ELEMENT CARE INC

ELEMENT CARE, INC. IS A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) WHICH ENABLES ELIGIBLE SENIORS TO REMAIN IN THEIR OWN COMMUNITIES. THE PACE MODEL PROVIDES ONE STOP COMPREHENSIVE HEALTH AND SOCIAL SERVICES FOR ITS PARTICIPANTS. PACE'S GOAL IS TO MAXIMIZE THE HEALTH AND FUNCTIONING LEVELS OF PROGRAM ENROLLEES TO ENABLE THEM TO CONTINUE LIVING IN THE COMMUNITY. TO ACCOMPLISH THIS, THE PROGRAM: PROVIDES A COMPREHENSIVE RANGE OF PREVENTATIVE, PRIMARY, ACUTE AND LONG-TERM CARE SERVICES; USES AN INTEGRATED INTERDISCIPLINARY TEAM TO MANAGE CARE; DEVELOPS APPROPRIATE COMMUNITY-BASED ALTERNATIVES TO PROVIDING CARE IN INSTITUTIONAL SETTINGS AND CONSOLIDATES CAPITATED FUNDING FROM MEDICARE AND MEDICAID.IN JUNE 2004 ELEMENT CARE, ALONG WITH GLSS AND LCHC BECAME A MEMBER OF THE SENIOR CARE OPTIONS (SCO) PROGRAM, THE PARENT ORGANIZATION IS COMMONWEALTH CARE ALLIANCE. THIS IS A STATE-RUN PROGRAM SIMILAR TO THE PACE PROGRAM, WHERE PATIENTS ARE CARED FOR, HOWEVER CCA IS THE DIRECT RECIPIENT OF THE MEDICARE AND MEDICAID REVENUE. THIS PROGRAM ALLOWS ELEMENT CARE TO REACH A WIDER POPULATION, AS THE QUALIFICATION TO BECOME A MEMBER OF THE SCO PROGRAM ARE MORE FLEXIBLE THAN THE PACE PROGRAM. WHEREAS PACE REQUIRES ALL MEMBERS TO BE "NURSING HOME ELIGIBLE", SCO MAY ALLOW FOR MUCH HEALTHIER MEMBERS TO JOIN THE PROGRAM, THEREBY GIVING ELEMENT CARE THE OPPORTUNITY TO ASSIST THESE PATIENTS EARLIER. ELEMENT CARE IS CONSIDERED A PRIMARY CARE SITE, AND PROVIDES SERVICES TO PARTICIPANTS IN THE NORTH SHORE AND THE MERRIMACK VALLEY. UP UNTIL DECEMBER 31, 2018 ELEMENT CARE OPERATED UNDER A FULL RISK MODEL WHEREBY, CCA RECEIVED MEDICARE AND MEDICAID REIMBURSEMENT (SIMILAR TO ELEMENT CARE) AND THEN REMITTED 86% OF THE PREMIUM RECEIVED LESS CLAIMS EXPENSES TO ELEMENT CARE. ELEMENT CARE IN TURN PROVIDED CARE MANAGEMENT SERVICES TO THESE PARTICIPANTS, AND REMITTED REQUIRED FUNDS TO ITS VENDORS, INCLUDING GLSS AND LCHC FOR THE SERVICES THEY PROVIDE. ELEMENT CARE OUTSOURCES TO LCHC AND GLSS FOR THEIR PROGRAM AND MEDICAL SERVICES EXPERTISE.ELEMENT CARE RENEGOTIATED ITS CONTRACT MORE RECENTLY WITH CCA EFFECTIVE JANUARY 1, 2022 AND NOW IS REIMBURSED FOR CASE MANAGEMENT SERVICES ON A PER MEMBER PER MONTH BASIS AT A RATE OF $312 PMPM. IN 2022 ELEMENT CARE STARTED CONSTRUCTION ON TWO NEW SITES, ONE IN LYNN AND ONE IN BRIGHTON. ELEMENT CARE ALSO INVESTED IN A PACE CENTER IN WASHINGTON DC.