missed a session or want to pass along to colleagues?
DESCRIPTION
Missed a session or want to pass along to colleagues?. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/1.jpg)
![Page 2: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/2.jpg)
Missed a session or want to pass along to colleagues? Purchase the VALUE PACK:
Full access to 200+ education session audio recordings and PowerPoints (as released by speakers for inclusion) – so you can gain access to many more sessions than you can
attend.
Pricing: $300 for 200+ sessions, $75/track or $25/session
Stop by Registration and ask for a Value Pack order formor visit www.leadingage.org/livelearningcenter
![Page 3: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/3.jpg)
PACE: A New Line of BusinessHow PACE Works
Session 211-POctober 15, 2011
Dan Gray
![Page 4: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/4.jpg)
Agenda
• Participant Net Growth Rate• Rates and Participant Payer Mix• Capital Costs• Operating Practices• Contracted Services• Financial Performance
![Page 5: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/5.jpg)
Participant Net Growth
• Most critical and difficult to predict
• Many factors interrelated (access, approval process, eligibility, community perceptions)
• Death rates (increase in years 3-5)
![Page 6: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/6.jpg)
Participant Net Growth
• Competition—real or perceived
• Marketing—reaching potential participants
• Gatekeepers—Division of Aging, AAA
• Financial Eligibility—100% to 300% of poverty level
![Page 7: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/7.jpg)
Participant Net Growth
• Greater initial enrollment (accelerate break even)
• Staffing for growth (assessment and timely additions of staff)
• Timely expansion of adult day health center capacity
![Page 8: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/8.jpg)
The Numbers
Statistic Experience Minimum Impact
Net Growth
1 to 14 per month
3 Five-year impact of achieving 5 instead of 3
Doubling of cash and operating income
Initial Census
1 to 20 participants
5 First year impact of opening with 20 instead of 8
Breakeven occurs 4 months earlier and operating losses drops by $500,000
![Page 9: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/9.jpg)
Rates • Medicaid rate—negotiated with the state
and usually has a rate for dually capitated participants and a separate rate for Medicaid only
• Medicare rate based on participant’s medical history and frailty
• Pharmacy (Part D) requires actuarial determined rate
![Page 10: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/10.jpg)
Payor Mix
• Higher capitation for ESRD
• Lower rate for Medicaid only
• Documentation dramatically affects Medicare rate
![Page 11: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/11.jpg)
Medicare Payment
Based on diagnosis plus frailty factor Medicare risk scores ranged from 1.672
to 3.424 based on January 2010 PDAC data
Average risk score=2.44 Improvement of .10 in risk score equals
approximately $100 PMPM
![Page 12: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/12.jpg)
Medicaid
![Page 13: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/13.jpg)
Medicare
![Page 14: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/14.jpg)
Capital Costs
*Range due to relationship between building condition and capital requirements
Component Expense
Adult Day Center
Build
Purchase
Lease
Capital Improvements
$4M to $15M*
$1M to $3M*
$3 to $30 per SF/year*
$900K to $2.3M ($60-$150/SF)*
Vans $45 to $50K each
Start-up Costs $500K to $1M
Operating Losses $500K to $4M
Cash Reserves $500K
![Page 15: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/15.jpg)
Capital Costs
• Reserves based on 30 days capitation revenue and contractual costs (approximately 12% of net revenues)
• Adequate Reserves– Cash– Guarantee– LOC
![Page 16: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/16.jpg)
Operating Factors/Practices
• Participants living alone—5 to 40% (dramatically affects costs)
• Prevalence of specific chronic diseases– ESRD– COPD– Behavioral
![Page 17: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/17.jpg)
• Primary care effectiveness
• Team Performance
• Day center attendance
• Day center expansion—mitosis or start from scratch
Operating Factors/Practices
![Page 18: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/18.jpg)
• End of life care
• Caregiver support
• Participant noncompliance management
• Review all hospital discharges and readmits within 30 days
Operating Factors/Practices
![Page 19: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/19.jpg)
Contractual Services
• Hospital—rates and utilization significantly affect financial performance
• Nursing Home—utilization
• Assisted Living
• Home health/home care
• Specialists
![Page 20: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/20.jpg)
Total Capital Investment $1M to $5M
Operating Margin 5% to 15%
Break Even 6 to 18 months
Program Revenue intensive for minimal investment
Financial Performance
![Page 21: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/21.jpg)
Total Income
![Page 22: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/22.jpg)
Total Expenses
![Page 23: Missed a session or want to pass along to colleagues?](https://reader035.vdocuments.mx/reader035/viewer/2022062422/56813080550346895d965aa7/html5/thumbnails/23.jpg)
Operating Margin