Empowering PACE Startups to Expand Community-Centered Senior Care

To support a PACE startup in scaling its culturally focused care model, Akros Advisory applied a comprehensive, data-driven methodology. Our approach leveraged a deep understanding of PACE dynamics, payer priorities, and value-based care principles to deliver meaningful results. 

Client Context 

A PACE startup dedicated to providing culturally tailored care for seniors faced challenges scaling its model to serve diverse communities. While the organization was rooted in a mission to expand access to quality, home-based care, it struggled to navigate the complexities of braided Medicare and Medicaid funding, address inconsistency in PACE adoption across states, and account for varied state-level funding models. With ambitious goals to grow in underserved regions and innovate within the PACE model, the organization sought expert guidance to address these challenges and create a sustainable path forward. 

Strategic Assessment of Challenges 

We began by evaluating the startup’s operational and strategic challenges: 

• Complexity with Medicare and Medicaid Funding: The startup faced challenges managing the intricate, state-specific rules for PACE funding, including inconsistencies in program adoption and reimbursement structures across different states. 

• Mapping Reimbursement for Fundraising: The startup needed a framework for estimating future revenues tied to reimbursement pathways to support accurate fundraising calculations and to evaluate alternative reimbursement schemas. 

  
  

This assessment identified opportunities to align the startup’s funding and expansion strategies with payer priorities and reimbursement models. 

Designing a Scalable Business and Care Delivery Model 

To enable long-term growth, we designed a tailored business model and operational framework: 

• Revenue Estimation Framework: Mapped state-level reimbursement pathways, integrating Medicare and Medicaid rules to project revenue potential and support fundraising efforts. 

• Alternative Reimbursement Schemas: Proposed strategies for accessing additional funding streams, including Medicaid waivers, Special Supplemental Benefits for the Chronically Ill (SSBCI), and value-based care arrangements, to expand financial sustainability. 

Payer Engagement and Market Positioning 

Recognizing the critical role of payer partnerships, we developed strategies to position the startup as a trusted partner: 

• Health Equity Advocacy: Highlighted the organization’s ability to address health disparities, aligning its mission with federal and state priorities in advancing health equity. 

• Data-Driven Value Propositions: Quantified the ROI of the PACE model, including reduced hospitalizations and improved member outcomes, to strengthen value propositions for payer partnerships. 

Results 

• Successful Launch: The startup successfully established operations in its target market, increasing access to culturally competent care for underserved seniors. 

• Successful Fundraise: Developed a reimbursement-based revenue projection model used to build confidence in fundraising calculations and secure additional capital - $22M Series A.  

• Informed Product Design: Our analysis guided the development of service offerings tailored to reimbursement structures, ensuring alignment with payer expectations and regulatory requirements. 

• Support for Fundraising: Akros Advisory’s deliverables were instrumental in board meetings and investor presentations, directly contributing to the startup’s ability to raise additional funds for expansion. 

Client Feedback 

“Akros Advisory’s expertise in navigating Medicare and Medicaid funding dynamics was invaluable. Their ability to map reimbursement pathways and provide actionable strategies has empowered us to scale our model and secure the financial backing we needed to grow.” ~ VP, Operations