Population health management (PHM) and utilization management (UM) are often treated as separate initiatives. One focuses on improving health outcomes through data-driven approaches, while the other streamlines PACE resource use. But in a PACE program, their true power comes when they work together.

PHM identifies risk across the participant population. UM ensures interventions are appropriate, timely, and cost-effective. Together, they create a feedback loop that improves participant outcomes and safeguards PACE program finances.

Here’s how leading programs are using data, transforming their operations, and aligning their team to sustain results with PRISM.

Start with the data

Many PACE programs start in “firefighting mode,” reacting to hospital admissions and approving services as they come in. The secret to transforming care delivery is moving away from this reactive mode to a proactive one. This starts with a clear picture of where risk and costs truly lie:

• Risk stratification & EMR data highlight participants most likely to be hospitalized.
• Clinical insights surface gaps in care so the IDT can intervene early.

PRISM helps programs by unifying data in IntusCare’s proprietary Analytics platform. This allows them to track trends, monitor gaps in care, and intervene before costs escalate.

Operational transformation

Data is a powerful catalyst, but real change happens only when it drives daily decisions. This requires operational transformation and strong change management practices. Here are a couple of our recent case studies that demonstrate the power of operational transformation:

Case study #1: Palm Beach PACE

With PRISM, Palm Beach PACE embedded a PHM nurse and a UM nurse directly into the care team so they could begin:

• Tracking trends and closing care gaps in real time.
• Using evidence-based practices to guide service authorizations, transitions, and care planning.
• Supporting the IDT with deep clinical insights and data to inform decisions without replacing their judgment.

Early outcomes: Avoidable hospital admissions dropped, stays became more aligned with participant needs and participant choices, and Palm Beach moved closer to an ambitious 15% medical claims cost reduction goal. All without sacrificing care quality. Here is a summary of what they achieved in the first four months:

• 70% improvement in observation vs. inpatient stays ($1,200 savings per participant per day)
• 12% drop in ER treat-and-release visits per 100 member months
• 9% reduction in inpatient admissions per 100 member months

Read the full case study.

Case study #2: A large PACE program

A 800+ participant PACE program used PRISM to combine analytics with UM workflows and saw:

• Better hospital admission and level of care decisions (inpatient vs. observation).
• Smarter transitions from SNF to home, reducing length of stay.

The outcome:

• $450K+ in savings in just four months
• 25% reduction in inpatient admissions.
• 40% reduction in 30-day readmissions.

Read the full case study.

Aligning teams around a shared goal

Data and workflows are powerful, but people sustain the model. Using PRIMS services, Palm Beach invested heavily in team engagement by:

• Creating interdisciplinary workgroups focused on high-impact areas like CHF/COPD management and post-hospital follow-up.
• Reframing PHM and UM as a quality initiative, not just a cost-cutting measure.
• Empowering managers and “super users” to champion the process and help peers adopt new practices.

This cultural shift helped frontline staff view PHM and UM as collaborative rather than punitive, making it easier to gain buy-in and sustain change.

The bottom line

When PHM and UM are integrated, they transform how PACE programs operate:

• See risk clearly across their population.
• Act early and with confidence to prevent costly events.
• Align teams to make these practices part of everyday care.

The experience of Palm Beach PACE and other programs using PRISM proves that this isn’t just theory. With the right data, workflows, and team alignment, PACE programs can improve participant experience, reduce avoidable utilization, and strengthen financial sustainability.