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Diane Gross, PhD, University of Rochester Medical Center, 1600 Roxanna Road, NW, Washington, DC 20012, 202 882 6737, dianegross@comcast.net, Helena Temkin-Greener, PhD, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, Stephen Kunitz, MD, PhD, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, and Dana B. Mukamel, Ph D, Department of Medicine, Division of General Internal Medicine & Primary Care, University of California, Irvine, Health Policy Research, 100 Theory, Suite 110, Irvine, CA 92697.
Early success of PACE as a demonstration program provided impetus for its designation as a permanent Medicare program under the Balanced Budget Act of 1997, and prompted ambitious hopes for a large-scale expansion nationwide. Expansion of PACE has not met these expectations, however, as program growth has remained steady, but slow. In this study, we examine the growth of PACE programs and enrollment to date in order to offer insight into the mechanisms influencing or hindering PACE expansion. We identify 17 barriers to expansion, related to federal and state regulation, programs' local operating environments, and program characteristics. Based on interviews and surveys conducted with program administrators from 27 PACE programs, we also ascertain the relative significance of these barriers across programs. While programs' experiences of barriers to enrollment growth varied, several types of barriers were consistently recognized as important by 30% or more of the programs. Our research indicates that the limited growth of PACE can be traced to combinations of certain environmental conditions (including competition and local labor shortages), characteristics of the PACE model itself (including physician lock-in, and out-of-pocket costs for the non-Medicaid-eligible), poor understanding of the program among patient referral sources, and the inability to finance physical expansion (either through sponsor funding or securing external capital). The experience of PACE offers important generalizable lessons for the planning and implementation of other federal and state strategies for providing helath care to the elderly.
Learning Objectives: At the end of the presentation participants will
Keywords: Aging, Medicare/Medicaid
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.