類別：提供者適用

For Providers: Pharmacists are Steady Hands Behind Safe, Reliable Medication Management

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Pharmacists serve as steady hands behind safe, reliable medication management for CenterLight Healthcare Program of All-Inclusive Care for the Elderly (PACE) participants. The Pharmacy Team works with the Interdisciplinary Team to help participants continue to live safely and independently in their own homes and communities.

What makes the role of a pharmacist essential?

Pharmacists play an important role in the lives of CenterLight PACE participants. They provide clinical oversight and coordination by supporting the care team with medication-related decisions. Below are some ways pharmacists make a difference:

Planning medication routines

Pharmacists develop strategies to make medication schedules easier to follow and ways to include it in participants' daily habits.

Promoting collaborative workflow

Collaboration is one of the hallmarks of a PACE program. CenterLight PACE pharmacists work with all members of the care team by aligning medication refills, helping prevent duplication of care, and reducing delays in essential medications by coordinating the workflow with prescribers and pharmacies.

Preventive care

One of the roles of CenterLight PACE pharmacists is to promote preventive care by providing guidance and coordination of vaccines for influenza, COVID-19, shingles, and other recommended shots.

How Pharmacists Support the Care Team and Network Providers

Transition of Care

When a participant goes home from a hospital or moves from one of our 11 PACE sites to another, the pharmacy team reviews the participant's medication list and provides an overview of "what changed" to members of the care team.

Using the Teach-Back Method

The pharmacy team provides training to the care team on how to effectively educate participants about their medications, especially when their prescription changes. One recommendation is the "teach-back" method, where clinicians educate the participants about their medication plan and have them repeat it in their own words.

Preemptive Medication Review

CenterLight pharmacists identify each participant's unique needs. For example, if a participant has mobility issues, they help set up medication delivery or pick-up that fits the participant's routine. For those who take multiple medications, blister/adherence packs are requested to reduce missed doses.

CenterLight Healthcare PACE 致力於提供準確的健康相關資訊，以協助個人好好生活、保持健康，並做出明智的健康照護決策。本資料中的資訊嚴格來說是教育性的。我們建議使用者向其醫療提供者諮詢有關其護理的事宜。

About the Authors

This blog post is written by Nourin Rahman, Performance Improvement Specialist, and Shu Jing, PharmD, MS, Senior Director of Pharmacy Services at CenterLight Healthcare.

In Nourin's own words:

"My goal has always been to do work that is meaningful and not just made up of deliverables. I like being in the healthcare field, where even small improvements can make a difference in the lives of others."

In Shu's own words:

"I'm very proud to work at CenterLight PACE. The all-inclusive care that we provide is a very unique model because you get everything in one place. It is very rewarding to be working in this kind of environment and to see partcipants really thrive."

H3329 Blog_NoPOInfo_ForProvidersPharmacy
Updated February 27, 2026

For Providers | Incident Reporting: Staying Compliant with CMS

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As a CenterLight Program of All-Inclusive Care for the Elderly (PACE) provider, your commitment to participant safety and program integrity is essential. One of the most critical tools to ensure that we provide high quality care and meet participants' needs is incident reporting.

In order to ensure positive outcomes for those we serve, you must inform us immediately if you become aware of any change in condition or if there are any incidents that may threaten their health and safety.

The Centers for Medicare and Medicaid Services requires CenterLight Healthcare and other PACE organizations to report incidents that include:

  • Suspected elder abuse, neglect, or exploitation
  • Medication related events such as adverse drug reactions or medication administration errors
  • Injuries or new wounds, including burns and pressure injuries
  • Elopements
  • Falls with or without injury

Incident reporting isn’t just about checking boxes—it’s about protecting lives and improving care. If your protocol is to send a participant to the Emergency Room after a fall, or if there is another valid reason for sending them to the hospital for evaluation, please call CenterLight PACE so that we can be a part of the care coordination. Let’s keep our standards high and our reporting accurate and on time!

This blog post is written by Jocelyn Pappalardo, Director of Quality at CenterLight Healthcare PACE.

H3329 Blog_ForProviders_IncidentReporting
Updated September 10, 2025

For Providers: Strengthening Care Through Collaboration

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At CenterLight Healthcare Program of All-Inclusive Care for the Elderly (PACE), we believe that high-quality, participant-centered care is only possible through collaboration with our provider network. Our providers play a vital role in ensuring that care is not only compassionate and effective but also compliant with regulatory standards.

As part of our ongoing commitment to excellence in care coordination, regulatory compliance, and health outcomes, we rely on our provider network to submit timely, complete, and accurate medical records. Your diligence in documentation directly supports the delivery of safe, effective, and coordinated care—and it gets results.

Shared Success: Measurable Impact

Thanks to your continued efforts, CenterLight PACE achieved:

  • An 8% reduction in emergency room visits per 1,000 participants
  • A 5% reduction in hospital readmissions

These improvements, recorded from Q1 to Q2 of 2025,* reflect the power of strong provider collaboration and thorough medical documentation. They also ensure we meet key standards set by federal and state agencies, including Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH).

What to Include in Every Medical Record Submission

As the participant's consulting physician or primary care provider, you play an integral role as a member of their care team. One of our regulatory requirements as a PACE program is to have the CenterLight care team review and update the individualized plan of care minimally on a 6-month basis.

To support this goal, visit notes must be submitted to CenterLight PACE to ensure that our participants' visits to your office become part of their medical record.

Please ensure that each medical record submission includes the following components, when applicable:

  • Plan of Care
  • Nursing and physician progress notes detailing the participant’s response to treatment
  • Specialist evaluations and recommendations
  • Laboratory, radiological, and other test reports
  • Medication records, including medication administration records
  • Physician orders
  • Reports of contact with informal support (e.g., caregiver, legal guardian, or next of kin)
  • Hospital discharge summaries
  • Discharge summary and disenrollment justification
  • Advance directives

Documentation Guidelines

  • Submit medical record documentation monthly
  • Submit documentation after both scheduled and unscheduled assessments
  • Ensure all records are legible, clearly dated, and signed by the responsible clinician
  • Send records to: visitdocumentation@centerlight.org

CenterLight’s staff is HIPAA-trained and committed to upholding strict data privacy and security standards.

Thank you for you for helping us provide high-quality care to those we serve!

Your commitment to thorough documentation and timely communication helps us deliver exceptional care to our participants. Together, we are building a stronger, more responsive care network—one record at a time.

This blog post is written by Jocelyn Pappalardo, Director of Quality at CenterLight Healthcare PACE.

*CenterLight PACE participant data collected by the organization's Quality Department.

H3329 Blog_ForProviders_VisitNotes
Updated July 15, 2025

針對醫療服務提供者：為您的病患提供全新層級的照護

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當您與 CenterLight HealthcareProgram of All-Inclusive Care for the Elderly(PACE) 合作時，您將可享有一系列的福利，同時幫助您的病患在家中安全、獨立地生活。PACE是一種整合式照護模式，55 歲以上有長期照護需求的老年人可享有他們所需的所有照護服務，包括醫療照護、復健、社工、營養和休閒服務、處方藥和非處方藥，以及居家照護。

在CenterLight PACE，您仍是主治醫師 (PCP)，並與我們的跨領域團隊 (IDT) 共同分擔病患照護的責任，該團隊包括但不限於護士、復健治療師、社工、營養師和康樂治療專家。有些參與者（參加 PACE 的個人）可能會接受我們提供的基本照護服務，但許多人仍會保留他們現有的醫生。我們與社區服務提供者合作，滿足服務對象的需求，並與他們的生態系統整合。因此，當我們的醫生和 IDT 的其他成員在您的病人的整個醫療旅程中遇到他們時，我們會滿足他們當前的需求，並努力與您溝通、協作，成為您真正的護理合作夥伴。由於大多數的 PACE 參加者都是體弱的老年人，他們有複雜的醫療和社會需求，因此我們需要與我們的基本醫療合作夥伴建立有效且高效的關係，以實現我們的共同目標，即提供有助於改善他們生活品質的高品質服務。 


為您的醫療實務帶來的好處

  • 單一付款來源：無需就 B 部分自付額和成本分攤向付費服務 Medicaid 開立帳單。
  • IDT 制定、協調並執行個人化的照護計劃，並向參與者及／或照護者提供健康教育。
  • 醫療預約的交通協調可減少不赴約的情況。
  • 提高不常來定期接受主治醫師診療的參加者的參與程度。
  • 透過 IDT 接觸居家的參加者。
  • 社工協助處理權益和行為健康問題。
  • 與藥劑師合作，協助進行藥物審查與核對。
  • 隨著我們會員人數的增加，您也有機會發展您的業務。


PACE 護理模式：經過驗證的結果

透過參與者的主治醫師與 CenterLight PACE IDT 之間的持續合作，參與者可從高品質的整體照護中獲益。IDT 的參與有助於避免不必要的住院、達到高品質的成果，並有助於改善健康成果的社會決定因素。以下圖表說明 PACE 結果與全國平均值的比較。

齊心協力提供高品質的照護

CenterLight 的核心職責之一是確保為我們的參與者提供照護協調和服務。我們參與者的主治醫師或基本照護提供者是照護團隊中不可或缺的一員。

  • CenterLight IDT 為您的病患提供全方位的服務（緊急護理、慢性病管理、護理過渡支援、緩和療護等），並作為您團隊的延伸。
  • 當參與者的狀況發生變化時，我們會與您合作，密切監測他們的狀況。當您無法看到他們時，我們就是您的耳目，我們努力讓我們的互動簡短、有效率且有益，並避免增加您不必要的負擔。
  • 必須提供醫療會診記錄，以確保參與者在您診所的就診成為其醫療記錄的一部分。
  • 作為 PACE 法規要求的一部分，CenterLight 參加者必須由其 IDT 成員進行半年度和年度評估。這些評估大多可在 PACE 中心進行。護士和物理/職業治療師必須每年在家中進行兩次評估和安全評估。

請稍後再回來查看更多文章，了解我們如何攜手合作，為我們的服務對象提供高品質的照護。

本篇博文由 CenterLight Healthcare PACE 的首席醫療官Ziad Farah 醫學博士、MBA 撰寫。


H3329 ForProvidersBlog Approved 10292024
最近更新日期：2024 年 9 月 4 日

* 由 IDT 決定。
1 CenterLight Healthcare PACE 品質報告，截至 2024 年 5 月 7 日最近 90 天內所有地點的資料
22021 年美國每 100 人的急診門診次數，Statista
3≥65 歲成人非致命跌倒及跌倒相關傷害趨勢，疾病控制與預防中心 (CDC)，2020 年 7 月 10 日
42014-2023 年美國流感疫苗涵蓋率，Statista。
5https://media.market.us/home-healthcare-statistics/
6 CenterLight Healthcare PACE Tableau 人口普查儀表板，截至 2024 年 5 月 2 日

參與者可能要承擔未經授權或超出 PACE 計劃協議服務的費用。入會後，PACE 計劃將是參與者唯一的服務提供者。參與者將可獲得跨專業小組確定的所有所需服 務，但不是這些服務的特定提供者。

CenterLight Healthcare 與聯邦醫療保險和醫療補助服務中心 (CMS) 及紐約州衛生局 (NYSDOH) 簽訂了 PACE 核准合約。CenterLight Healthcare PACE 的註冊取決於與 CMS 和 NYSDOH 續約的情況。參與者可能要個人承擔未經授權或 PACE 計畫協議外服務的全部費用。加入後，PACE 計畫將是參與者唯一的服務提供者。參與者將可獲得跨領域小組所確定的所有所需服務，但無法獲得這些服務的特定提供者。如需詳細資訊，請與我們聯繫。

H3329 CLPACEWebsite Approved 10222024

Last Updated on March 6, 2026
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