Review| Volume 10, ISSUE 3, P155-160, March 2009

Program of All-Inclusive Care (PACE): Past, Present, and Future

      From modest beginnings in 1973 to over 60 programs nationwide, the PACE concept has proven the value of integrated, interdisciplinary-based care for frail older adults. The evolution of PACE and its regulatory and reimbursement model have changed over time, but the principals of care have remained unchanged. Nationally PACE programs are dealing with some of the same challenges they had 30 years ago and yet PACE programs continue to expand and provide care to an ever wider distribution of populations. The looming issue of ever-growing health care expenditures represents another opportunity for PACE to demonstrate its value while providing a level of quality beyond what could normally be provided by typical Medicare and Medicaid payments for similar conditions and patient characteristics. The future for PACE includes a number of possibilities including flexibility in financing and reimbursement, design changes to work with community-based physicians, potential eligibility adjustments, and growth of rural PACE. The PACE model has clearly demonstrated that in a debilitated, frail population in whom health care expenses would be expect to be high, a combination of team care, managed health care services, and care coordination can lead to both improved health outcomes and reduced expenses over time.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rogers S.
        • Komisar H.
        Who Needs Long-Term Care? Fact sheet.
        Georgetown University, Washington, DC2003
        • Stone R.
        Long-Term Care for the Elderly with Disabilities: Current Policy, Emerging Trends, and Implications for the Twenty-First Century.
        Milbank Memorial Fund, New York2000
        • Georgetown University Long-Term Care Financing Project Factsheet
        National Spending for Long-Term Care.
        Georgetown University, Washington, DC2007
        • Ansak M.
        • Zawadski R.
        On Lok CCODA: A consolidated model.
        Home Health Care Serv Q. 1983; 4: 147-170
      1. Eng C, Pedulla J, Eleazer GP, McCann R, Fox N. Program of All-inclusive Care for the Elderly (PACE): An innovative model of integrated geriatric care and financing. J Am Geriatr Soc 997;45:223–232.

        • Doste T.
        On Lok: replicating a capitated LTC program.
        Hospitals. 1987; 5: 112
        • Trice L.
        PACE: A model for providing comprehensive healthcare for frail elders.
        Generations. 2006; 30: 90-92
      2. National PACE Association. PACE and Pre-PACE Providers. Available at: Accessed November 1, 2008.

        • Mukamel D.
        • Temkin-Greener H.
        • Clark M.
        Stability of disability among PACE enrollee: Financial and programmatic implications.
        Health Care Financ Rev. 1998; 19: 83-100
        • Eng C.
        The On Lok/PACE model of geriatric managed care: Interdisciplinary approach to care of frail elderly.
        Current Concepts in Geriatric Managed Care. 1996; 2: 3-24
        • Eng C.
        Multidisciplinary approach to medical care: the On Lok model.
        Clinical Report on Aging. 1987; 1: 10-11
        • Greenwood R.
        The PACE model.
        Center for Medical Education Brief. 2001; 2: 1-7
        • Weiland D.
        • Lamb V.
        • Wang H.
        • Sutton S.
        • et al.
        Hospitalization in the program of all-inclusive care for the elderly (PACE): Rates, concomitants, and predictors.
        J Am Geriatr Soc. 2000; 48: 1373-1380
        • Temkin-Greener H.
        • Mukamel D.
        Predicting place of death in the program of all-inclusive care for the elderly (PACE): Participant versus program characteristics.
        J Am Geriatr Soc. 2002; 50: 125-135
        • Sands L.
        • Yaffe K.
        • Lui L.
        The effects of illness on ADL decline over one year in frail older adults with and without cognitive impairment.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M449-454
        • Mukamel D.
        • Temkin-Greener H.
        • Delavan R.
        • Peterson D.R.
        • et al.
        Team Performance and risk adjusted health outcomes in the program of the all-inclusive care for the elderly (PACE).
        Gerontologist. 2006; 46: 227-237
        • Grabowski D.C.
        The cost-effectiveness of noninstitutional long-term care services: Review and synthesis of the most recent evidence.
        Med Care Res Rev. 2006; 63: 3-28
        • Friedman S.M.
        • Steinwachs D.M.
        • Rathouz P.J.
        • Burton L.C.
        • et al.
        Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people.
        Gerontologist. 2005; 45: 157-166
        • Branch L.G.
        • Coulam R.F.
        • Zimmerman Y.A.
        The PACE evaluation: Initial findings.
        Gerontologist. 1995; 35: 349-359
        • Tan E.J.
        • Lui L.Y.
        • Eng C.
        • Jha A.K.
        • et al.
        Differences in mortality of black and white patients enrolled in the program of all-inclusive care for the elderly.
        J Am Geriatr Soc. 2003; 51: 246-251
        • Sands L.P.
        • Wang Y.
        • McCabe G.P.
        • Jennings K.
        • et al.
        Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs.
        J Am Geriatr Soc. 2006; 54: 339-344
        • Friedman S.M.
        • Steinwachs D.M.
        • Temkin-Greener H.
        • Mukamel D.B.
        Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly.
        Gerontologist. 2006; 46: 456-463
        • Mukamel D.B.
        • Peterson D.R.
        • Bajorska A.
        • Temkin-Greener H.
        • et al.
        Variations in risk-adjusted outcomes in a managed acute/long-term care program for frail elderly individuals.
        Int J Qual Health Care. 2004; 16: 293-301
        • Temkin-Greener H.
        • Bajorska A.
        • Mukamel D.B.
        Variations in service use in the Program of All-Inclusive Care for the Elderly (PACE): Is more better?.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 731-738
        • Gross D.L.
        • Temkin-Greener H.
        • Kunitz S.
        • Mukamel D.B.
        The growing pains of integrated health care for the elderly: Lessons from the expansion of PACE.
        Milbank Q. 2004; 82: 257-282
        • Bodenheimer T.
        Long-term care for frail elderly people—the On Lok model.
        N Engl J Med. 1999; 341: 1324-1328
      3. Anderson W, Wiener J, O'Keefe J. Money follows the person initiatives of the systems change grantees. Final Report: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2006:1–18.

        • Kane R.L.
        • Homyak P.
        • Bershadsky B.
        • Flood S.
        Variations on a theme called PACE.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 689-693
        • Kane R.L.
        • Homyak P.
        • Bershadsky B.
        • Flood S.
        The effects of a variant of the program for all-inclusive care of the elderly on hospital utilization and outcomes.
        J Am Geriatr Soc. 2006; 54: 276-283
        • Reardon G.
        • McNabney M.
        • Bloom S.
        • Eng C.
        Should programs of all-inclusive care for the elderly use community-based primary care physicians?.
        J Am Med Dir Assoc. 2008; 9: 275-278
      4. National PACE Association. Setting the PACE for Rural Elder Care: A Framework for Action, 2002. Available at: Accessed November 1, 2008.