Zemplee Podcast : Episode 15

Majd: I firmly believe in the effectiveness of the PACE model and its alignment of incentives between payer and provider. It's a setting where we can do a lot of innovation — including the adoption of technology solutions that enable care delivery and support independence, as your center's name implies.

Let's go ahead and start with you, Justine. Can you share a little background about yourself, your role at CEI, and the programs you run under the PACE umbrella?

Justine: Thank you. I have nearly 40 years of healthcare experience across many different roles. I found the PACE world about two decades ago, and I wish I had found it earlier in my career — it really is an amazing model.

I joined CEI here in 2023, and I'm responsible for developing strategic growth and expansion efforts in our catchment area, which covers both Alameda and Contra Costa counties in Northern California. My work is really about finding new business opportunities, building partnerships, and asking: how do we at CEI truly embrace the community we live in? We want to keep our seniors here. We want them to stay at home. So we want to be good partners to everyone else doing business in our community.

This is my fourth PACE program. My most recent one before CEI was a startup, for-profit PACE program based out of New York City, focused on bringing the PACE model to suburban and rural areas across the country. We had a rapid growth plan, and I learned a great deal about how to take this wonderful model and embed it into communities in rural middle America and outlying areas beyond major urban centers — which often have far more resources than smaller rural communities. That experience really rounded out my PACE background.

Before that, I worked for one of the largest PACE programs in California, in Los Angeles — nearly 4,000 participants across multiple counties. I'm proud to say I had a hand in doubling that census over five years, largely by embedding ourselves deeply in the community.

And I started my PACE career with the great opportunity to open the first rural PACE center in California, up near the Oregon border. It was a very small, tight-knit community that fully embraced caring for its seniors. Walking down the street and having people know your name — and know that you're doing good work — was a really wonderful thing.

Prior to PACE, I held leadership positions with the American Association of Critical Care Nurses and worked with many physician groups, focused on improving education and practice. My real passion is the care of older adults. My graduate degree is as a gerontological clinical nurse specialist, with a focus on acute and critical care. Moving into the community has been the greatest joy of my career.

As for CEI specifically — we've been in this community for 45 years. It still amazes me when I walk into a community-based organization and people don't know who we are. In 1982, activists and leaders in Alameda County — which was really at the hub of the free speech movement and a lot of social activism — saw the need for the community to care for its own. They partnered with the local community hospital and started the first PACE program in the Bay Area. We are deeply embedded in the fabric of this region, with longstanding partnerships with organizations like Meals on Wheels and senior housing communities. This past year, we opened three new PACE centers, extending our reach within our own catchment area. Our guiding principle is that services should be as close as possible to where people live.

Majd: Given your vast experience in PACE and elder care, what are some of the trends you've observed — or are currently observing — around technology, and its potential in PACE programs? Both at the centers themselves and for services delivered into the home. And I'll add my own observation: I'm seeing a growing demand for in-home services, as opposed to participants coming to the centers. Would you agree?

Justine: The PACE model was really built around a hub, with services wrapped around the individual. At the core is the PACE center — it's a clinic, an adult day center, and a rehab gym. We have 11 disciplines available to participants daily: dietitians, social workers, physicians, nurses, therapists — you name it. I used to say, you just need to knock on the magic door and you can see your provider. It's one-stop care for folks who have difficulty getting to appointments, and for family members who are stretched thin trying to keep up with all the needs of a frail senior.

Technology, honestly, is underutilized in our sector. We're a high-touch business, and we work with a cohort of individuals who grew up with paper and are just beginning to embrace technology — not at the same level as their children and grandchildren. So we always have to ask: does this tool help the caregiver, the healthcare provider, or the participant directly? And is it meaningful to them?

Here at CEI, we brought on a wonderful new CIO a couple of years ago who has really helped us see the opportunities in front of us. We've been experimenting — looking for opportunities to use AI, which we deliberately call "augmented intelligence," because we're using it to drive better outcomes. It's always in service of something. The goal is to look at where technology can enhance human capabilities at every level of our operations: transportation, logistics, anything that reduces administrative burden on healthcare workers, physicians, and nurses so they can focus on participants.

We've also spent a lot of time on cybersecurity, and on making sure we're not adopting technology just because we can. I tell folks: if I can't explain this to my own mother and feel good about it, we need to pause and really understand what we're trying to accomplish.

We've looked at how we deliver care, how we support enrollment and outreach, how we achieve seamless care delivery — making sure our EHR, our applications, and our systems all work together. In our outreach and enrollment department, we use a robust CRM for everything. Before some of these innovations, we were manually transferring regulatory reports into other systems — the amount of error we've eliminated has been incredible.

We've also looked at how our interdisciplinary team members communicate with one another. One of my responsibilities includes marketing and communications, so I think a lot about how we keep our entire workforce engaged and informed through technology. Can my drivers get the same information on their phone as a finance employee sitting at a desktop all day? We have to think about the intent of the need, and the best tool to meet it.

None of this is cheap, and we're a nonprofit. We've been here 45 years, and every investment has to earn its place. We've had great opportunities to support our experiments through grants and other funding sources, which takes time and energy but has been really valuable.

One program I'm especially proud of: we received a wonderful grant that allowed us to run a program called Web Links. We created a mini university for our participants, teaching them how to use an iPad, get an email address, talk to their grandchildren, and protect themselves from online fraud. It was about enriching their lives in ways that go beyond healthcare. When they graduated, they got to keep their iPad. We couldn't have afforded that on our own. Once your grandmother calls you on FaceTime and asks how you're doing — that's when you really feel what technology can do for a family.

Majd: You've touched on a lot of the impact already, so let me shift to a related question. Since your participants live in the community, and since you're a capitated model where an exacerbation of a chronic condition — or noncompliance with a medication regimen — can lead to hospitalization or even institutionalization, have you considered remote monitoring technologies? Things like biometric remote patient monitoring for vital signs and chronic disease management, or behavioral and activity monitoring to detect early signs of health decline?

Justine: Proactive care is quality care. The more we know before a problem happens, the better. That's actually how you and I got connected — we were looking for ways to gather information and data before a crisis occurs.

As a PACE program, we provide all services at no additional cost to participants. So anything we can do that would otherwise require a live human presence 24/7 — or that would land someone in a skilled nursing facility — is worth exploring. We're looking for technology that can alert us, keep people out of the emergency room, and do it all in a way that honors participants' dignity and wishes.

Hospitals and ERs are genuinely harmful for older adults. We want to prevent those visits whenever we can. Home care will always need some human support — helping someone to the bathroom, assisting with a shower — but when we know specifically what's needed, we can help caregivers do that more efficiently and give family members a break, so they can just be the daughter or the son, not the caregiver.

The challenge, as always, is cost. But what we're finding is that remote monitoring is actually cost-saving. One hospitalization or one ER visit can pay for this technology across many participants over an extended period. The challenge for me, as the business development person, is going to my executive leadership team and saying: I can save you money you haven't spent yet. That requires being able to clearly articulate long-term ROI — and it's helpful to have technology partners who can help make that case.

There's also another dimension that I think technology is uniquely positioned to address: social isolation. We see it all the time — people coming into our program who may not have seen another person except for a doctor's visit. They feel completely cut off. Technology is helping us find ways for them to connect. It sounds simple, but the research and our own experience show that connected seniors demonstrate greater quality of life and report being significantly happier. It's not just about monitoring physical health. It's about the whole person, which is what the PACE model is built around.

Majd: That's a great point. And from my own background — both as a researcher at the University of Virginia, where I worked on remote monitoring technologies, and in my time at LeadingAge — I'veseen a real need for better understanding of an older adult's ability to perform activities of daily living. A doctor's office visit gives you a short snapshot. It doesn't give you a clear picture of how someone is actually managing at home. Would you agree?

Justine: Absolutely. Once people enroll with us, they typically stay with us until they pass — so we get to know them daily, year over year. We are, as my friends would say, all up in their business. And the more we know, the more we can help.

It always comes back to this, though: did the person feel the impact? I'll share one of my favorite stories. I was with a nurse and we were speaking with a participant — an older gentleman, a bit grouchy, not particularly connected to people at the center. We were doing a continuous improvement review, and this nurse asked him: "Mr. Smith, we've made some changes here. I'd really like your opinion about how we're doing."

He took a deep breath, looked at both of us, and a tear ran down his face. He said: "You know, it's been a long time since anyone asked my opinion. People tell me what to do. They tell me when they'repicking me up. They tell me what to eat."

You can't get that in a 15-minute doctor's appointment. You get it through deep human connection. And that nurse only had time for that conversation because she wasn't buried in documentation. That'sthe real promise of technology in this space — freeing up our clinicians and caregivers to make the human connections we all need as we age.

Majd: That's a beautiful story. So what are some of the broader challenges you see — either sector-wide or specific to CEI — and where do you think technology can help address them?

Justine: A few things come to mind.

We talked about social support — and that need extends to family members and caregivers, not just participants. Technology could really help caregivers stay on top of things without carrying the full burden themselves.

Critical gaps I keep seeing: limited resources for diverse communities, particularly for people who are bilingual or who have grown their entire lives with economic barriers to care. The PACE program is designed for poor, frail seniors who want to live in the community — but many simply don't know we exist. Awareness is a huge challenge.

We wish we could grow faster and serve more people, but growth takes capital. It takes facilities, hiring, and training staff. And finding qualified healthcare workers — even caring individuals without advanced degrees who want to do home care and personal care — is genuinely difficult.

Regulatory requirements and funding uncertainty also present real challenges. We're funded by Medicare and Medicaid, so anytime there's political uncertainty around those programs, it ripples into the community. Prospective participants wonder: if I enroll, will you still be here next year? Anything we can do as a society to stabilize funding for frail senior care is incredibly important. Institutionalization is extraordinarily expensive — and PACE demonstrates that there's a better, more cost-effective model for people who want to stay home.

For smaller PACE organizations especially, all of these pressures are magnified. They often don't have the resources to invest in technology, marketing, or organizational development that larger programs like ours can manage. If technology can help support those smaller programs, that investment will pay dividends for the entire sector.

Majd: Let's talk about growth and participant awareness. Have you considered advertising — not just to older adults, but to their family members? Things like public radio, podcasts, public service announcements?

Justine: Yes, we've really embraced getting our name out there. Part of my responsibility is community engagement, and I started by asking: what does our community actually know about us? It's a marketing and communications discipline — making people aware that a resource exists.

It is an expensive endeavor, but we feel it's part of our responsibility. We focus on opportunities that don't break the budget: presenting as thought leaders, appearing on television news segments, getting our chief medical officer on Spanish-language television for things like nutrition month and heart health month. The more people hear our name, the easier everything else becomes.

We do a lot on social media, targeting family members and caregivers — that's where healthcare decisions are increasingly made. We've also seen an uptick in seniors themselves using cell phones as their primary source of information, so we've invested in web banners, social content, and really telling stories that show people what a great life looks like in a program like ours.

We completely revamped our website a couple of years ago and revisit it every six months. It's no longer a static digital brochure — it's a resource. We have billboards on the freeways. We have enrollment development specialists knocking on doors and meeting with community organizations. It's a constant effort.

What I'd say to any PACE program: you have to feed it. You have to continually remind people that this resource exists. It's the old adage — if you want results, you have to invest consistently. We've seen real returns on that investment, including the ability to open new centers. It works.

There are now more than 200 PACE organizations across 33-plus states, and every one of them is shaped by the community it serves. You can walk into one PACE center and think you know what all of them look like — you don't. The model is the same, but the flavor is entirely local.

Majd: Let's talk about workforce. You touched on it earlier. Is this primarily a recruitment problem, a retention problem, or both?

Justine: Honestly, it depends on the year and the role.

For licensed, skilled positions — physicians, nurse practitioners, nurses, physical and occupational therapists — these are hard to fill. They're the backbone of the interdisciplinary team. But non-skilled positions are equally challenging: CNAs, drivers, home care workers, personal care aides. There are more and more job options for people in those categories, and where do they get PACE-specific training?

On recruitment: I don't have difficulty getting applicants for most roles. The real challenge is finding people who understand that PACE is a fundamentally different care model. This is not like working in a hospital. You have to be engaged in the outcomes you're trying to achieve. You have to live the mission. Finding those people — and getting the story in front of them — is the challenge.

On retention: we invest in robust training programs and career development pathways. We partner with vocational schools, offer clinical experiences to university students, and even work with local high schools — students come in to help with operations and get to interact across generations. We give people opportunities to grow, and sometimes that means they grow beyond us. We have to be okay with that. That's part of what we're offering to our community.

What I do know is this: if I can give you a technology solution that frees you up to do the parts of the work you love, you're not going to be looking for another job.

Majd: There are also AI-based tools that can help with retention through employee engagement — gathering signals about dissatisfaction, for example. And you mentioned leadership: the adage is that people don't quit jobs, they quit supervisors. Is finding good leaders a pain point?

Justine: It is. And it's easy to overlook. We talk a lot about recruiting and training direct caregivers, but finding managers, supervisors, and directors who understand that leadership isn't just about getting the work done — it's about creating an environment where people feel heard — that's equally difficult, if not harder.

At CEI, we've built an organizational development and training department specifically to support our team members and help our leaders continue to grow. We've created a culture of engagement. And in a market like the Bay Area — a short distance from Silicon Valley, across the bay from San Francisco — there are a lot of options for workers. We have to differentiate ourselves through culture.

I'll also say: my CHRO is someone who constantly asks how he can help his recruiters and HR business partners do more. Using AI to pre-screen candidates for cultural fit is absolutely something we look at. Wherever we can extend the expertise of our team members so they can focus on the highest-impact work — real human interaction and development — that's where we want to invest.

Majd: What are CEI's goals for the next one to five years?

Justine: In five years, I would love to double our enrollment. There is so much unmet need. The question is how to grow fast enough — and responsibly enough — to do that well.

I also see a real opportunity for CEI to be a thought leader and trainer for other PACE organizations. We were the second PACE program in California. There's a lot of institutional knowledge here, and there's value in sharing it — not as a "here's the quick answer" shortcut, but in the form of real case studies: here's the situation, here's how we approached it, here's what we learned, here's our advice for others who want to replicate it.

I believe deeply in that kind of experiential learning. You still have to experience it yourself — but you don't have to start from scratch if someone has already done the hard work and is willing to share it honestly.

Majd: What advice would you give to the audience — whether they're another PACE provider, a technology developer, a payer, or a family member?

Justine: Don't look for the easy answer. I get calls all the time asking: can you share your tool? Can you just tell me how you did it? I can do that, but it won't solve your problem.

My real advice: figure out your methodology for understanding the problem you're trying to solve. What is the actual problem? Who does it touch? What are your guardrails — regulatory, financial, ethical? The regulations in PACE are there to ensure you can achieve a certain outcome 100% of the time. What works at CEI may not work for another PACE organization, because conditions differ.

For every challenge, start with: what problem are we trying to solve? What resources do we have? Are we allowed to approach it this way? And is there room for creative thinking?

Carve out time in your week — even just to sit and think about a really hard problem. Think through everything you need to know about it before you start solving it. If you don't, you'll be lured by a solution to a problem you don't actually have, because you wanted to move fast.

To my technology colleagues and hopefully future partners: stop trying to sell me a solution. Help me understand my problem, and then show me why your solution is the right answer. We're a nonprofit. Every dollar we spend on technology is a dollar we're not spending on participants. That investment has to hold up five years from now — not just solve today's problem.

And I'd add: when you're defining the problem, engage everyone it will touch. Internal partners, external partners, the people whose workflows will change. Don't automate the same broken process and call it innovation. Think about how technology can genuinely streamline and improve the way care is delivered.

Own your expertise. Keep learning your craft. And create environments where your team members feel safe bringing their best ideas forward — because often, they have the best ones.

Majd: This was supposed to be 30 minutes and we're nearly at an hour — which tells you everything about the quality of this conversation. Justine, where can our audience learn more about CEI and connect with you?

Justine: You can find us at www.elders.org. We have a robust website with virtual tours of all our centers, educational resources for caregivers, and an evergreen blog covering topics like caregiver stress, healthy aging, and more. Our leaders are all on LinkedIn with full bios and accessible contact information. Our email format is first initial + last name at ceci.elders.org — please feel free to reach out. I'm always open to engaging with people who have good ideas, and to sharing what we've learned.

This is the only way we're going to raise awareness about this wonderful model and get it into every community — so that our seniors don't have to be institutionalized, and can live at home safely, with high quality and high satisfaction.

Majd: Thank you so much, Justine. This has been genuinely informational, engaging, and inspiring. And to everyone listening: if you have suggestions for a future guest or topic, please reach out. Subscribe to the YouTube channel and follow along on LinkedIn. Thank you all.