did a statewide PACE summit yesterday. And and you know they've got three organizations. They want to go statewide but they still have some arbitrary caps on enrollment. And I say this hopefully if states are listening that really sends a message that it may not be, it may not be an, an open opportunity for an organization to step into a state new and, and, and make sizable investments to build out PACE if there isn't clarity that they can grow. Have you noticed? So let's say if if there are states with the cap, what will be the advice you would give those states and how they should approach talking to the state representative about how we should remove the cap or or grow? Yeah, no, that's that is a really good question and gives me an opportunity to make a really clear point, because having had those conversations over the years with elected officials, even administrative leadership and Medicaid, a lot of states, rightfully so, will often look at new programs as additive budget. Right. So you will we're establishing a new line item. What's really, really important to note, and I think history validates this, is that if states are successful in seeing people move to PACE, that's a diversionary cost away from in some cases much more expensive, could be twice as expensive in some states. Nursing home use. So we really are a improvement with respect to spending as well as outcomes. Not to mention the fact that the people served by PACE are highly satisfied with the services they receive. Are there any state overall you felt like even from the beginning, not just today at overall, all have done a good job with expanding PACE. Yeah, I mean, I'll point to a couple recent states because they come to mind because they're new. I would say about 3 or 4 years ago, the state of Ohio, I give the governor DeWine an enormous amount of credit, where he used some of the Arpa relief money from the pandemic. And he said, I really would like to build out new service options for frail older adults in the state. So he allocated $50 million, and NPA had the good fortune of being able to work with the state to identify new markets that could support PACE, and the state put in an RFP, and they warded, I think, 6 or 7, maybe eight new programs around the state. And those organizations are moving forward. And I think they're nearly all operational today. And equally so, Kentucky. Kentucky is a wonderful state. I think over the course of 3 or 4 years, they built out nearly approaching statewide access to PACE. So I think states have to move in that direction. And I think the states recently that have have done so, I think with great enthusiasm, not only to improve care but to lower cost. So I one thing that I'm so proud of is you mentioned the Kentucky is nearly approaching to assigning PACE to all the areas as a new Jersey and a proud new Jersey, and new Jersey is the first state in America that has assigned a PACE program to all the counties and all ZIP codes in the state. Yeah, no new Jersey. I probably should not have skipped over a very strong legacy state, as I call it. You know, you go back there, there were several years where we had one program in new Jersey, and the state has very, I think, very intentionally but very systematically built out. They've done an enormously good job. Thank you. So yeah, we are very excited, even at the new Jersey PACE Association level, that also mostly, I hope in 2 to 3 years we'll have all 21 counties PACE program up and running. So we are very excited about that. So staying on the growth point now where do you see has NPA taken any initiatives moving forward in focusing on growth and what we will do? And where do you see growth in next maybe five to possibly ten years? Yeah. So we it's worth noting I think dating back you go back 25 years at NPA and among our what I call kind of four pillars of strategic focus growth has always been nearly at the top of that list. And so we we and I think our first kind of approach to supporting growth was really to do a lot of nearly evangelical outreach to providers. Say, you really need to think about this model of care. It's good. It really delivers good outcomes for the people it serves, so on and so forth. But we realized that really who we needed to convince were not providers but states. And so even today, as recently as yesterday, we go to great lengths to inform states and encourage their consideration of PACE. And then if they choose to move forward, we've got a whole resource set that we bring to bear in supporting their efforts to build out the infrastructure to roll PACE out. Oh that's good. And where do you see if you if you have to take a guess, mate. I'm not I won't I would not hold you five years from now that Shawn you said that. But if you have to guess, he made it five years from now where you think we will be. Yeah. Yeah. And I'll preface my comments. I. I'll give you a very enthusiastic, optimistic view if we continue with this exponential growth, I think in 3 or 4 years we're going to be approaching, you know, I notwithstanding the number of programs, I think the most important measure of our impact is the people served. And it would not surprise me within five years that we could triple. I think that's absolutely conceivable in my if you look at the trend of where we're where we've been last few years and where we're heading, I think it's very, very possible within our reach, the more measured, I think response to the question is many of us know, last summer there was a piece of legislation passed called HR one and that that, that measure, that, legislation is going to make very, very substantial changes to the Medicaid program. And while PACE was not specifically targeted, there was no specific reference to PACE. I think the residual concerns we have are the significant reduction in federal Medicaid matching dollars, which is probably going to be about 15% over the life of implementation of ten years, might have a trickle down impact on states where they may become reluctant to add new service options. Having said that, we're not seeing that we are seeing I could go down the list of states. We're seeing many states move forward very enthusiastically in building out PACE throughout their states, despite what looms ahead in the way of some pretty difficult Medicaid payment, funding constraints from the federal government. So in the simple term, if I'm running a PACE program in new Jersey, how this will affect me then? Yeah, I think as we tell our members, I think it's very, very important to engage the state, understand what they're thinking is and their interpretation of the changes that are taking place to Medicaid and see how they're going to respond. And that response is more than likely going to play out in the legislative budgeting process for Medicaid. And an NPA has developed for its members on its website a whole HR one implementation kind of toolkit and advocacy toolkit. And we have identified states that we think are most at risk. When you look at all the modifications to Medicaid that states are required to make. Not all states will be equally impacted. So it's very important for PACE organizations to really understand their state environment and where states are going to be forced to make modifications, which may impact their funding and overall budget status in that. So it's pretty early never ever podcast. But you started laying out your playbook and that's the reason we started this podcast, right? So it sounds like there is already a play in your playbook which you go to a website. And what part of NPA website the state pays organization can go, because they can also see if how much their state will be impacted or at what risk they will be. So exactly, can you repeat that one more time where they can find that on a website? Yeah. If you go to npaonline.org in the members section, there's a whole it's called HR one hub, and it's really meant to serve 2 or 3 purposes, one to really inform our members about what the impact of HR one is, what HR one is two to really understand, our anticipated impact on the states. And three, it's a toolkit for use by PACE organizations to engage their state and encourage the state to consider PACE a solution to those challenges rather than an additional cost. Because, as we talked about earlier, you know, every every person that moves, that chooses PACE over a more expensive institutional option saves the state enormous sums of money. So we can be a solution. We should be considered a solution rather than a simple cost line item. That is that is awesome. So thank you for sharing the play from your playbook. So staying on the growth side and last time when we talked about it, you know, we talked about that mostly either PACE organizations are standalone or under the the health system umbrella like mine is at Inspira life. But you did mention and I would say you were right actually like few years ago, you mentioned that more effective are getting into PACE. And now today when we see that we see more is getting. But who else few see who else are getting into PACE now. Yeah. You know, if you look over the if you look over the lifetime of the PACE model of care, it began with, I think sponsorship by really community based nonprofit organizations that were really focused on serving the needs of the community. Then we began to see an expansion into other sectors. Hospice. We saw a lot of long term care, traditional long term care provider entities developed PACE. Then we began to see a lot of health systems develop PACE. And then, you know, I would say about ten years ago, there was clarification in federal law that you didn't have to be a not for profit organization to sponsor PACE. And we've seen a substantial growth by for profit taxable organization sponsoring PACE. But to your point, FQHCs I'm seeing the degree of interest among the FQHCs community grow very, very substantially. And it kind of makes sense if you understand FQHCs, the population, the serve their mission and how align. I think the operating models as well as the mission are for PACE and FQHCs. Know I exactly as I learn. You know, we have one here in new Jersey. One of the PACE organization is with and PACE. It's a health system umbrella but FQHCs and PACE. The health system has both. And when I learn more about FQHCs and I was thinking oh my god. FQHCs, pretty much the similar population that I would say somebody joining the PACE program today would possibly and should be an FQHC patient like five years before that and after five years when the social needs increases, especially with not able to get to the Doctor. So they need more transportation, they need more help in the home. When that comes in, they are most ideal transition to PACE. Yeah, I think it's a, we've done a lot of work over the years to really look at what are what's kind of the architectural framework of a good sponsor, a PACE. And I will say personally, I still always circle back to cease, I think are organizations that are really ready. They're capable and and again, mission alignment, a lot of mission alignment. And mission I agree. Are you concerned. So let's say if we are and I hope you know you're right in this and I'll be like rooting for you is tripling the senses, you know, over the next five years. Are you sometime concern of overall like if PACE grows exponentially, we will lose our mission at some point? Yeah. No, that's a really good question. We one of our new strategic planning goals is to kind of go back to where we started, as I call it. You know, one of the foundations of PACE early on was to really understand and honor and uphold the integrity of the model, because as I, we we just did an update for members today and I made a statement about we need to remember where we came from, the, the the the we are enjoying the success of our reputation right now. And our reputation is really built on achieving good outcomes and being trusted and accountable to the care we provide and the good outcomes we achieve. We need to kind of maintain some truth to that. So we are in the process of trying to understand and clearly document what is the fidelity of the PACE model, because we do we have something very unique and very effective here. People like IT. Providers do well at it. I think, taxpayers save money because of it. There aren't many win win win scenarios in this country, and it's a model care that we really need to protect and uphold. You know, I don't know if you know that, but as a geriatric, I call PACE is a Disney World for geriatrician where all your dream comes true. And literally I feel like before, every time it's like I'm discharging a patient or taking care of the patient. Every time I mention it's like, oh, I wish I had a social worker, I wish I had a PT. I wish I the patient could have gone to a Doctor and have transportation. I wish they can afford their co-pays. And everything that we talk about is is in PACE model of care. So for geriatrician is always remember it's a it's a Disney world for us but in peace. One thing that always like we have answers to a lot of the things when it comes to determinants of health, housing is one of the things that I feel like, you know, it's not in our hand, and then we feel like, okay, participant will lose a house or they're homeless. We want to help them. But how so what are your thoughts? One in housing side what she's doing and also the article about health affair that you know that a lot of people may not have read it. So if you can explain them, like about the housing, the continuity of care that are possible, participants can get more in a in a simple language for everybody. Yeah. You know, I think as a country, I think we have done and we're doing increasingly a good job at honoring, I think, the wishes of older adults to remain living in the community as they age. It stands to reason that a major factor in our success in achieving that evolution is consideration of housing, as we all know. You know, in this country, healthcare is kind of over here, you know, if you need assistance with housing or fordable housing, it's kind of over there. It's been very little relationship between the two from a federal and state policy standpoint. And I think there's growing recognition that for us to really, succeed in honoring people's wishes to stay in the community, which happens to be more typically, more cost effective. We've got to really consider, I think, the housing piece. So we are beginning to see, I think, expanded interest among the PACE community and either establishing collaborations with housing or even moving into partnerships where they may build housing. And, there are many good examples around the country of that. So I just that's an area where I think we could do a whole podcast on not only the importance, but I think the strategic imperative for not only senior housing, but for PACE. And then we could also kind of dive into what are the characteristics of individuals that lead to perhaps premature institutionalization. In many cases, that could be insufficient safe housing. They could be that their housing is unaffordable or it's simply not safe. So housing is really important. Yeah. And then you did mention and coming to the the Health of fair article about creating the whole continuum of care for dual eligible. Where you see that going. Yeah. No, I, I think that it's a really smart article. And you know, sometimes when you have these thoughts and considerations and you haven't really been able to articulate it, or in my case, I'm not a researcher, I did not have the credibility to advance these theories. And all of a sudden something comes out. So if you look at the parallel, a fee for service for older adults, we've seen a growth and a creation of the continuum of care for older adults and what I call the fee for service sector. You know, many, many years ago you had nursing homes, which were the tip of the spear. And we said, you know, maybe we ought to develop something a little bit less. And we had assisted living and and there was the natural marketplace, marketplace tension and it which tended to say either or. And then we began to build out community based services in the way of HCBS. And again, a little bit of tension. But I think what we learned through that process is it's this isn't my individual to serve or your individual to serve. We have an array of services through which people progress, and it is truly a continuum of care. You know, there is a kind of principle in aging care called the least restrictive environment. Right? And you've got to bring the right service to the right time. So if you take that kind of concept for years, I think managed care has either been PACE or an insurance company, you know, Medicare Advantage or PACE or Medicaid, long term managed care or pay. And I have argued for years that we we are really not organized and I don't I and I think we're a little overdeveloped for what I call dually eligible individuals that have minimal health needs. Now, can we serve them? Yes. But I don't think that we're designed to serve that population. I think alternatively, many of the health plans, you know, they they do a great job serving certain segments of the dually eligible population. But I'll go on to lemon say, my observation is I think they really struggle. And evidence indicates their outcomes are nowhere near as good as they are in PACE and serving individuals that are nursing home eligible. So the article really does a good job at laying out. We got to quit thinking about these things as single solutions and think of them as a diversified system of care and a continuum of managed care, integrated care products along the way. Yeah, it's always exciting to see every time in PACE when we talk, even within one year, I feel like there's a lot of new things comes either if it's on the vendor side, PACE, organization side, people are trying different things. But what I love most about NPAs and coming there is the excitement of people about loving and serving the community and to that point, about preserving what we believe in, PACE and what they should be like when we are growing, as a lot of new people are coming into PACE. And that's what I feel like the stories can happen that because a lot of us either, you know, have you are one of the example on the NPA side, on PACE organization. We know a lot of Doctors and administrators have worked in PACE for a long time and just getting their stories that what kept them in PACE, because I felt like today's PACE. I feel like a lot of you all have helped us creating a great foundation for us. The struggles are there, but not anywhere close to what you guys had, the struggles in the early 2000 and now it's for us is like the foundation is there. How can we build the building on top of that? Yeah, no, that's a really good observation and I appreciate it. And and over the years, there have been a lot of individuals and a lot of organizations that have really helped move this along. But I, I'm very fond of I first off, I think we should acknowledge that I don't think there's broad consumer awareness of PACE, and that may look like some to be a challenge. I think for me that's an opportunity. And then if you look at PACE organizations, brand names, they're quite variant. You know, when you read them. I think for an uninformed consumer, very few people can associate that with PACE. So what's the what's the opportunity here? The opportunity I think, is the degree of passion and excitement among people that work in PACE is very significant, and I think a lot of people don't know what to do with that at times. And my strategy over the years and I've tried to kind of repeat this is tell the tell the story, you know, associate the name PACE with some stories, but you have to meet people where they are. And my experiences, you can't go out. You can't, you know, force down someone's throat a definition of PACE. That's not the right way to learn about it or access to services. Easy. And is the cost affordable? No. And I think, well, there is a there's a possibility here and it's PACE and it gives you an opportunity to meet people where they are, understand what they're struggling with. And PACE is really presented as a solution. Tell the story, describe it as PACE and keep telling people. And to your point, you know, a lot of times we always our focus is, you know, serving the participants. But indirectly, we might have served a lot of caregivers like, you know, that that is something that, you know, especially I always say, being an in a sandwich generation right now, having a ten and a 12 year old, boys and aging parents and their need comes in, I felt and me and my wife are just talking. I think this part of our life is, I think, one of the most stressful part of balancing. And then you in your own career, you are growing to somewhere at that time, your career. You are growing, your kids needs you, and you need to be there for the baseball game and teach the baseball game and and coach it. And then your parents need you. And even I'm saying I'm a geriatrician. I have all the connections in South Jersey. I have Doctors number that I can text them and say I need help for my mom, right? Still, it's stressful. So think about a normal caregiver that we can serve and deliver, which is amazing. And 1 in 4 caregiver usually rate their own health to be fair to poor, right? And I have never seen a healthy participant if the caregiver is not healthy. If you plug that in with what I call the demographic realities of this country, you know, we all, you know, in particular, the the majority of care delivered in this country are by caregivers, family, unpaid caregivers. Correct. Families, friends, siblings, children. And if we look at the growing numbers, I think, what is it? By 2040, 22% of this country will be by individuals over the age of 65. Individuals over the age of 65 have a 70% chance of needing long term care at some point in their lives. Yes. Doesn't take a lot of math skills to realize this is going to expand as a need in our country, and we have to honor the caregivers, which are going to be, by necessity, be brought into these circumstances. So we have to be mindful of our our support for caregivers as well. And I'll just make a last point. And to the audience, I'm totally going off script because this was not part of of what I was thinking, but this is amazing conversation that is going on because also when unpaid caregiver and also that's also a survey out there that 1 in 5 caregiver rate their financial health very poor. I think you read the same study I did. Yes. And then on top of that, so what we are seeing too, right now, they are seeing each participant or each patient, you know, in the community will have directly or indirectly, seven caregivers. That means it will be me, my sister, my wife. But sometimes my cousin will help if I need. Right? But what's happening with the migration and post-Covid? People can work anywhere and people are more migrating out, more out of state. They don't want to take out, take their parents out of their social environment to a new state, and that number of seven will reduce to four, directly or indirectly, caregivers. If you are thinking about caregiver burnout today, think about five years from now. Yeah, you make an observation. I think that is lost in the discussion of caregiving burden. And it's this whole social network migration. Kids move. You know, we're no longer a three generation, agriculturally focused society. You know, we're very mobile, professionally transient. You know, I mean, I'll speak from personal experience. I've got an older mom living in Kansas, living. I've got a dad living in Florida, and I happen to be an only child. And and, you know, fortunately, my kids are grown, but still taking care of two older adults and two different states remotely is difficult. Yeah, you're right, it is. And I think you're going to see more and more of that. Yeah. You can have a geriatrician fond of French and you can give me a call for advice if you need a wise. So going back we were talking same thing. Right. The PACE and connect the story. And you know, as much as I used to take it as a compliment that, you know, when we used to call the past is the healthcare's best kept secret for years as like, yeah, and it shouldn't be a secret. But I'm like, you know, at some point now I'm thinking it is the best model of care. I know it, we all know it. I think PACE now in future should be influencing other health organizations and other health systems, and that's what we want to see. And hopefully with this podcast, we can do that too is not just the best kept secret, but we want to, like other people, come to us. Why can't the Medicare Advantage plan or any other managed care program come to us and be like, teach us how you guys are doing it? And that's what. So if you had to put a date or ears like when you see, we will start doing that. Yeah, I really like your questions. You have a you have a lot of you've been doing this a while on it and I can you know, it shows you have these insights and I think that's the right way to think about it because I part of it is awareness. And this is not only on terms of other health care providers and sponsors, but I think consumers. But on the health care provider side, I think we've got a care delivery model, which I think is second to none. And I think there's opportunities also to bring to bear the principles of PACE and, and in particular, the it functions into other approaches to care. No doubt about it. I could I could lay out several different, care models that have really been informed by PACE. But I would say, I would say within 5 to 10 years, there's going to be a recognition that that PACE should be a goal, should be a gold standard by which we measure our operational effectiveness and our ability to achieve good outcomes. That day will come. Yes. Can't wait for that. And so what is what's going on? New in PACE at NPA. Like what makes Shawn Bloom excited every Monday morning? Yeah. So in addition to the growth, I feel like we're, you know, used to put one degree of input led to it was, you know, the proverbial ten steps forward, nine steps back, a lot of effort to a very small increment of progress. Today, I feel like our efforts and it's not just hours, but I think everyone's are yielding heightened awareness, heightened appreciation, growth. And I think respect for the PACE model of care that I'm very, very, very excited about that. And I'm also excited about our ability and in some ways, our mandate to serve a new generation of seniors in a way that is perfectly aligned with their preferences, yet substantially less costly than service solutions we had ten, 20, 30 years ago. That excites me. That that is amazing. And then maybe one more thing. We we we we we for years have been talking about, as we all know, if you look across older adults, there aren't this bifurcated subset of older adults nursing home eligible, and all the others are perfectly fine running marathons. Right. It is a continuum of decline whether we like it or not. That's what happens. So I say that because people don't just wake up one day and say I'm nursing home eligible and I'm going to PACE. There are a lot of individuals that reside outside the boundaries of eligibility in every state that I think could benefit from PACE. Now we need to think about them differently, what their their preferences may be different, but I we're excited about the potential to really test that question potentially in a pilot. With CMS. And so we we've offered a lot of input. And so I think that if we succeed in seeing that pilot initiated and if we see success in making an impact at slowing the decline and even slowing the spend down of individuals that are residing independently in the community, I think we will have contributed something that is very, very significant on top of what we do today. Thank you. And I'm glad you brought up CMS. Just, you know, few questions regarding, you know, Washington to Main Street. Pay. So, you know, things are happening in Washington, you know, things changes. New bill comes, what is going on in Washington? That is something that we all should know at CMS level, Medicare level, or anything that you feel that it's very important for our audience to know. Well, just recently we've had bicameral bipartisan introduction, the PACE Access Improvement Act and the PACE Access Improvement Act. Would would I identify or includes a lot of barriers that we've identified for PACE, growth and expansion, as many people may or may not know, when a person chooses to enroll in PACE, they've got to wait till the first next month. And if, if, if any of you in particular, but we those that have been involved in care for the older adults, a lot of people that come to PACE, come to PACE after an event and the notion people have to wait in some cases up to 29, 30 days, I think we can do better. So this would allow for any time enrollment. So it's quick as a person deemed eligible they can be served, payment would follow, so on and so forth. It would also make substantial modifications to the PACE application process that would make more efficient the establishment of new or growing existing programs. So it covers a variety of different addresses of different obstacles that we've identified standing in the way of expanded PACE access. But does that so let's say at the federal. Level, if they say that we can enroll participant any day of the month, how that works on the state level in new Jersey, can I start doing that? Or they will say, well, our Medicare, Medicaid, you can't do it. Yeah, I think I got a lemon. Say, I think states are likely more interested and more capable to make those changes. I think the real obstacles exist at the federal level under Medicare, because the whole enrollment process in PACE is done within the functional context of Medicare Advantage, which is really months to months. So I think it would compel CMS to make systems modifications that would allow for partial month capitation based on the number of days they've been served. Okay. So definitely, you know, the PACE community is always a good buzz when you see, you know, a celebrity Doctor is going to PACE centers like Doctor Oz has been to AtlantiCare PACE program in new Jersey. You know he has been to On Lok in California. Yeah. He's been he's been in several programs that are in fact what's important to note on the his first day in office as the CMS administrator, he went to On Lok. Yes. Is it that awesome? So that's a good buzz. So so even when we had him, as of our keynote speaker during the spring conference, there was a good buzz in it. Any back stories about how we were able to get him? What did we tell him? He just, you know, for what it's worth, seen as believing. I think those of us in the PACE community really get that. So it has been a tradition of CMS administrators dating back at least ten years or longer, their first day in office. They typically go to On Lok. And so, he Doctor Oz, you know, he's a clinician, he's a thoracic surgeon. And I think the more likely you've got a, you know, a background in clinical care, the more likely you're going to push PACE. Like similar to what you said. It's like a geriatrician Disneyland. And I think he's all he saw that. And then if he even if you go to non clinicians there was a by the name of Andy Slavitt. Yeah. During the pandemic. And if you want to see something really interesting Medicare turned 50 while he was CMS administrator. And he had a very big national event at HHS. And one of the main points he made is he said, I have seen the future of health care for older adults in this country, and it's PACE. And it is. Getting CMS administrators involved in PACE really helps to garner their support, and we're really looking forward to working with Doctor Oz. He's demonstrated a great degree of enthusiasm. He's got some really good ideas and that's great. And we're working very closely with him in particular on also deregulation to lower the administrative burden and PACE. So, okay. Is that what keeps Shawn Bloom up at night. Making what keeps me up at night? Growth is good, but growth without good leadership and commitment to really operate and stay true to the PACE model, you know that that that concerns me a little bit. And I think it's true within the industry when you are a relative and I still think it's relatively new, we're a proven model, don't get me wrong. But I think we we have outPACEd the number of trained professionals to operate PACE, and I think that will catch up. But right now, I think we really want to do all we can to offer resources and training for new PACE leaders and leadership teams. So that keeps me up a little bit. My favorite always when I was in new medical director in PACE and what helped me the most in PACE was the summer conference, the medical director conference that we did when that's the time I met, you know, Doctor Padula, Jim Padula, I met Adam Burrows, like, you know, everybody, Dave Windsor, like everybody that, you know, somewhere micro-mentored me along the way, a lot of them even knowing or not knowing, just following them, learning from them, what kept them in PACE and going that that tremendously helped and shaped my life. And then, you know, even on the on the now, being an administrator, running a PACE program give a lot of great leaders before me has done great work. And I feel like you don't even have to like, invent sometimes a new we'll just, you know, copy and paste that what has worked in PACE. And I felt like also our PACE people who work in PACE and geriatrics are also like tend to be more on the humble side. And this is what I want to do with the podcast is share your place that work. I know that you are being humble, but when you are staying humble and not sharing it, people don't know. Share your place with us. We can put it in our playbook so other people can learn from from this. Thinking about it like, you know, when you see this, you have seen PACE grow tremendously. What separates a really high performing PACE organization from everybody else? I think it's simple to say this, but it's really leadership. But I think it's leadership with the with the vision toward the future. You know, I mentioned I've been doing a lot of work with the states and states that really want to expand access to PACE. It's interesting. They have identified we would like to partner with organizations that are thinking two, three, 4 or 5 years out, not just about the next step of developing a program. What is the business plan to build out in that market? So I think I think the definition of a very high performing PACE organization are one organization that really values leadership, forward thinking leadership, two, that's an organization that will never grow faster than their systems of care will support. And three organizations that recognize the importance of strategy in their local environment and their state environment, because it's changing, those environments are changing a lot. And when you see those three things, forward thinking organizations, I can name many. They do very, very well. But I would say those are the common characteristics. Okay. Are there any developments going on in PACE that either you want to share or you think that on the other side, people who are running PACE programs should more talk about that? We are not talking right now. Yeah. I think increasingly, you know, with improved data and improved measurement systems of outcomes and cost reveal opportunities for PACE to potentially serve other individuals. And what I mean by that. Imagine a big health system that's operating in ACO. And they've got a lot of people in the ACO that might do better in PACE. So if we could identify what are the characteristics and what, you know, how do we stratify that population and identify a subset of the ACO enrollees that would do better in PACE? And yeah, this is kind of real life. I think there's enormous opportunities, enormous opportunity to surpass. So I'm just thinking right now that health system run PACE organization. Most of the health system has their ACOs. They have the data. So it's more breaking it down possibly. Which one will be the one qualifying for for PACE at some point of time? That's a great advice. So Shawn this is The PACE Playbook. So I have to ask you this. What's one play in your playbook that you think every PACE leader should be running right now. Yeah, I think it's really understanding the strategic advantages of PACE. Within the marketplace. Where are you different, where are you better. And being able to tell that story? That's really it. I've come off 2 or 3, four weeks of a lot of road work with states, and you've got to meet people where they are. States are there to balance the budget, but they also want they want to buy the best product. We have to make the pitch that we're the best product. However, you may do that. So so working with the state is very close and very important to do that. Before we go towards the end of our podcast and, you know, get into our rapid fire question, is there any question, if you were sitting on my chair that I should have asked you that I didn't ask you? You're a very good interviewer. And you again, you have special insights because of your long experience and PACE. So I. Hope that's awesome. So now we'll get into our rapid fire round. I'll ask you five questions and you can answer in 1 to 2 sentence. So you're ready. Okay. What one leadership lesson you learn the hard way. These are scary questions. Yes. So I would say I think most any leader by necessity, you have to kind of be willing to be courageous and move forward. You can't spend four days thinking about the solution, but you don't have to do it alone. So the biggest lesson for me, I don't have to do all that alone. And and changing that mindset, especially coming from small to a growing organization, I don't care whether you're running a convenience store PACE or NPA, you have to change mindset. You have to evolve. It's it's as much about the organization around you as it is about you. Okay. Great answer. Describe PACE in one sentence. Good care made simple. We and I should be more adherent to our typical playbook, but we are a proven and we are proven model care that is recognized as one of the best models of care for older adults. That's great. If you get a magic one and can change one thing about PACE, what would it be? The regulatory structure around it. You want to possibly expand that one multiple times for that. Yeah. Trying to think here I've taught of these things. But but I think, you know, our mission is to expand access to PACE. But I think the regulatory structures around it are very antiquated. They're very well intentioned. But I think there's a better way to do it. Correct. Correct. I always say regulations are always made with good intention. It's just they don't see what happens in the in the side effects of like a medication. So this is something I was even laughing when I was, like, typing this questions because you ain't PACE for so long. So if you weren't allowed to save the word PACE for an entire day, could you actually do it? That's a good question. I mean, I probably no, I don't think I have the discipline to do that. Because I, you know, it's so top of mind for you as well. I'm sure it's always here. It's always PACE. I would commit to trying. I would not promise success. Let's start with a week end, possibly, and see if it works. The last one. If you could have dinner with anyone, any person living or dead, who would it be and why? Oh, yeah. That's a that's kind of an easy one. Marcus Aurelius. Okay. Okay. And and it would be because from, just from a personal leadership standpoint, he, he was a selfless leader. You know, he kola the Roman Empire. We're talking 100 to 200 A.D.. He co-led with his brother, who he was not in tension with till his brother died. He had to fight multiple wars. He had to protect the city. He he he, in a very respectful way, led his, community or his country through the plague. And it's mostly about who he was as a person. Stoicism. He was he really he had this deep, deep principle that you should you can only change and only worry about things over which you have control and everything outside of that, you should acknowledge and understand, but you need to be mindful. You could spend a lot of emotional energy and a lot of baggage in that area. Really figure out things over which you have control and focus in that area. And, you know, be honorable. Be fair. It's just the principles of stoicism are very solidly based, and I've always respected him. You did. You did amazing. Shawn. So we are at end of the podcast. Well, thank you, Shawn. It was a pleasure speaking to you. And thank you for being my guest. Thank you so much. And I cannot tell you how much I appreciate it after two years. So thank you very much. That's awesome Shawn, thank you to everyone listening. Thank you for being part of The PACE Playbook. The PACE Playbook is proudly presented by our exclusive founding sponsor ChorusRx. Thank you to ChorusRx for supporting our mission to grow and advance PACE across the country. If you enjoyed today's episode, please follow or subscribe The PACE Playbook on whichever platform you are listening on so you will never miss a new episode. And if you found this conversation valuable, please take a moment to rate the podcast and share it with your colleague. It is one of the best ways you can help us grow the PACE community. Keep learning. Keep sharing. Keep innovating. And together, let's continue advancing the future of PACE. Until next time. Namaste.
