Opinion | Metro Detroit seniors need more home health care

A recent guest commentary in Bridge that attacked bills to hasten PACE expansion in Michigan manifested the authors’ lack of familiarity with both the legislation and shortcomings of the current provider in metro Detroit.

PACE stands for the Program of All-inclusive Care for the Elderly that Congress expanded in 1997. It authorizes qualified health care providers to provide full Medicare and Medicaid benefits to frail seniors at their homes rather than more expensive long-term care facilities.

Identical state bills – House Bill 4432 and Senate Bill 203 – seek to outline the conditions in which an area could be served by more than one PACE provider. Indeed, that is all they do.

Yet, incredulously, the authors of that April 22nd column assert the bills “in a nutshell … would allow out-of-state, for-profit companies to come to Michigan and shoulder out nonprofits that have been helping seniors for years.”

Poppycock!

While it is true that InnovAge, the company pushing the bills at the Michigan Capitol, is for-profit, publicly traded and headquartered in Colorado, it is also accurate that state law – as prescribed in statute and a 2017 Michigan Department of Health and Human Services bulletin – states: “A prospective PACE organization can be a not-for-profit, for-profit or public entity.”

In other words, a provider’s organizational structure is irrelevant. And rightfully so because an operator’s tax status, ticker symbol or mailing address have nothing to do with its ability to minister to vulnerable seniors. And shouldn’t that – the assurance of quality and sufficient health care options for Michigan citizens – be state lawmakers’ aim?

Clearly, the answer is yes. But diverting attention from that laudable public-policy goal may be the objective of critics of these sensible bills, many of whom are blindly loyal to PACE Southeast Michigan, one of 13 PACE entities in the state and currently the exclusive provider for Wayne, Oakland and Macomb counties.

I have no issue with PACE Southeast Michigan. It does a fine job. It just doesn’t do so for enough people, having fallen woefully short of the expansion promises it made to MDHHS in its 2017 Strategic Growth Plan. Specifically, PACE Southeast Michigan vowed to enroll 2,600 seniors and build two new centers by 2021. Today, however, it serves roughly 1,250 participants – less than half the 2,600 it forecasted – and has broken ground on only one center.

PACE Southeast Michigan’s failure to hit its growth targets – and the subsequent surplus of unserved PACE candidates its underperformance has begotten – inspired InnovAge in 2018 to petition MDHHS for entry into the metro Detroit market, the largest in the country with a single provider. Determined to protect its monopoly, PACE Southeast Michigan – in tandem with the PACE Association of Michigan – lobbied the Legislature during the 2018 Lame Duck session to pass a bill banning new providers here unless MDHHS determines there is “unmet need” in a specific geographic area. The new law further instructed the department to work with the association – whose 13 members are regulated by MDHHS – “to develop an acceptable methodology to determine unmet need.” Now, more than two years later, “unmet need” remains undefined.

House Bill 4432 and Senate Bill 203 aim to fix that problem by reasonably declaring “unmet need” exists when an incumbent provider serves fewer than 20 percent of the clients in a market with more than 5,000 PACE-eligible consumers. Only one area in the state meets that description right now: That served by PACE Southeast Michigan, which currently enrolls fewer than 5 percent of the estimated 25,000 PACE-eligible clients in the tri-county.

Yet, the bills show respect for existing PACE providers by requiring entities seeking to launch in their respective backyards to:

• Verify they have the “relevant experience and financial resources” to run a PACE center;
•  Prove their operation “will not create an unnecessary duplication of services” in the area; and
• Affirm their presence “will not impair the financial and service viability” of the existing provider.

That is a far cry from seeking to “shoulder out” current PACE providers, as alleged by the authors of that specious April 22nd column, one of who sits on the governing board of Presbyterian Villages of Michigan, which co-owns PACE Southeast Michigan with Henry Ford Health Systems.

The pending legislation also is potentially life-saving in this era of the COVID-19 pandemic. That’s because residents and employees of nursing homes – which, again, PACE helps feeble seniors to avoid – account for roughly a third of all COVID-19 deaths in Michigan and nationwide. Through May 10, Michigan reported 18,239 deaths from the deadly virus, according to Bridge. Nationwide, more than 575,000 people have succumbed to the disease.

That undoubtedly is why the Michigan House is considering appropriating more money in the Fiscal Year 2022 state budget to increase the number of Michiganders enrolled in PACE. The state also is poised to score lots of federal money under the American Rescue Plan that might be used to add even more slots.

For its part, InnovAge hopes to build two PACE facilities in metro Detroit at a total cost of $30 million. It would employ 250 Michiganders in good-paying jobs at each site and, as a for-profit venture, pay taxes to both local and state governments.

Quality health care. Jobs. Investment in state and local economies. That is at the heart of House Bill 4432 and Senate Bill 203, which are supported by numerous other Southeast Michigan thought-leaders, like Wayne County Commissioners Alisha Bell, who chairs that body, and Tim Killeen; Detroit City Council President Brenda Jones and her colleague, Councilman Andre Spivey; and Detroit NAACP President the Rev. Wendell Anthony.

Digs to the contrary only divert attention from PACE Southeast Michigan’s deficiencies. They, thus, are more about foolishly defending a floundering monopoly than augmenting medical and long-term-care options for Michigan seniors.

State lawmakers should ignore the frivolity and pass either House Bill 4432 or Senate Bill 203 forthwith.