PACE services are provided by an interdisciplinary team composed of at least the following members: a primary care physician, a registered nurse, a social worker, a physical therapist, a pharmacist, an occupational therapist, a recreational therapist, a dietician, a PACE center manager, a home-care coordinator, personal-care attendants, and drivers (Mukamel et al., 2007). The team approach in PACE is innovative in its inclusion of both professionals and direct-care workers as part of the care team. Each member of the team performs an initial assessment of each patient, and then the group works together to create a single care plan that takes the different assessments into account. The team holds weekly care-planning meetings during which the care plans are reassessed.
The services, which are provided primarily at an adult day-care center, are also highly coordinated (Cooper and Fishman, 2003; Mukamel et al., 2006). The center includes a health clinic and at least one common room for social and recreational activities. PACE enrollees attend the day center approximately three days per week, enabling team members to identify subtle changes in health status or mood and to address them quickly. Team members regularly reassess the medical, functional and psychosocial conditions of patients and document any changes in the medical record.
An evaluation of the PACE demonstration program found that enrollment was associated with higher patient satisfaction, improved health status and physical functioning, an increased number of days in the community, improved quality of life, and lower mortality (Chatterji et al., 1998). The benefits of PACE were even greater for the frailest older adults, whose enrollment was associated with lower rates of service utilization in hospitals and nursing homes and higher rates of ambulatory care services.
An analysis showed that capitated payments under PACE were about 10 percent higher than the payments that would have been likely under the fee-for-service (FFS) program. The analysis found savings for Medicare but higher costs for Medicaid. Capitated Medicare payments were 42 percent lower than projected Medicare FFS expenditures, but capitated Medicaid payments were 86 percent higher than projected FFS expenditures (Grabowski, 2006; White et al., 2000).
It is also notable that PACE programs have achieved some success in the recruitment of direct-care workers (Hansen, 2007). The program has a 12 percent annual turnover rate among aides, well below rates reported nationally. Aides at PACE sites are given opportunities for career advancement, and PACE provides financial support to direct-care workers seeking additional training.
The Evercare program, originally developed by United Health Care Corporation, assigns nursing-home residents to a risk-bearing health main-