‘PACE works’: Massive HHS study supports clinical benefits of integrated care program

This article was originally published on McKnights Home Care.

A new major government-backed study finds the Program for All-Inclusive Care for the Elderly (PACE), a fully integrated, team-based care model, makes a real difference in the lives of dual eligibles, or those who receive Medicare and Medicaid. PACE participants experienced significantly lower rates of hospitalization and emergency department use compared with beneficiaries enrolled in Medicare Advantage integrated care programs, the study, led by the Department of Health and Human Services, found.

“This analysis offers fresh and strong evidence supporting the benefits of integrated care models, especially the PACE program, in promoting better health care use and health outcomes,” the report, prepared by RTI International, said.

Using data from the 2021 Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse, the study of 3 million dual-eligible Americans found that PACE delivers superior health outcomes compared to seniors enrolled in nonintegrated MA plans. PACE also fared better than other integrated MA health plan options such as Dual Eligible Special Needs Plans (D-SNPs) in certain outcomes. In 2021, 11.8 million individuals were dually enrolled in Medicare and Medicaid. While they made up only 19% of Medicare beneficiaries and 13% of Medicaid beneficiaries, they accounted for 35% of Medicare spending and 27% of Medicaid spending.

The study found that PACE’s integrated care model yields the following outcomes:

• PACE participants were significantly less likely to be hospitalized than comparable enrollees in MA integrated plans
• PACE participants had significantly lower ED use compared to Dual Eligible SNPs and Fully Integrated Dual Eligible SNPs, which showed higher rates than the comparison group
• PACE participants were significantly less likely to die within the year
• Institutional use — primarily nursing home stays — was lower among PACE participants than in the comparison group, though that difference did not reach statistical significance.

The study, “Integrated Care and Health Outcomes for Dual Eligible Individuals,” noted that PACE’s fully integrated and team-based care model underlies its success. PACE is the only program whereby a single organization is accountable for both Medicare and Medicaid services, including no gaps in coordination or financial incentives to shift costs between payers.

The study results serve as a call to action to protect PACE and expand it so that all eligible Americans can take advantage of its benefits, Shawn Bloom, president and CEO of the National PACE Association (NPA), said. Currently, just 4% of eligible seniors have access to a PACE program.

“This study makes it impossible to ignore what the evidence has been telling us for decades: PACE works,” Bloom said in a statement. “PACE expansion enjoys broad support because it is cost-effective for taxpayers and families. An alternative to nursing home care, it provides seniors with an opportunity to remain safely independent while reducing the strain on families and caregivers to deliver a better quality of life.”

Despite its success, expanding PACE is not a given. There are numerous regulatory barriers that prevent growth, including state-level enrollment caps in at least 10 states, enrollment being restricted to the first of the month, and organizations being limited to submitting one expansion application at a time, NPA said.

PACE enables older adults with complex care needs to live safely in their homes and communities. With its integrated care model, interdisciplinary teams provide all necessary medical, behavioral, and long-term care services to participants. More than 200 PACE organizations serve 94,500 seniors in 33 states and Washington, DC.