PACE 

Service Offering Playbook

Introduction

Qualicare as a Learning Organization

A learning organization, a term coined from the work of Peter Senge, is a company tha facilitates the learning of its members and works to continuously transform itself. Learning organizations do not organically develop but are intentionally created in order to stay competitive in the business environment.

As you know, there are a number of competitors in the home care space and it is critical that Qualicare learns faster than our competitors and at speed with the industry. For any learning to take place, it requires a diffusion of knowledge and experiences from the network, and a subsequent systemization of that knowledge for others to implement.

This continuous inflow of new experiences and knowledge keeps Qualicare dynamic and prepared for change. It is also how we can ensure we are providing the Breadth of Service, Depth of Care that we promise to our stakeholders.

How to use this playbook?

This playbook has been created in collaboration with past and current Franchise Partners in the Qualicare network. Through interviews, deep dives and collaboration with Franchise Partners as well as research in the external market, this playbook was created to provide a framework for marketing, selling and delivering a specific service in your business.

In order to use this playbook most effectively, it is recommended that you review each component of the playbook before implementing. The playbook has been broken into four main categories:

1. Marketing – learn the best practices to effectively market this service in both direct and indirect marketing sources

2. Sales – learn how to sell this service to a prospective client at each stage of the sales process

3. Care Delivery – understand the best practices for preparing your caregivers to deliver a high-quality service to your clients

4. Data – identify key metrics to track to ensure you are receiving the best ROI for your business with this service offering

Note - It is important that every Qualicare location research their own local market as there may be geographical, economical, and market differences at the local level. This playbook provides you with the initial framework that you will be able to build upon in your business.

Home and health care is a fast-paced industry with changes happening on a regular basis. As applicable, with validated resources and a data-driven focus, updates will be made within this playbook. 

Qualicare Code of Conduct

The Qualicare Code of Conduct is a set of client-centric standards that are the foundation of the Qualicare Brand Experience. The Code describes the behaviors and actions that, when delivered consistently by our franchise partners, link the Qualicare brand promise to the building of our brand reputation. This Code anchors our mindset and interactions,-bringing our company to life-and giving practical meaning to the Qualicare brand.

Qualicare’s Code of Conduct

1. Be proud of our brand promise and deliver ‘Depth of Care’ – Our brand promise is an idea that lives beyond words. It is something we wear over our hearts and drives our commitment to our clients every day. We exceed expectations with every action and demonstrate a sincere concern for the people we care for.

2. Serve clients with daily acts of kindness, empathy and gratitude – Believe that everything we do in the act of providing care will make a difference in the lives of our clients. Understanding we can improve their lives with simple, respectful actions is the foundation for care that they seek and deserve.

3. Establish health and safety as obvious matters of priority – From day one, our clients should feel that they are in careful and thoughtful hands. Make sure that everything we do while providing care is informed by the latest professional safety information and protocols.

4. Make every interaction with clients an opportunity to create a brand difference – Our everyday actions while delivering care are the most powerful form of marketing we can invest in. From the way we say “hello” to how we leave a client’s home adds value and uniqueness that makes us stand apart from our competitors.

5. Practice immediacy in the moment – Our client’s well-being and time is a priority. Your undivided attention and sincere concern demonstrates a respect that will reinforce trust while providing care.

6. Commit to requiring clients to tell their story only once – Building trust starts with

listening and remembering what’s important to our clients’ well-being. People want to

know that they’ve been heard and that their concerns are always a priority.

7. Communicate with clients on their terms and in the way they want – Trust and understanding starts when we pay attention to how our clients feel when discussing their care needs. Create a relationship that is customer led and founded in listening.

8. Always be prepared to adjust to client needs – Every client is different. Approach each relationship with an open mind and commit to creating unique care ideas that are responsive and sensitive regardless of what we offer.

9. Remember and respect the difficult journey clients are on – Our clients live with issues that affect the quality of their lives every day. Every conversation should start with what they feel is important – only then can we deliver effective care.

10. Honor the completion of our work for clients – Providing care to our clients is both meaningful and rewarding. Letting them know what a privilege it was to help them build a foundation for the future reinforces the idea that they are more than just a client and we are more than just a company.

Throughout this playbook, you will find examples of how to utilize the Qualicare Code of Conduct within this service offering.

Program of All-Inclusive Care for the Elderly (PACE)

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PACE and Home Care

Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE programs coordinate and provide all needed preventive, primary, acute, and long-term care services so that older individuals can continue living in the community.

PACE serves as both the provider and insurer for participants, thus PACE programs typically deliver most services directly. However, when necessary, PACE programs may contract with other healthcare and service providers to meet the needs of their participants.

Here are the steps a home care agency in the United States might take to get set up with PACE:

1. Understand the Requirements: PACE has strict requirements to ensure quality of care. These requirements cover both organizational and clinical areas. Before getting started, make sure you understand what the program involves and what will be expected of your organization.

2. Prepare your Application: You'll need to provide a detailed plan of how you'll meet all PACE requirements, as well as how you'll provide all necessary care. This includes things like having sufficient staff with the required qualifications, ensuring access to necessary medical specialties, and providing transportation for participants to the PACE center.

3. Complete a Trial Period: Before getting a permanent contract, your organization may need to complete a trial period. Each PACE program has to be compliant with Medicare’s and Medicaid’s requirements, and PACE is responsible for ensuring their providers (e.g. Qualicare) are compliant on care delivery.

4. Await Approval: If your application is approved, you'll receive a three-way contract between your organization, Medicare, and your state's Medicaid program. You can then begin providing PACE services.

5. Comply with Ongoing Requirements: Once your organization is providing PACE services, there are ongoing requirements you'll need to meet. This includes reporting data to Medicare and your state Medicaid program, as well as participating in regular audits.

Keep in mind that the above steps are only a general guideline. The exact process and requirements can vary by state. It's crucial to contact your state's Medicaid office or the CMS (Centers for Medicare & Medicaid Services) for the most accurate and detailed information.

Additionally, keep in mind that PACE organizations are expected to provide a very wide range of services, and the bar for quality of care is high.

Becoming a Preferred Home Care Vendor for PACE

Here are the steps a home care agency could take to become a preferred vendor for a PACE program:

1. Understand PACE: The first step is to understand the requirements of PACE and the specific needs of PACE participants. PACE is designed to help older adults stay independent and living in their own homes for as long as possible. This means services must be of high quality, reliable, and suited to the needs of older adults.

2. Contact Local PACE Programs: Reach out to PACE programs in your area to express your interest in becoming a vendor. They can provide you with information on their process and requirements.

3. Align Your Services: Ensure that your services are tailored to meet the needs of PACE participants. This could mean offering specific types of care, adjusting your hours, or providing additional training to your staff.

4. Prepare a Proposal: You'll likely need to prepare a proposal detailing the services you can provide, how you will provide them, and how your services will benefit PACE participants. Be sure to include information on your organization's experience, qualifications, and any relevant certifications or accreditations.

5. Undergo Evaluation: PACE programs will evaluate potential vendors based on a variety of factors, including the quality of their services, their reliability, and their understanding of the PACE model of care.

6. Contract Negotiation: If the PACE program is interested in your services, you'll negotiate a contract. This will include details like the services to be provided, the compensation, and how the vendor relationship will be managed.

7. Compliance and Quality Assurance: Once a contract is in place, vendors must comply with all contractual obligations, and they may be subject to periodic reviews to ensure services are being provided in accordance with PACE standards.

● Primary Care Services: PACE programs include primary care services, often provided by PACE physicians.

● Hospital Care: If a participant requires hospitalization, the PACE program covers care.

● Medical Specialty Services: This can include services from cardiologists, rheumatologists, podiatrists, and other medical specialists as needed.

● Prescription Drugs: PACE programs cover all necessary prescription medications.

● Nursing Home Care: If a participant requires care in a nursing home, the PACE program will cover this.

● Emergency Services: Emergency care is covered by PACE.

● Home Care: Many PACE participants receive care in their own homes. This can include assistance with activities of daily living (ADLs) like bathing, dressing, and meal preparation, as well as medical care like wound care or medication management.

● Physical, Occupational, and Speech Therapy: These therapies are covered when needed.

● Nutritional Counseling: PACE programs often include dietary and nutritional counseling to help participants stay healthy.

● Social Work Services: Social workers can assist with a variety of issues, including coordinating care and helping to manage social and emotional concerns.

● Medical Equipment and Supplies: Necessary medical equipment and supplies are covered by PACE.

● Recreational Therapy: Recreational or activity-based therapy can be an important part of keeping PACE participants active and engaged.

● Transportation: PACE programs provide transportation to the PACE center for activities or medical appointments.

● Dental, Vision, and Hearing Services: PACE programs also typically cover these important services.

● End-of-Life and Hospice Care: Should a participant reach a stage where they require hospice care, PACE programs typically cover this as well.