Expanding the PACE Model of Care to high-need, high-cost populations

Issue: High-need populations benefit from integrated care such as that offered by the Program of All-Inclusive Care for the Elderly (PACE) model. Understanding the diversity of high-need populations and Goals: Identify high-need, high-cost (HNHC) populations that may benefit from an expansion of the PACE model and determine the size and geographic distribution of these populations. Methods: Conduct a literature review and form an expert advisory panel to identify key HNHC populations. Analyze Medicare and Medicaid claims data to capture the size and distribution of these populations, and the extent to which they are particularly high cost. Key Findings and Conclusions: The greatest opportunity for expansion is to the population currently eligible for PACE programs. Significant opportunities exist to serve other high-need populations, some of which are particularly high-cost, and some of which may require changing how PACE is structured. Other high-need populations also could benefit from PACE if its scope were expanded and if reimbursement rates were appropriately structured to recognize variation in costs.