How PACE offers a roadmap to achieve the Triple Aim

Craig Worland - © One Senior Care

It’s never once crossed my mind that I’d write an authorization to remove bed bugs from a patient’s home. Further, I wouldn’t have thought that treating bed bugs would save money for taxpayers.

That is until I joined the Program of All-Inclusive Care for the Elderly (PACE), a national program that helps seniors age independently in their own homes. PACE programs nationwide understand that our patients, known as “participants,” want to stay at home.

As we deliver these services, we’re guided by the Triple Aim of health care – a framework to improve outcomes and reduce costs, all while boosting patient satisfaction. This benchmark is particularly familiar to those who serve high-need populations, like senior care organizations. What’s less known, however, is that PACE has been delivering on the Triple Aim for over 50 years. Here’s how.

Improving Outcomes

Rather than watch, wait and then simply treat symptoms, as is often the case in the traditional, fee-for-service (FFS) Medicare model, PACE helps address the root cause of a participant’s health issues, reducing the potential for later complications and downstream costs. This can range from monitoring a pre-existing condition to preventive health exams and tests, or even addressing a bed bug infestation that caused severe skin irritation for a participant. Though unconventional, it’s a perfect example of what makes PACE unique.

The secret to this quick intervention is our interdisciplinary team (IDT), a key facet of any PACE program, which includes primary care physicians, nutritionists, physical therapists, home care aides and drivers who coordinate transportation to and from PACE day centers, among others.

Reducing Costs

In a capitated payment system, like that used in PACE, providers receive a fixed payment amount per patient. This model incentivizes providers to prioritize quality and efficiency, aiming to keep patients healthy and minimize costly, unnecessary interventions. PACE’s approach demonstrates how a focus on value-based, patient-centered care can create a sustainable system that improves health outcomes while efficiently managing health care spending.
By addressing the source of health care issues, PACE has generated impressive results. PACE participants are significantly less likely to be hospitalized or use emergency care than Medicare Advantage (MA) enrollees. It’s no surprise then that PACE also provides substantial cost savings to participants and payers. One study found that South Carolina and Wyoming save over $9,000 and $12,000 per year, per PACE participant, respectively, when compared with residents in alternative long-term care settings such as nursing homes.

It's not only state budgets and taxpayers that benefit; PACE covers the costs of any services it doesn't offer internally to its participants, such as emergency department visits and hospital stays. And saving on fees, co-pays and deductibles makes an enormous difference for low-income, older Americans.

Boosting Satisfaction

Cost is a necessary topic in any health care discussion, but PACE is so much more than the bottom line. The program is designed to improve participants’ physical, mental, and emotional health, helping seniors – many of whom are in fragile health upon enrollment – transform and thrive.

And let's not forget family caregivers. PACE services help to relieve the burden on these undervalued caregivers who often are juggling the demands of their own jobs and families while providing care for aging loved ones. It’s no wonder, then, that 95% of family caregivers would recommend PACE.

Expanding PACE

The PACE program is a vital component of the long-term care puzzle. More can and must be done in Congress and in state houses to help older adults access the PACE services that they need when they need them.

The bipartisan PACE Anytime Act (S. 4781), recently introduced in Congress, is a promising start. Currently, older adults are forced to wait until the first day of the month to enroll in a PACE program – a bureaucratic requirement that creates delays and puts chronically ill seniors at risk for falls, hospitalizations, and other acute medical crises. The PACE Anytime Act would allow potential participants to enroll any day of the month, removing an arbitrary obstacle for older individuals who will immediately benefit from PACE services.

Expanding the program is an important step to bring the entire senior care industry closer to achieving lower costs, better outcomes and greater satisfaction. That’s why I urge our lawmakers to act immediately and advance the PACE Anytime Act to make the Triple Aim a reality in our health care system.

Craig Worland is the Chief Operating Officer (COO) of One Senior Care.