Fallon Health celebrates historic milestone

Worcester, Mass., March 27, 2014 - Fallon Health, a nationally recognized, not-for-profit health care services organization, joins caregivers across the country celebrating a historic milestone in the growth of community-based care for seniors. With the opening of four new programs this month, the number of Programs of All-inclusive Care for the Elderly (PACE) now exceeds 100. PACE, which was developed in San Francisco in the 1970s, helps to keep nursing home-eligible elders living in the community.

“The story of PACE is a rarity in today’s health care policy environment,” said Shawn Bloom, president and CEO of the National PACE Association. “PACE is a commonsense approach to providing care to older people that was rigorously studied and tested and then able to become a permanent part of our health care system. We don’t often see successful innovations allowed to thrive and grow like PACE.”

PACE programs bring together a coordinated team of doctors, nurses, social workers and therapists to provide seniors with an individualized care plan that addresses each person’s unique medical care and social needs. The result is higher quality care and far more favorable outcomes compared to traditional care options. More than 90 percent of PACE enrollees reside outside of nursing homes.

“In Massachusetts, Fallon Health is proud to have led the way in senior care services with our PACE program, Summit ElderCare®, which we’ve offered for the last 19 years,” said Richard Burke, President of Senior Care Services and Government Affairs. “Today, Summit ElderCare is the largest PACE organization in New England and the fifth largest in the nation.”

“Fallon’s PACE program has helped thousands of individuals and their families by providing an innovative way to keep older individuals in the community for as long as possible,” said Dr. David Wilner, Summit ElderCare Medical Director.

The PACE model was developed in the 1970s in San Francisco by On Lok, a community-based organization serving Chinese and Italian American neighborhoods. Marie-Louise Ansak, a health care consultant, developed the model with the goal of allowing elders to remain in their communities for as long as possible. The PACE model was so successful it was studied by the state of California and federal health care policy officials.

Support from the Robert Wood Johnson Foundation and the John A. Hartford Foundation led to the development of a Medicare Demonstration Project and start-up funds for different types of sponsors to develop PACE in their communities. Fallon Health was one of the first health insurers in the country to participate. The success of 15 PACE replication programs led Congress to pass legislation creating PACE as a permanent provider type as part of the Balanced Budget Act of 1997. Just this week, President Obama’s 2015 budget proposal seeks to extend the role of PACE by calling on Congress to create a PACE pilot program for people under age 55 who need long-term services and supports.

PACE is unique because it integrates care delivery by directly providing all medically necessary care and services through an interdisciplinary team, transportation system and PACE center. Using a bundled payment model, PACE serves high-need, high-cost individuals, who require daily hands-on care.

There are now 103 PACE organizations operating in 31 states. As the only health plan in Massachusetts that is both an insurer and a provider of care, Fallon Health operates its PACE program in six locations in the Commonwealth: Worcester (two sites), Charlton (two locations), Leominster and Springfield. For more information, visit summiteldercare.org.

Carrie Wattu
508-368-9345

About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products.