PACE 2.0: A Prime Opportunity for Delivery Systems and Payers

By Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation

One of the most pervasive challenges in our health care system is allowing people to optimize their independence and continue living at home as they age and develop more complex health and social needs. These individuals often need long-term services and supports (LTSS), and their number is increasing. It’s estimated that the population of Americans in need of LTSS will rise to 27 million by 2050.

Fortunately, there’s a solutionbut it’s been underutilized. The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive, compassionate medical care and LTSS to older adults with persistent complex needs who are eligible for nursing home care. Yet, today PACE only reaches 47,000 people, or less than 2 percent of those who could benefit from its services.

PACE is ready to grow, and there’s no better time than the present. The John A. Hartford Foundation is partnering with West Health to fund an expansion of the PACE program in order to serve populations not served, or underserved in their current health care setting.

It’s a tremendous opportunity for health systems, payers, patients, and caregivers. PACE is a comprehensive, community-based care model that integrates preventive and chronic care, behavioral health, and LTSS for frail, older adults across a variety of health care settings, including the home.

PACE centers also offer a daytime health program to provide respite for caregivers who often bear the large responsibility of coordinating care and managing a household on top of working and maintaining their own health. PACE participants can receive the support they need while remaining a part of the community, and their caregivers are able to shoulder the responsibility with a team of providers. Participants in PACE and their family members love the program and how it changes their lives.

Over many years, PACE has demonstrated again and again that its integrated care model provides cost-effective, high quality care to vulnerable older adults. Even more important: the model is replicable, particularly for accountable care organizations, health plans, and other entities engaged in value-based payment. PACE can serve individuals across the complex care spectrum, including younger adults with disabilities. The PACE model leverages a truly interdisciplinary care team to provide holistic care aligned with what matters to the individual.

Delivery systems and payers are poised to accelerate the growth of PACE that we need to see. The expansion of PACE provides them a unique opportunity to expand cost-effective, patient-centered care and improve their financial performance—and they don’t have to start from scratch. PACE has a proven track record of results:

  • Reduced hospitalizations and readmission rates—PACE participants experience fewer hospital days, and the hospital readmission rate for PACE programs is a low 19 percent. Additionally, emergency room visits for PACE enrollees are fewer than one visit per year.
  • Increased longevity—Care provided at PACE centers has proven to reduce mortality when compared to similar individuals in nursing homes.
  • Better care management—PACE participants report better self-rated health status and preventive care from hearing and vision screenings to flu shots. There are fewer unmet needs, especially in regards to activities of daily living such as getting around and dressing.

For delivery systems and payers, PACE organizations are an overall boost to quality and marketability. PACE centers are woven into the fabric of a community, serving as a beacon of care and trust. Disenrollment rates are very low—less than 3 percent in 2016—indicating enrollees are highly satisfied with their care. Furthermore, PACE centers are prepared to share financial risk with delivery systems and payers because they are comfortable and adept at resource allocation and deploying innovative, integrated care.

Transforming delivery systems and health care financing can seem intractable, but PACE is a model that works. PACE 2.0 has the capacity to deploy a proven model to 200,000 more people in need by 2028. PACE helps patients maintain their independence and stay in the community to the furthest extent possible, a truly path-breaking approach to care for people with complex health and social needs.

For delivery systems and payers looking to improve patient outcomes, maintain financial health, and turn the tide toward what matters most to patients, the PACE model is ready and the time is now.

To find out how your organization can sponsor a PACE program, please visit the National PACE Association.

Editor’s Note: Want to learn more about PACE on the Playbook? Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community is a case study of On Lok, the original PACE program.