senior man in front of home

A recent article in the Harvard Business Review lauds the Program of All-Inclusive Care for the Elderly (PACE), which provides comprehensive services to vulnerable older adults at home, as an innovative program that can serve as a model for the rest of the United States healthcare system.

“Given that PACE currently serves only about 60,000 of these patients, expanding the program has useful management and cost implications for health care systems nationally,” authors Leonard L. Barry, Mary Kummer Naber and Sunjay Letchuman wrote. “Although nursing home and other institutionalized elder care clearly demand improvement, the United States also must invest in reimagining what elder care can be. PACE provides a roadmap.”

PACE, a program funded by Medicare and Medicaid, delivers all-inclusive care to adults who are eligible for nursing home care through both in-person visits and care at a local center. Services include nutrition, social interaction transportation and home upkeep.

“The goal is to treat patients with dignity as they safely live at home, rather than in an institution, and receive every needed service from one entity — all while lowering costs,” the article states.

The article cites PACE Southeast Michigan (PACE SEMI) as an “outstanding PACE program.”

Among the evidence of its success, about 15% of participants in this program visit an emergency room each year for any reason compared to 25% of PACE participants nationally and 31% of Medicare Advantage enrollees. Participants also use inpatient hospital services less frequently — 302 fewer hospitalizations per 1,000 people in 2019 compared to MA enrollees.

The article adds to a chorus of support for the program. Two former PACE medical directors recently sang the program’s praise to McKnight’s Home Care Daily Pulse

“It’s sort of been a secret for 20 years,” David Wilner, MD, senior medical consultant for Tabula Rasa Health Care, which provides services to PACE, said. “It was developed in 1980s and replicated in 1990s. It was a secret until the results came out during the pandemic. Even though this was nursing home level of care for participants, they are living in the community, and their level of infection and death was a third of that of nursing homes.”

Mike Brett, MD, senior vice president of consulting services and chief medical officer for TRHC, noted the similarities between PACE and Medicare Advantage, which uses capitated dollars and spends funds as it chooses.

“That’s the beauty of PACE,” Brett said. “They are getting capitated dollars from Medicaid and Medicare and they can throw it in one pot.”

He continued, “You can take care of the whole patient, but you don’t’ have to play ‘mother, may I?’ with Medicaid because you are Medicaid and you don’t have to play ‘mother, may I?’ with Medicare because you are Medicare. You can tailor personalized care not knowing where the dollars are coming from.”

Since Wilner started with PACE in 2002, the program has grown from 30 programs to over 150 programs. He believes the program will more than double in size in the next 10 years.

“My hope is every older person in the United States who might need long-term services and supports has PACE as an option,” Wilner said.