During this episode, host Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer, Tabula Rasa HealthCare, interviews Dan Drake, President and CEO of Trinity Health PACE. Prior to his current role, Dan served as President of Continuing Care for Trinity Mid-Atlantic. Dan was also the Vice President of Continuing Care at St. Mary Medical Center in Langhorne, Pennsylvania. Dan has served on the Pennsylvania Aging Council, and leads Trinity's Advocacy and Legislative efforts in Pennsylvania. He is a Registered Nurse and a Licensed Nursing Home Administrator, holds degrees in Nursing Science and Business Administration, and a Master’s Degree in Health Science Administration.
During this episode, host Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer, Tabula Rasa HealthCare, interviews Dan Drake, President and CEO of Trinity Health PACE. Prior to his current role, Dan served as President of Continuing Care for Trinity Mid-Atlantic. Dan was also the Vice President of Continuing Care at St. Mary Medical Center in Langhorne, Pennsylvania. Dan has served on the Pennsylvania Aging Council, and leads Trinity's Advocacy and Legislative efforts in Pennsylvania. He is a Registered Nurse and a Licensed Nursing Home Administrator, holds degrees in Nursing Science and Business Administration, and a Master’s Degree in Health Science Administration.
Hello and namaste, everyone. I am Dr. Ankur Patel, Chief Medical Officer, Tabula Rasa HealthCare, and the author of the book Age is Just a Number. Welcome to the episode of Keep up with PACE. I'm pleased to introduce today's guest Dan Drake. Dan is the president and CEO of Trinity Health PACE. Prior to his current role, Dan served as president of continuing care for Trinity Mid-Atlantic. During his tenure as a president of Trinity Health PACE, he consolidated Trinity Health PACE and Trinity Health Mid-Atlantic into one ministry. Despite the COVID-19 pandemic, Trinity Health continues to grow its current census and open new sites. He is a registered nurse, a licensed nursing home administrator, and holds a degree in nursing science and business administration - and a master's degree in health science administration. Namaste, Dan, and welcome to the episode of Keep up with PACE. Thank you so much for having me. Dan, I wrote my book with a purpose to serve more people and I start my book with
a quote from Mother Teresa:"a life not lived for others is not a life." I love organizations who are mission and vision-driven. What stands out with Trinity Health PACE - you are also a value-driven organization. Tell us more about your PACE organization. Thank you for asking that question. It's very important to us - our mission. Our mission is to serve the frail elderly in all of the catchment areas that we currently operate and to expand our footprint throughout the nation to give more participants access to care. Right now, Trinity Health PACE in its consolidated form is the largest provider of nonprofit PACE services in the United States. We are in nine states, have 13 programs, and 18 centers currently. And how many total participants do you serve? Approximately 3,500 participants and 1,200 colleagues. We call our employees colleagues because they're part of the family. I'm thinking about nine states. That reminds me of Albert Einstein's quote: "out of clutter find simplicity." How do you handle regulations from nine different states? Because all states have different rules and regulations. So, how do you keep up with everything? Well, I think we have a fantastic executive leadership team. Our chief nursing officer, Carrie Hays McElroy, is on top of compliance and quality. Anne Lewis, who is our chief operating officer, makes sure everything is operating well, smoothly within state and county guidelines. And, our chief medical officer, Dr. Karen Nichols, is on top of everything. In fact, she's in Alabama as we speak, talking to them about compliance. That is great. No, you have a great team. I know some of the members that you mentioned and they all are excellent. Tell us more about the PACE organization there. Which state has most amount of participants or centers? Yeah. Our history in PACE is we started in the state of Pennsylvania. We were one of the pioneers of PACE services. So, we've been in operation in the state for over 30 years. And, that is really our stronghold. We consolidated Mid-Atlantic, which was Mercy Health, St. Francis in Delaware, and St. Mary in Langhorne, PA. And then, when we consolidated, we added Mercy Life West Philadelphia, which that program alone has 400 participants. So, in the state of Pennsylvania, we have over 1,500 participants in our program. Wow, that's a big number. Yeah. D o you have any favorite state that - which state is more easier compared - regulations-wise - compared to others? No - they're all pretty friendly to PACE, to be honest with you. I think everybody feels that it's a wonderful program. It serves the frail elderly in the communities where they live. We are seeing in each one of the states, each of the nine states we operate in, they're reaching out to us since COVID to see what we need, what type of support we need. So, I would say all nine of the states we're in are pretty PACE friendly. Some of the states - and I'm not sure if Trinity falls - Trinity has an organization or a center in any of the states - but, what I'm learning more from PACE is also that some states have caps that you cannot grow more than "X" number of participants. Does Trinity have any centers in those states? Yes, we do. We operate under caps in numerous states that we operate in, but most of them are soft caps. So, if you go to the state and say, hey, we're expanding the service area to grant more access to more participants, they usually will move that cap up. They're normally soft caps. Alabama is probably one of the states where there is a hard cap, but we've never exceeded that and never had to go back to them and ask for more. I guess two years ago they gave us 25 more participants in a cap. So, with the cap, is it something fair to say - for the states - they want to see that here is your X number of participants, see how you are doing, and if serving and helping more participants will increase the number? Yeah, I think that's what they look at is, hey, this is what we have in our yearly budget, and they multiply it out times participants and say, hey, this is what we're putting in. This is the cap for the state, not just for Trinity, but for the whole state, everybody who operates there. And, let's do a mid-year reconciliation and see, can we add more participants or, hey, you're getting close to the cap. In the state of Pennsylvania, for example, with all the providers in Pennsylvania, we've never exceeded the cap that they gave us at the beginning of the year. And, they are very pro- PACE and pro-growth. When I talk to a lot of executive directors from different states, I learn a lot about the state and what they do. Trinity Health PACE, being in nine states, do you kind of have - as a leader - the best practices that you learn something from state A, that you are like, oh, this is something good. Let's apply on state B. Yes, we do. We look at best practices and gold standards throughout, not only within our company, but within National PACE Association. We have a strong relationship with NPA, and we are on their weekly/monthly calls. And if they have anything special, we join that also. Each year - prior to COVID - they would have a conference where they would show best practices. And, we've learned a lot from other centers. In fact, it's funny, we're based in the mid-Atlantic at this point. A lot of the information that we have and the history of PACE originated on the west coast. So, we have learned a lot from our PACE brothers and sisters over on the west coast over the years. Nice. At the national level, NPA is a great platform. I interviewed Shawn Bloom on my first episode, so that was a very great episode, also. But, at a state level, do you work - because I was talking to other executive directors and CEOs and they all mentioned, to empower PACE within your state, you need to be very close to the state PACE organizations. How have you worked on the state level? Yeah, we do work on the state level. And we have a vice president of advocacy and legislative affairs named Donna Wilhelm. And, talk about somebody who's busy - she oversees all nine states. So, she's in contact with every one of the state governments and even brings it down to the county level in some states. In PACE, quality means a lot to us. And, my understanding is that - and you can correct me - that Trinity Health PACE has a magnet status. That is correct. We were certified for Pathways to Excellence. We were the first PACE site to have any type of magnet certification. And, we're extremely proud of that because that means - at our locations - the interdisciplinary team operates as a team and collaborates on the care of individuals - not just one leader telling everybody and dictating what to do. We work as a team. And, when they came out to do the designation, they saw that in action. So, we are trying right now to really grow that designation at other sites. So, I did not know that PACE can get a magnet status. So, Dan, can you explain to our listeners what is a magnet status, how it works, and how it will benefit their PACE organization as well? Well, the magnet status is similar to hospital magnet status, where you have to have, really, an interdisciplinary team, working together and making decisions. And, this magnet status we have is more of a nurse-based status where you have to have leadership in nursing. You have to have committees with nursing and really the whole view of the participant as an individual and caring for them as an individual and having positive outcomes for that individual, even though you're serving 3,500 participants. So, I think it benefits the colleagues because they are more involved, and they've more involved in decision making. And, it really benefits the participant because they are really focused. Talking about nursing, I would love to hear more about your own journey. You started as a nurse to becoming a CEO of a big PACE organization. Our listeners would love to hear your story. Well, my wife was a first degree business and engineering student who went back to nursing school, and she was much happier in her nursing job than I was in my accounting job. So, I decided to look into it, and I became a nurse. I started out in the nursing home industry, which I loved. It was wonderful. I was a floor nurse - part-time, and then became a nursing supervisor, director of nursing, and then a nursing home administrator. And after that, I was in the nursing home industry for a good bit of time. And, the School of Nursing at the University of Pennsylvania reached out to me for a position as their executive director over at their PACE program in West Philadelphia. And I really didn't know too much about PACE. I went on the interview and thought, wow, this is wonderful. They're the same participants that I'm treating and caring for in a nursing home, but they get to go home every night. And, they seem to really enjoy coming to the center knowing that they're going to get all this care, socialization, and activity. But, then they can go home to their house that they've lived in for 20 or 30 years in the community that they've always lived in. And, I was hooked. That's when I knew that this is what I wanted to do. And then once you entered PACE, you continued your journey within PACE? Yeah, well, I was over in West Philadelphia for about five years. Then I transitioned over to Trinity Health at St. Mary and Langhorne, and then became the president of the Mid-Atlantic over all the PACE operations in the m id-atlantic and home health. And, from that job, I was recently - it's almost two years now - promoted to the president of Trinity Health PACE. So, it's been an experience. Nice. Because I always have so much respect for nurses. And, I always say that behind every successful doctor, there is a great team of nurses. And, PACE is one of the examples - that I always used to call my nurses the gladiators there, or I call like, in general, I feel like nurses are the parents of health care. And, the examples that I give is - because they always go above and beyond the nursing. And, I remember my nurse at my previous PACE program was going to a patient's home, and the light bulb was not working. And, she went to the nearby store, got the light bulb, and fixed it. One participant was getting discharged from the hospital, and the participant was in hospital for six days and had no groceries. And my nurse even went to the grocery store and did grocery shopping for the participant before they come home. And, they always go above and beyond. So, how do you translate your nursing values that you learned over the years into your leadership role? I think I understand that, as you just said, the nurses are the backbone of your program. Along with, again, the caregivers, transportation. Everybody we've seen during COVID has come up to the plate and hit a home run. I mean, we don't have anybody in any department who hasn't gone above the call of duty. As you said, changing a light bulb, decluttering a hallway for somebody. But, I think the philosophy of nursing is to care for the individual. And, that is my philosophy, that we need to look at everybody as an individual in our program. And, I go back to we have 3,500 participants, but if we have one that isn't being cared for, that's a failure. Yes, I agree. Quality is everything. And, I always say that - a lot of time when we talk about percentage, but if we do not give care to that one participant, it's 100% for that participant. Right. And, we hear stories from the families. And, the great thing about PACE is the majority of people in the program love it. I mean, we have a 97% favorable rate right now, and that's during COVID. And, when you look at families, normally the families at hospitals or nursing homes are the ones who complain a little more. Not here because we're taking over a lot of the responsibilities that they used to
do:taking somebody to the cardiologist, or a podiatrist, optometry. Well, they come into our center and receive those services. Now the loved one doesn't have to get in the car and say, oh my gosh, this whole week, Monday - I have eye doctor, Tuesday - podiatrist, Thursday - this. So, in the eyes of participants and their family, we are the right program for them. Absolutely. PACE is a very complex model, and there's a lot of things happening within the same day. What keeps Trinity PACE CEO Dan Drake up at night? Well, COVID has the last couple of years. Keeping people safe is our number one priority and keeping our colleagues safe. So, I think if you had to ask about what keeps me up, it's that. I look at that individual basis and the burnout right now with some of our colleagues and even the participants. You know, they were used to coming into the center two, three times a week. Now, they're lucky if they come in once a month because of the COVID rate in each county. We have regulations where we can't bring people in when the rate is at a certain percentage. But, yeah, if you were to say what keeps me up right now, it is COVID. And, I know the trends are looking better, but we've seen that happen in the past. So, we're ready for anything at this time. So, I think the positive about COVID is we're the most flexible team and group that I've ever managed. Everybody knows that this could last ten years or another two weeks. We don't know what's going to happen. So, we have an emergency plan for everything. That's the beauty about PACE. Yeah. So, staying on the COVID topic, what went through your mind in March of 2020, that all of a sudden COVID hit, and you had to think about a whole different pathway now to care for our participants. Yeah. I think at the very beginning I was like every other provider. We thought we were going to be shut down for maybe a month. We did deep cleaning, we focused on education with our staff - with any type of disease or virus prevention. And then, it just continued and continued. And, so, that's when we really had to sit down as a team and have a plan. And, I was really thrilled with my leadership team, and the leadership teams around the country - at each one of the PACE sites - with the plans they came up with. And, talk about learning from each other - you had asked that question before. The people on the ground floor are the people who live it every day. And, you forget when you're the executive director, the difference when you become the CEO, they're there every day. And, some of the ideas that they had were wonderful. And, I think one of our philosophies is to listen over at Trinity Health PACE, and we did listen. And, we formulated a great emergent plan that we've been working on, for almost two years now, and we've been very successful. I mean, our outcomes are excellent - q uality care continues to be excellent. And again, the participant satisfaction results are really good. Yeah. And definitely COVID went a lot longer than most of us thought. And, it's not over yet. And, so, how is the situation with your employee morale, retention, shortage - staffing shortage - right now? How do you keep up with everything? That's probably one of the toughest things we face on a daily basis - the burnout. And, as you said, healthcare workers were really affected by this. Trinity Health System office has done a great job supporting all of Trinity - the acute care, and Trinity Health PACE, and continuing care. We've looked at compensation. We've given bonuses at times. They are heroes, the people who work for us. And, we look for things to do to boost morale constantly. And, we do have an executive leader in the mission portion, Terry Anderson, who is in touch with colleagues who are in distress, or participants that are in distress. She can't be everywhere for everyone, but she does an excellent job pretty much being everywhere. You mentioned when we talked last time about your retention rate during COVID was pretty well - I don't want to jinx it, knock on wood. But, how? Well, we're dedicated to our colleagues. They're dedicated to our participants. And, I think we see that - and, they see that. We have a weekly call where everybody's invited. We do a COVID call, we do an update, and people feel like they're part of the team. They can ask questions, they're on it. They can see our face. A lot of the things we've done, we've had to pivot because I can't be at all the locations. Because of COVID rates and other factors, we really try to check in via Webex, Teams - anyway we can. The positive of COVID is the technology innovation that we have seen and we have grown. In the past, we never thought we would be able to do it. There was always an excuse why we couldn't put an iPad or a tablet in a participant's home. Oh, it's going to get lost, it's going to get broken, it's going to get stolen. Well, guess what? We do it now, and it's ultra-successful. Everybody has a smartphone- that works for us. They can use that when they go into some. So, there are some positives about COVID. Not many, but. I was talking to CEO of Centers for Elders' Independence,Maria Zamora, for an episode, and she mentioned that COVID is an opportunity that nobody wanted. That is something, that one of the examples that you use, that using technology - definitely putting iPads, or any kind of devices in the house, has definitely helped. What are one or two opportunities now that you will utilize in future? I think when we look at the growth and new centers, we look at the square footage of buildings, how many participants we can have in a building at a time. We used to have really large buildings, and COVID has shown us that we could operate with a smaller footprint there. And, the other thing that we really learned is a lot of participants like being care for at home. They like the socialization in the program and coming to the center, we will never stop that because I think that's the basis for good behavioral well-being. However, we have found out that we added more home health aids and more home health nurses, and quality has gone up. So, we have learned a little bit with that. I think definitely I agree with PACE - is that maybe the participant might not come in now five days a week, but it's still important for them to come two days a week. And socialization is the key. Like, when I read a lot of reports and studies from different organizations, and how they are mentioning that senior loneliness has increased during COVID, and senior loneliness also - me and you know - that leads to depression and a lot of other health conditions. So, I feel very grateful that in PACE, our participants still have an option to go to the center, still stay, meet their friends, keep up with their socialization - which is one of the very positives of a PACE organization. Absolutely. I think that was always one of our strong points was center attendance, and I remember when we had an eight-day snowstorm, I think I can't even remember what year it was. But when the participants came back to the center, it was like a family reunion. And, we see that now in COVID when they haven't seen somebody for a month or two, and they come into the center and everybody's masked up and vaccinated and all the precautions are taken, but they see them and you can even see through to mask the big smile and their eyes light up. Nobody wants their best friend to be the TV set. It's really one of the great - our success story is getting people out of their homes and into the center. A lot of times when they join our program, they said, I only want to come to the center for my doctor's appointments or whatever, and then they have breakfast at a table with other participants, and then they find out they live in the same area and that they know their cousin or their sister. That was always something that made me feel really good about this program. Staying on the success story - our listeners love to hear PACE success stories. Would you like to share any success stories? Yeah, I think I have one that always stands out in my mind. I was executive director at LIFE University of Pennsylvania, and the state of Pennsylvania came to us and said, hey, we have this new initiative. We'd like to take people out of the nursing home that we feel could live independently and we'll get them an apartment, but they need health care. And we said, okay. And we assessed a couple of people. And, one of the participants, who was just a wonderful woman who lived in West Philadelphia, was so happy that she was able to transition from the nursing home to her own apartment. And, she kept coming into the program and we were thinking, wow, she's doing pretty well. Why were you in a nursing home? Well, she lost her housing. So, the reason she was in a nursing home was she lost her housing. She was nursing facility eligible with her diagnosis, but could have stayed in the community with a program such as ours. She had been in a nursing home for seven years. Wow. Seven years because she didn't have housing. So, that Thanksgiving, she invited three of us to her house because she hadn't cooked Thanksgiving dinner in seven years. I always remember that story because I think one of the biggest barriers to care for the elderly in a lot of communities we serve is housing. And, we would like to do a better job partnering with different senior housing so that we can bring people who are in the nursing home because of that. Most people in the nursing home are there because they need to be there. But there, you know, we just looked it up - it's almost 33% of people in the nursing home are there because they have no housing. Wow. Yeah. That is a barrier. Do you see Trinity Health PACE going into the housing business, or will more stay with partnering with senior living? Well, you just gave me a softball. So, we are starting a new site in Woodland, Pennsylvania called Mercy Kinder Park. It will be open in June of 2022. And we are partnering with the Delaware County Housing Authority. So, it's going to be an over 65 building. We are taking up 18,000 sq. ft. on the first floor, and then there are going to be over 100 units above us for senior housing. New Cortland, in Philadelphia, did a similar model when they ran PACE, and it was ultra-successful. So, we would really like to partner with anybody who wants to build senior housing in the nine states that we operate in, because that is a huge barrier to our program. That is a great point. So, to our listeners, one of the barriers for caring for seniors is housing - that we see. A lot of PACE organizations, we are good in caring for our participants, we are not sometimes good in running the whole business about housing. So, this is an opportunity for any of you - and Dan's open invitation - about the nine states. And, if they're looking for something to partner with Trinity Health, please reach out to Dan, and I'll get the information at the end, too. Talking about growth in PACE, how did you manage to grow during COVID when all other PACE organizations were struggling? Right before COVID occurred, we were working with a large religious organization to join our program, and I think we were very blessed the month before COVID happened, they joined. We had been working with them for about two years, and there were over 106 participants all in one month to join our program. So, that really helped stabilize our census during this whole pandemic. And, we've also been fortunate that we operate in states where they do want people in home and community-based programs. So, we've been allowed to enroll. We have been continuously allowed to enroll in every state we operate. We have some restrictions on where we can go in senior housing because of COVID rates, things like that. But, we've done pretty well. And, we again opened up a brand new program last March in Newark, Delaware. And, the enrollment there is good. It's not great. But during a pandemic, I think that that team there's done a spectacular job. Staying on this growth conversation, how do you see, nationwide, we can grow faster than our current rate? I think right now you will see an uptick in the growth, and getting quicker through CMS in the state, because of the need, and because of the focus on the pandemic, and how many people passed away in congregate housing and nursing homes. When you look at a home and community- based programs such as PACE, they're all nursing facility eligible participants. So, they're the same participants, but if they can live at home, we saw the death rate is a fraction of what it is in congregate housing. So, I do think that the state government and federal government has learned, through this pandemic, that the best place for a nursing facility eligible person, if they have housing, is in their home. To that point, you mentioned about federal regulations, when we talked last, you mentioned about the Build Back Better Act and PACE Plus Act. Do you think if it passes, how it will benefit the PACE organizations? I think they're both great for PACE. The PACE Plus was authored by Senator Bob Casey of Pennsylvania. So, we know him well. He's a friend of PACE, and what he's trying to do through his act is increase access for the frail elderly. I am 100% certain that that's going to pass. I've heard positive things from both sides of the aisle, and we do a lot with advocacy and legislative affairs. Democratic, Republican - we're friends of everybody because of our program supports everybody. And, when you look at it, most people who are in the political realm are probably 40 plus years of age. They all have parents or grandparents that need services. And when we start talking to them, we visit Harrisburg and Washington, D.C. And all the local state capitols - we get in. It doesn't matter if they're Democratic or Republican, they want to talk to us - because, first of all, it cares for more of the frail elderly, which is the highest cost of care in the country, the frail elderly. And, they can budget it because we're a dual eligible program where we get a capitated rate. So, they know at the beginning of the year if they give us this capitated rate that they formulate times how many participants in the program, that's all they give us. We're 100% risk based. They don't give us extra if more people go to the hospital. So, again, that helps us really coordinate care and quality better. The Build Back Better Act - there, at one point, was over $200 billion allocated for home and community-based services. That has been lowered, as we know. And, I'm not as confident that's going to be passed, but I do think that there's going to be a lot of funding in the future for home and community-based programs such as PACE, home health, and hospice. So, I'm very confident in that. But, I think the PACE Plus Act is extremely exciting. That is really great to hear, Dan. So, what - on the other side - do you see as barriers to growth in PACE? Well, I think the lack of knowledge of what PACE is - we still have that, we're still fighting in a lot of states to say, hey, what is PACE? We all know what nursing homes are. They've been around forever. And the ease to discharge somebody from a hospital to a nursing home is much easier, of course, than a PACE program. For those who don't know, we can only enroll once a month. So, if you're a hospital and you're trying to move a patient from your hospital to a program, a nursing home will take you in 24 hours - within 24 hours. Where, we have to go through the entire assessment, we have to go through the county assessment, we need to get approval, and then they can enroll on the first of the month. So, we are working with state and federal representatives. It won't be automatic enrollment, but maybe a lot quicker. Yeah. So, what is the current - that's a great point that you brought up. So, I wonder what is the - because me as a medical director, I know about when a patient or participant joins my program, and I take over. But, what is the current average time to bring somebody in? It probably takes 45 days, and we've sped that up. It used to be 60 days, and we would lose a lot of participants to other programs because of that. And, some states have waiver programs where they provide care in the home setting. They don't have a center, they don't have the all-inclusive care that we have. But, it is an alternative. And, we have people that are sent to those locations and nursing homes instead of home and community-based PACE programs. Because what I understand is that means an average day is 45. And, if somebody's paperwork is ready and approved on, let's say February 6, they cannot start the program until March 1, correct? Yeah. And we have a lot of participants that are cleared the day before, as you probably know. So, it would be February 26. We get all their bank statements, and we get all their medical, and we get their assessment from the county, and we're just making it at that point. And again, to my listener, I am requesting you, if you are listening to this, this is somewhere it's a gap. And, I feel like if you have any power to expedite this process, or can help us decreasing the time to enroll a PACE, participants will be appreciated because participants will be able to benefit faster from the program. So, we were talking about you and went into COVID, but I still want to go one step back about the leadership role, and then we'll move towards the future of PACE. But, how can we grow, because I feel like in PACE, not a lot of people know about PACE, and then we always feel like we are in a search for talent and leadership in PACE. What are your thoughts about growing leadership within our own organizations? Yeah. That's always a tough one because it's not a glamorous field. The nursing home field, home health, and PACE aren't something that a nurse going to nursing school says, boy, I want to work in a nursing home or I want to work at a PACE center. They say, I want to work in ICU, I want to work in ER- these exciting things. So, what we've done really is try to grow our own somebody who is in our day center through Trinity Health, the corporation, we have multiple leadership track programs. We have a senior leadership program, we have mentoring programs, and every year all leaders get together and we do succession planning. So, we really stress and communicate to our managers, and really our colleagues at the line staff, that you can grow here. Because, we know we're not going to get a lot of outside applicants who say, jeez, I want to run an inside-out nursing home - that's glamorous, I can tell all my friends. No, that is - what advice would you like to give to our next generation of leaders? I think you have to really want to do this. This isn't for the faint of heart. I've said that before. You're caring for the frailest of frail in areas that are usually Medicaid eligible areas. So, they're sometimes not the prettiest, but the satisfaction you receive from the happiness from the participants and colleagues when you provide excellent care - there's nothing like it. Excellent advice. Let's move on to future. As a CEO of the biggest non-for-profit PACE organization, where do you see PACE going in the next five years, and then more - 10 to 15 years? I think in the next five years you're going to see tremendous growth. I think with the COVID pandemic, and the fact that so many elderly people passed away in congregate housing and nursing homes - that the government, federal and state, are finally seeing the true value. They knew that we were valuable, they supported us. But, I think right now you see the funding that they're proposing for this. So, I think you're going to see tremendous growth over the next five years. And, I really hope that we're highlighted a lot more in the next - I have to give the National PACE Association tremendous credit, because people know who they are. And, they have a huge presence in Washington, D.C. They have a huge presence in every state in the United States. And, that has really helped us move forward. They've helped us start new programs, again, with some of the leadership there. We were informed that there would be a request for proposal to serve parts of Louisiana - we put in for Freeport Louisiana. We did not get awarded that, but they liked our presentation so much they just gave us Alexandria, Louisiana - and we're thrilled. Congratulations. Because again - yeah - our mission is to serve more people. It's to grow and expand. And, we are a Catholic organization. We are a non-for-profit Catholic organization. So, we're not looking to make tremendous amount of money, but we have to, of course, make money because no margin, no mission, as the sisters would say. But, we're very confident with our growth strategies moving forward. We are going to be one of the lead PACE providers in the next five years. Ten years - boy, I couldn't see COVID coming. So, I don't know if I should be the best predictor of the 10 years, but I do see, again, with the aging population in the United States, we're going to have to look and rely more on home and community-based services. You're going to see, in my vision, less nursing homes and more home and community- based services where we can serve people where they want to be served - in their home. Yeah, that's excellent. And we all want PACE to grow. And that is one of the reasons we have this podcast so we can increase the awareness. You mentioned about PACE growing. And, also you being the one of the biggest non-for-profit PACE. We know that for-profit PACE is entering the market. Will you change your strategy with this growing competition? I don't think so. I think our quality of care and our past history speak for themselves.
So, our growth strategy is three-pronged:organic growth, which we do extremely well; acquisitive growth, where we're going to look to see if people want to partner or collaborate with us; and then de nova, anything new coming out there. Like I said, Alexandria came up. We're starting a new site in 2023 in Pensacola, Florida. But, I really see the for-profits joining this industry for the reason that is the right reason - to increase access to care. When I spoke to people at InnovAge, they have the same goal and the same mission we do. They may be a for-profit, however, what their main goal is to expand their footprint and more people can receive services. So, I'm confident, with CMS and state regulations, we're all playing on a level playing field. So, anybody who wants to start a PACE program, and wants to do it for the right reason, which is access to care, they can join. Absolutely. Thank you, Dan. I love your passion. I love your passion. Well, you got me on a good day. It's Friday. Talking about passion - me and you have something in common - that we both are Philadelphia Eagles fans. So, we will totally go out of PACE. And, let me ask you a trivia question. Okay! Who did the Philadelphia Eagles draft with the second overall pick in the 1999 NFL draft? Well, I guess it's their best quarterback ever, Donovan McNabb. You are right. Who really had a great career here. And we almost won a Super Bowl with him. But, I'm in my office right now. I have two cards - a football card and a baseball card - of my favorite two Philadelphia sports heroes. One of them is Nick Foles. Somebody gave it to me the week that Carson Wentz got hurt, and thought it was kind of funny because I always liked Nick Foles. And, they bought it for me for a $1.99, and it's in this little plastic container. Oh that is awesome. And, I put it on my board at work, and they went on a tremendous run and won the Super Bowl - with a backup quarterback. So, I'll never forget that. And the other one is Greg Luzinski, who was a hero of mine. I'm older than you - growing up - for the Phillies. That is awesome. And just an opinion kind of a question. Should Jalen Hurts be the starting quarterback for the next season? Yay or nay? Yes. I think he's proven that he should - and, I'd like to use those three draft picks to make the team better. But, I like him. He's a fine young man who's done an excellent job. I mean - who thought we were going to get to the playoffs this year? That is correct. And, one last one, just your opinion. Our ex-Eagles head coach is just appointed as a head coach in Jacksonville. What are your thoughts on that? Well, I love Doug Pederson. I think he's a very mission-based leader. I think he'd fit in well at Trinity Health PACE, and I think he has one of the best young quarterbacks with Trevor Lawrence in the NFL. So, good luck to him. I wish him and his family well. When they leave here, we always try to think about all the positives they did and winning a Super Bowl in Philadelphia, what more can you do? I have a tremendous amount of respect and admiration for him. Yes. I took a day off and went to the parade. There you go. You should have called us because we have a location on Broad Street and it went right by our windows. Next time, let's hope they win the Super Bowl soon. Okay! So, before - we are coming towards the end of our conversation, but I ask all of the interviewees who comes to my show is if you could step into my shoes, what would you ask yourself that I didn't ask you? That's a really thought- provoking question. I think you asked so many good questions, I'm trying to think now you put me on the spot. I would probably say, what state do you think PACE is going to take off the most in? Yeah. Because you have to remember there aren't many states that really provide a lot of PACE services. That is correct. So, I would think that's a question that would have me scratching my head. Which one? What would be your guess? I would think Florida. I think with the aging population in Florida, and one of the reasons we're moving into Pensacola is lack of service providers in certain counties. They have Florida PACE, which is in Miami, does a wonderful job servicing their participants. But, there are rural areas and areas that are underserved. That, I really think that their state government sees as an opportunity. And, they are similar to the state of Pennsylvania where they have a lot of nursing homes. So, this would be a great thing for PACE - it would be a great thing for the elderly in that area. But, yeah - see, you had me scratching my head and I came up with something. That's awesome. I'm thinking now the states can have, like a healthy competition. My guess would have been Florida or California. Yeah. California is a great state to operate in, and it's just so spread out. And, I'm thinking about it more, too now. Texas - I look at Texas and say, look how large that state is. How would you do it? But, it's something that I would like to ponder over. And believe me, if somebody said to me, hey, you want to service Texas? I've had to get my leadership team together and the people above me in Trinity Health and say, what kind of funding do we have to start something in Texas? I really believe in the program, and I have elderly parents. My father, unfortunately, just passed away in July, but the services that they received at home through home and community-based service were wonderful. I mean, the hospice service my father received. And, so I'm a true fan of both - you need nursing homes. That's what I did from 1993 until I joined PACE 13 years ago. They're great. The people who run them are heroes like everybody else. They really care. And, they took the brunt of this because what were you going to do? You have congregate housing. You can't change that. They couldn't pivot like we could. But really access to care is my focus. If we could start more programs, PACE, PACE-like, or anything that expands the care, because we're looking at an explosion with the growth of the elderly population, and what are we going to do? So, need we some answers. Yeah. And, I think definitely with America aging, what we can do during this process. And, I feel like the biggest opportunity is people like to stay home. I think that is the key. Yes. And, how we can do services - if it's PACE, non-PACE - but how can we keep our participants, patients, our loved ones home? And, try to get them as much care as we can - and I think that's the key to the future. Yeah. We can figure it out. I think we're all smart people. We saw what happened during the pandemic, new technology, people pivoted the way they provided care. It's been a horrendous pandemic, but we've learned a lot. And, as you said, it's forced learning. It's forced learning. Yeah. And, that's what - now you made me think, like, I should reach out to all the states now - it's like, let's have a healthy competition. Do they have a PACE program in Texas? You know, I don't know. That that would be a question for National PACE Association. Okay. I have a grid with all of our locations, and I just did a presentation with the vice president of Ascension Health, and saw where they're located. But, yeah, I'm not sure. I know the California and Colorado market, but I don't know the Texas market. Okay. So, something for you to think, and look into also. Yes. So, Dan, before we go to my favorite part of the show, which is the rapid-fire round, how can our listeners connect to you? I guess they can reach out to you and get my email. Sure. And, I'd be happy to talk to anybody who - especially if they have senior housing in any of the states that we operate, because that's our greatest need. And, that's really exciting to me. That's something that we talk about to our system office about creating senior housing. The difficulty again is where do you put it? Everybody thinks it's a great idea, but nobody wants it in their neighborhood - type thing. Sure. If I can make more money renting to young, up-and-coming executives, and they do that. So, we are a Medicaid/Medicare business, so, our participants are not wealthy people. Okay. So, let's move on to my favorite part of the show, which is a rapid-fire round. I will ask you, Dan, five questions, and you can answer in one to two sentences. Okay. Okay. The first one, what does failing mean to you? That's an easy one. Not providing excellent care to our participants, and not caring for our colleagues properly. Great. Describe PACE in one sentence. An all-inclusive health care plan for the over-55 that are nursing facility eligible. Awesome. If you had a magic wand, what is the one thing you would change about PACE? Make it easier to enroll in. Great answer, Dan. Who inspired you and why? I have to say Peg McMullen, who was the first director of nursing I worked for, and the one thing she always focused on, no matter - I went through the first nursing shortage working there. But, the one thing she always focused on was the participants' residence - whatever you would call them in a nursing home n ow, I know they've changed the wording. But, she focused on care - quality care, which I always thought was the best. But, she looked at the employees, also. Then, she said to me one time, if you have an unhappy employee, you have a poor caregiver. So, the focus on morale retention. That reminds me of Richard Branson always says that, you take care of your employees, they will take care of your clients. One positive message for our listeners? Work on something you like, have fun. The pandemic is long, and you need to do some things to make your life better. But yeah, I think having fun right now isn't on anyone's agenda. So, I would say have some fun this weekend. Great message, Dan. This was such a fun episode. I enjoyed it. I hope you enjoyed it as well. And, we are at time. Thank you, Dan, for being our guest. It was a pleasure speaking with you. Thank you so much for having me. And, it's great to have a platform to grow PACE. I've been very fortunate - yesterday I spoke at the Healthcare Friendly Association, and today this. So, I've had a great week. Awesome. Thank you, Dan. Thank you for joining us for this episode of Keep up with PACE. We hope that you found the information shared valuable, and I invite you to join us for the next episode. Keep up with PACE is sponsored by CareVention HealthCare, a division of Tabula Rasa HealthCare. CareVention HealthCare provides comprehensive services and solutions for PACE organizations at every stage. For information about CareVention HealthCare, visit our website at CareVentionHC.com. See you in the next episode with a new guest. Until then, namaste and goodbye.