Alliance for PACE Innovation and Quality Will Carry Forward PACE 2.0 Growth

The new Alliance for PACE Innovation and Quality (APIQ) will capitalize on the successes and lessons learned from the PACE 2.0 growth initiatives while offering services that advance the growth and quality of Programs of All-Inclusive Care for the Elderly (PACE).

When PACE 2.0 launched in 2017, the PACE growth effort set out to identify strategies and resources that could accelerate the growth of PACE to serve more older adults. PACE 2.0 aimed to kickstart the next phase of PACE evolution. When the initiative concluded, PACE enrollment had increased from 40,000 to 58,000 people.

PACE 2.0 was supported by The John A. Hartford Foundation, West Health, and the Harry and Jeanette Weinberg Foundation. One of its earliest steps was to identify the types of growth necessary. The initiative pursued three growth streams:

• Scale: How could currently operating programs increase the number of people they served in their communities?
• Spread: How could new programs serve people in new communities or existing programs expand their service areas to new communities?
• Scope: How could programs expand the scope of the populations they serve, including Medicare-only older adults and people younger than 55?

PACE 2.0 examined each area to identify what was necessary to accelerate access to and enrollment in PACE. Also considered was the role of stakeholders in achieving the goal of serving 200,000 people, such as state agencies, financing sources, and related health and human service providers.  

PACE 2.0 to PACE 200K

Tools and resources to accelerate PACE growth were developed during the first phase of PACE 2.0, reflecting some of the growth tactics implemented over the course of the initiative, which concluded in June 2022.

With more work to be done, the PACE 200K project will be launched in 2023 to reach the goal of 200,000 PACE participants by 2028. The new initiative will capitalize on the lessons learned from PACE 2.0 to grow the PACE community, with the added goal of helping to assure PACE quality during the period of exponential growth ahead. APIQ is a significant part of this emphasis on balancing quality and growth.

The growing number of older adults with complex care and functional support needs is increasing recognition of the failure on the part of the health care delivery system to serve them effectively. As a result, state and federal policy-makers are more interested than ever in integrated, capitated care models that can serve the most challenging and costly populations.

PACE has assessed the effectiveness of its model of care over several decades. The care model has been shown to have the necessary qualities for serving high-need, high-cost individuals, allowing it to achieve a high quality of care to support a high quality of life for participants.

PACE organizations have demonstrated the flexibility of the model and their ability to adapt it to the needs of their communities. They use operational variations to increase capacity and provide care for a range of populations in such areas as behavioral health, physical disabilities and end-stage renal disease.

Evidence, along with recent increases in the rate of PACE growth, indicates that the PACE model of care can be scaled to serve more people and spread to provide access in more communities.

Current Supports of PACE Growth

During the time of the PACE 2.0 project, new opportunities became available for PACE to overcome previous barriers to growth:

• Expanded Service Populations: Congressional enactment of the PACE Innovation Act authorized PACE pilots to serve an expanded range of populations with the operational and payment flexibility needed to adapt the model to their needs.

• Options for Increasing Service Capacity: Proposed updates to PACE program federal regulations will increase the ability to integrate community resources into the delivery system of the PACE care model. This will allow PACE organizations to extend their capacity beyond their own care setting and staff.
• Federal and State Policy Interest: Medicare and Medicaid programs are more interested in serving high-need, high-cost individuals through provider-based solutions. With recent experience showing the significant challenges that insurance-based managed care organizations face in serving this population, people are looking to the PACE capitated model as a solution.
• Health Provider Interest: With state Medicaid programs diminishing their fee-for-service programs, the same health care providers who historically avoided financial risk sought it as a strategy to position themselves for direct payment, rather than operate as a contracted network provider to a managed care organization.

Most recently, the COVID-19 pandemic highlighted the value of community-based alternatives to nursing homes for older adults and the effectiveness of the PACE care model. The National PACE Association (NPA) collected data for 113 weeks during the pandemic and found that the rates of infection and death among PACE participants were one-third those of nursing home residents. In its response of to the pandemic, Congress increased federal funding to states for community-based care, including PACE, which helped drive an increase in state expansions of PACE.

The PACE 2.0 project met these opportunities with a new approach for expanding access to PACE. Rather than seek incremental growth through a static PACE model, the project identified strategies, tools and tactics to achieve exponential growth:

• Partnerships for PACE: PACE organizations can partner with community-based organizations to increase operational capacity and community outreach for increased awareness of PACE as a care option.
• Prospective New Provider Outreach and Training: Assistance was provided to identify Federally Qualified Health Centers (FQHCs), Area Agencies on Aging (AAAs), and Adult Family Health Services (AFHS) as potential sponsors of new PACE programs to serve new communities.
• Pathways to PACE: The PACE care model can be made available to older adults not enrolled in PACE through contracts with new payers such as health plans.
• State PACE Action Network: Model state policies were identified to accelerate PACE enrollment, expand PACE organizations into new service areas, and develop new PACE organizations.
• NPA Growth and Investment Summit: The summit showcased the financial resources PACE organizations can identify and access for growth.
• PACE 2.0 Growth Model: PACE organizations accelerated enrollment growth to serve more people in their community.

Throughout the initiative, many PACE Organizations, PACE Provider Organizations and states participated in PACE 2.0 activities. Fifty-nine PACE organizations participated in the PACE Growth and Learning Community, 102 organizations participated in the virtual Prospective New Provider Outreach and Training for FQHCs, 20 organizations participated in the virtual Prospective New Provider Outreach and Training for AAAs, 164 participants registered for the Prospective New Provider Outreach and Training for AFHSs, and 12 states attended the introductory session of the State PACE Action Network.

Alliance for PACE Innovation and Quality

The Alliance for PACE Innovation and Quality is an independent nonprofit corporation, with NPA as its sole member. APIQ will be governed by its own board of directors made up of PACE organization representatives and external (non-PACE) representatives appointed by NPA. Its mission is two-fold: support and sustain PACE quality and increase access to PACE.

Where PACE 2.0 and PACE 200K are projects made up of initiatives undertaken by NPA, APIQ is an organization that will use the resources developed and tested by the PACE 2.0 initiative to champion PACE growth by eventually providing fee-based advisory services.

Prior to offering fee-based advisory services, APIQ will develop and pilot them with a limited number of PACE organizations between July 1, 2022, and June 30, 2024, through funding support provided under the PACE 200K grant.

APIQ will capitalize on the successes and lessons learned from the PACE 2.0 growth initiatives, while offering services that meet the following objectives to advance PACE growth and quality:

• applying proven strategies for scaling current PACE organizations,
• facilitating access to financing for growth for current and new PACE organizations,
• establishing quality guardrails as PACE growth accelerates, and
• creating a state policy environment supportive of PACE growth and quality.

The development phase of APIQ began on July 1, 2022, and will continue until June 30, 2024. During that time, APIQ will design and pilot advisory services, design and pilot a provider recognition program, and establish administrative and management functions.

July 1, 2024, will be the start of the operational phase for APIQ, which is expected to be self-sustaining at that point to continue the work of achieving widespread access to PACE while assuring the high standards of care established by PACE​.

The Need for APIQ

The increased rate of new PACE organization start-ups is attributed to several factors, including state interest. More states are interested in developing PACE than ever before. For example, Illinois approved 11 organizations to move forward and develop PACE in 2022, and Maryland and Louisiana have approved new PACE programs.

New provider sponsor interest also is contributing to new PACE organization start-ups. More than a hundred potential sponsors of PACE programs participated in the PACE 2.0 Prospective New Provider Outreach Training.

Post-COVID interest in PACE success has contributed to growth as well. The pandemic added to the challenges of residents in residential long-term care facilities and their families, from the high rates of infection and death to the inability to see or spend time with loved ones due to the necessity for social distancing. There is renewed interest in alternatives to traditional models of care for those with complex care needs.

At this time of rapid growth, the capacity of available technical assistance is limited for discernment; leadership training; organizational development (census growth, scaling); increased variation in quality with rapid growth; and state RFPs.

APIQ is uniquely positioned to support PACE growth and quality because it is an established entity, can leverage PACE 200K grant funding to support start-up and development of PACE, complements NPA membership services, and assures quality at a time of rapid growth.

Exponential Growth

APIQ will enable rapid growth by assisting PACE organizations in the discernment of PACE potential for prospective organizations, PACE management team training, and guidance for census growth and effective practices for scaling.

APIQ also will enable growth by connecting with state policy leaders for a State Policy Leader Network, new program development and selection, eligibility and enrollment, rate setting, and quality and oversight.

Additionally, the provider recognition program will serve to assure PACE quality so growth remains responsible and effective. The program will work with PACE organizations seeking improvement strategies to shape a culture of quality and performance excellence while reaching high standards of care and satisfaction.

The program will have three tiers:

• Level 1 – Quality Measurement: Measuring and reporting key indicators of performance.
• Level 2 – Quality Improvement: Using the indicators to implement a systematic improvement process.
• Level 3 – Quality Distinction: Achieving and sustaining consistently high standards and outcomes of care.

APIQ services will help prospective PACE organizations achieve rapid census growth with lessons learned from the fast-start learning community, along with other PACE 2.0 efforts. Operating PACE organizations will benefit from the PACE growth model and lessons taken from the learning collaborative, which APIQ can help them to apply to their own organization. Finally, APIQ will support PACE State Administering Agency leadership by establishing quality measures that support accountability for PACE organizations and ensure the best care for local communities.

For More Information

• Alliance for PACE Innovation and Quality (APIQ)