For-Profit Program for All Inclusive Care for the Elderly Plans and Patient Characteristic

This article was originally published on JAMA Network Open.

Introduction

The Program for All Inclusive Care for the Elderly (PACE) is an integrated care model for Medicare beneficiaries who qualify for nursing home–level care but wish to remain in the community.1 Historically nonprofit entities, PACE programs receive capitated Medicare and Medicaid payments to provide comprehensive medical and social services to participants through adult day centers to help beneficiaries age in the community by preventing hospitalizations and long-term nursing home placement.1 Approximately, 188 PACE programs exist nationally, with more than 82 000 participants.

Seminal evidence shows that PACE reduces hospital use.1 In 2016, regulatory changes allowed for-profit programs to enter the market, including private equity (PE)–backed firms.2 Evidence from other health care industries suggests that for-profit and PE entities can impact patient selection and pattens of service use to maximize profits.3 However, little evidence examines how PACE populations and their health care use patterns adapted after these market changes.4 Thus, we describe Medicare enrollee characteristics and health care use patterns in PACE by ownership type (nonprofit, for-profit, for-profit with PE, and for-profit without PE).

Methods

This cohort study conformed to the STROBE reporting guidelines for cohort studies, and we completed analyses from May to November 2025. The Johns Hopkins Institutional Review Board approved the study. Our primary sources of data are 2021 Medicare and Medicaid claims data. We used the Medicare Master Beneficiary Summary File to identify and describe PACE enrollees, health care use, and mortality by linking plan identification numbers to a previously constructed dataset of PACE ownership characteristics.5 We incorporated Medicaid claims to identify nursing home use.

Our primary outcomes include emergency department (ED), inpatient, and skilled nursing facility use. Our primary exposures were (1) nonprofit vs for-profit status of PACE and (2) for-profit with vs without PE backing. We compared outcomes using χ2 tests for categorical variables and analysis of variance for continuous variables across groups using Stata MP-Parallel Edition version 17.0 (StataCorp). We reported 2-sided P values, with P < .05 indicating statistical significance.

Results

Among 63 741 PACE enrollees in 2021, the mean (SD) age was 76.94 (9.83) years, and most enrollees were female (42 254 enrollees [66.3%]) and enrolled in Medicaid and Medicare (63 125 enrollees [99.0%]). In total, 50 184 individuals (78.7%) were served by nonprofit PACE, and 13 557 (21.3%) by for-profit PACE (9474 [14.9%] with PE and 4083 [6.4%] without PE backing). Among for-profit enrollees, 9474 (69.9%) were enrolled in a PE-backed PACE (Table).

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