Program of All-Inclusive Care for the Elderly (PACE): Integrating Health and Social Care Since 1973.

According to the Centers for Medicare & Medicaid Services (CMS), the future of older adult care in the United States has arrived in a provider-sponsored health plan model that integrates medical, behavioral, and social care for frail elders. This approach gives the provider complete control over patient outcomes and total cost of care and enables participants to live safely in the community - rather than a nursing home - for an extra four years, on average. This article reviews the Program of All-inclusive Care for the Elderly (PACE) model, whose roots go back to the 1970s in California, and offers case studies on two PACE-RI participants with chronic healthcare needs. In both examples, the patients reduced hospitalizations and increased mental and physical health, all while alleviating caregiver stress. With the older population slated to double by 2060, the time has come to expand PACE to more people. A few years ago, the acting administrator of the Centers for Medicare & Medicaid Services (CMS) said he was "glimpsing into our future" when he visited a provider-sponsored health plan that integrated medical, behavioral, and social care for frail elders, allowing them to remain in the community rather than live in a nursing home.[1] This approach to aging services successfully braided Medicare and Medicaid funding and gave the provider complete control over patient outcomes and total cost of care over a significant period - the key elements to delivering "value-based care." What is noteworthy is that this program of the "future" has been in Rhode Island since 2005 and in other parts of the country since 1973! It helps its medically complex participants live at home for an extra four years on average and retain a much higher quality of life, all while controlling associated costs for the government through capitated payment arrangements.[5] The program is called PACE - short for Program of All-inclusive Care for the Elderly - and it is a comprehensive and community-based model of care that coordinates medical, behavioral, and social services for individuals ages fifty-five and older who have high care needs but can remain safely in the community. PACE is currently offered in 31 states.[2] The model is backed by the National PACE Association and serves 50,000 seniors in 126 sponsoring organizations at 260 PACE centers across the country. While PACE has already had some success at scaling its integrated services, emerging demographics and heightened outreach poise the program for significant growth.