PACE programs were built on the promise that holistic, wraparound care could deliver better outcomes for older adults while keeping costs in check. But today, that promise is under increasing pressure.
With rising healthcare costs, workforce shortages, and Medicaid uncertainty, many PACE programs are facing (or expecting) unprecedented financial strain. Nearly every organization finds themselves in a never-ending game of whack-a-mole, facing impossible decisions to make it work—delaying upgrades, reallocating already scarce resources, and leaning harder on staff who are already stretched thin.
Let’s face it: Budget cuts alone won’t solve the problem. What if the key to financial sustainability isn’t just cutting costs, but seeing more clearly and acting more strategically?
The real problem: It’s not overspending. It’s underseeing—and underacting.
Financial stability in PACE isn’t about trimming every line item—it’s about focusing your efforts where they’ll have the greatest impact.
Hospitalizations represent one of the largest expenses for many PACE programs, making them one of the most powerful areas to focus strategic intervention.
This is where two strategies come in:
Population health
Helps you avoid utilization before it happens. It identifies and manages risk across your entire participant population so you can mitigate risk before it escalates.
- A strategy for population-level impact
- Just a dashboard
- A way to spot gaps and intervene early
- A long-game strategy for reducing risk
Utilization management
Helps to prevent avoidable costs when patients visit an ER, hospital, or SNF. It ensures care is aligned with standards, participant needs, and PCP decisions.
- A tool for aligning care with need
- A mechanism for denying necessary care
- A way to create consistency in care decisions
- Just more bureaucracy or paperwork
But for most PACE programs, putting these strategies into action isn’t as simple as it sounds. Three major roadblocks stand in the way:
Fragmented data
Outdated, siloed systems make it nearly impossible to get a full view of your participants’ needs. Information is scattered across disconnected tools, isolated spreadsheets, and paper files—fragmented and difficult to access
Clunky manual processes
Teams spend hours trying to patch together insights, but by the time they do, it’s often too late to intervene. Trends go unnoticed, risks increase, and avoidable costs, especially from hospitalizations, pile up.
Lack of capacity and expertise
Even when the problem is clear, who has time to fix it? PACE teams are already juggling complex care, compliance, and daily operations. Population health and utilization management can feel like add-ons instead of essential and integrated.
Imagine a smarter, stronger PACE model
Now, imagine a world where those barriers are removed:
You see clearly
- All your data is organized, accessible, and tailored to how you operate.
- High-risk participants and rising utilization patterns are flagged before they escalate.
- You have real-time oversight of hospital and SNF stays.
You act strategically
- You focus efforts where you know you can drive results.
- Population health and utilization management are seamlessly embedded into your workflows.
- You develop strategies to proactively manage population health risks.
- You ensure care is appropriate, transitions are smooth and payments are accurate.
This smarter, more integrated approach isn’t just about cost control, it’s about real financial stability. Too many PACE programs are stuck with outdated systems that block progress and keep insights locked away. It’s time for something better. Something built for the future you’re working hard to create.
Do more with better
Let’s stop asking PACE programs to do more with less. Instead, let’s help them do more with better. Better data. Better tools. Better support.
You can’t cut your way to sustainability. But you can build toward it. Financial stability becomes possible when your data works for you, not against you, and insights are paired with action.
These two strategies—especially when used together—are the foundation for better outcomes and financial resilience, even amid uncertainty.
Stay tuned for our next post, where we’ll explore how to put these strategies into practice, day in and day out. Let’s reimagine what’s possible in PACE.
P.S Ready to get started now? Let’s chat.
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