Evaluating PACE: A Review of the Literature

Publisher: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Tern Care Policy
Jan 01, 2014
Authors
Arkadipta Ghosh, Cara Orfield, and Robert Schmitz
  • Significant challenges exist in evaluating PACE, with most quasi-experimental studies of PACE failing to meet the standards of a rigorous evaluation.
  • The evidence from studies with the strongest design show that PACE has no significant effect on Medicare costs; however, it is associated with significantly higher Medicaid costs, with the Medicaid spending gap between PACE and matched comparison enrollees decreasing over time.
  • Although PACE enrollees have fewer inpatient hospitalizations than their fee-for-service counterparts, they appear to have higher rates of nursing home admission.
  • PACE improves certain aspects of care quality, and PACE enrollees have a lower mortality rate.

Based on a comprehensive review of existing evaluations of PACE, this report brings together available evidence on the effect of PACE on several key outcomes of interest: Medicare and Medicaid costs, hospital and nursing home utilization, quality of care, satisfaction and quality of life, and mortality. We summarize findings from past studies and assess their methodological approach. We improve on these earlier evaluations by conducting a more detailed review of the studies, as well as a more rigorous assessment of the quality of evidence presented in each.