Assessing the Current State of PACE

PACE programs meet the health needs of over fifty thousand older Americans, allowing them to live in-home while receiving full-service care through interdisciplinary teams. Today, the PACE model has demonstrated positive outcomes in cost savings and quality of care, despite regulatory and data interoperability challenges.

Our Chief Strategy Officer, Laura Ferrara, shares her insights on the current “State of PACE,” and the opportunities for more seniors to benefit from the model of care. Read her LinkedIn article here to learn about ways to expand PACE, support bills in legislation that could remove barriers to access, and increase data interoperability in geriatric care.

Excerpt:

Through my work at Intus Care, I work closely with Programs of All-Inclusive Care for the Elderly (PACE) across the United States. Supporting PACE’s unique and innovative programs which help dual Medicare/Medicaid eligible seniors age in place is the backbone of the Intus Care mission. We’re proud to be able to help our PACE partners make more informed patient care decisions, based on data and our ability to correlate many difficult-to-detect trends.

PACE was created in the 1970s to provide older adults with an alternative to institutional care, and it has since grown to serve more than 60,000 participants across the country -- and that number reflects only a small portion of the people who meet eligibility requirements. A 2021 study by the federal Department of Health and Human Services noted that PACE “stands out from our analysis as a consistently ‘high performer[1].’'" There are presently 306 PACE centers and 150 sponsoring organizations[2]. Intus Care is proud to work with over 40 of those PACE programs across 14 states, and those numbers continue to grow regularly.

The state of PACE in the United States today is both promising and challenging. On one hand, the demand for PACE services is increasing as the population of older adults does. People who are eligible for both Medicare and Medicaid often have complex medical needs which may include multiple chronic conditions. The National PACE Association has identified that the top five chronic conditions of PACE participants as of March 2023 are vascular disease; major depressive, bipolar and paranoid disorders; diabetes with chronic complication; congestive heart failure; and chronic obstructive pulmonary disease. PACE’s model has proven to offer a coordinated and integrated approach to care that can meet the needs of people with these complex diagnoses.

PACE Outcomes and Results

PACE has demonstrated positive outcomes in terms of cost savings and quality of care. PACE participants have been found to have a lower mortality rate compared to similar populations not enrolled in PACE. Research has shown that PACE participants have lower rates of hospitalizations and rehospitalizations compared to fee-for-service Medicare and that only 5% of nursing home-eligible PACE participants currently reside in nursing homes[4]. This translates to cost savings for both the government and participants themselves. Additionally, PACE has been shown to improve health outcomes for participants, including increased satisfaction with care and improved functional status, such as increased ability to perform daily activities. PACE participants have been shown to have lower healthcare costs compared to fee-for-service Medicare, according to a study by the National PACE Association. PACE has also been shown to improve the burden on familial caregivers.

In addition, PACE is also beneficial to support participants ’preference to age in place. A 2021 AARP “Home and Community Preferences Survey” found that 77 percent of adults 50 and older want to stay in their homes for as long as possible. The percentage has been consistent for more than a decade, despite the COVID-19 pandemic. The same survey found that two-thirds of older Americans, if faced with an illness or disability, would prefer help from family or paid professionals to stay in their homes. PACE supports this preference by providing resources such as transportation to appointments and services within the participants’ home. This meets seniors’ desires and needs, while keeping down costs through avoidance of expensive rehabilitation or long-term nursing facilities.

Challenges Facing PACE

Despite these successes, PACE faces several challenges in the United States. One of the biggest challenges is the lack of awareness and understanding of the program among both healthcare providers and potential participants. Many older adults and their families are unaware of PACE and the comprehensive services it provides, which can make it difficult for them to make informed decisions about their care. Healthcare providers may also be unfamiliar with PACE and how it can benefit their patients, which can limit referrals to the program.

In addition, federal and state policies can create barriers for entry to PACE. For instance, some states do not offer PACE as a benefit or have enrollment caps that prevent seniors who meet eligibility from participating. Federal barriers include issues such as PACE participants being unable to enroll in the Medicare Part D benefit, which is more affordable than the PACE prescription benefit. Legislation, the PACE Part D Choice Act⁵, has been proposed to try to remove that current barrier. Other proposed legislation looks to remove additional barriers, such as the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act of 2023⁶, which would allow veterans enrolled with the U.S. Department of Veterans Affairs (VA) to enroll in programs like PACE.

Finally, many PACE programs adapted during the COVID-19 pandemic, such as offering some services and resources via telehealth, among other changes. As the public health emergency expires, programs are wrestling with what beneficial changes they may be able to continue and what will need to adapt back. The hope is that programs will be allowed to continue some of the changes that worked well for the program and its participants, but there is uncertainty for now.

Read the full article here.

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[1] Comparing Outcomes for Dual Eligible Beneficiaries in Integrated Care: Final Report(hhs.gov)

[2],[3]  NPA-infographic-Mar2023.pdf(npaonline.org)

[4] Segelman, M., Szydlowski, J., Kinosian, B., et al. (2014). Hospitalizations inthe Program of All-Inclusive Care for the Elderly. Journal of the AmericanGeriatrics Society, 62: 320-24

[5] 2021AARP Home and Community Preferences Survey

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