Comparing PACE with a Medicaid‐Only Managed Long‐Term Care Plan: Health Outcomes Over Time

Abstract

Outcomes from a partially integrated model of managed long‐term care—The VNS CHOICE program (VCP)—were compared to those from a fully capitated model—the Program of All‐Inclusive Care for the Elderly (PACE). A retrospective cohort design examined discharge, morbidity, and functional status for 3,200 individuals over 18 months. Although the two populations were close in average functional status, the PACE sample was sicker and more cognitively impaired. Higher rates of death were found in the PACE program (22 percent vs. 10 percent over 18 months) and a greater likelihood of decline in instrumental activities of daily living; higher functional disability scores (ADLs) predicted discharge in PACE but not in VCP. When propensity score stratification was used to compare like populations, the impact of program enrolment on outcomes became statistically insignificant, suggesting that a partially capitated model performs at least as well as the fully capitated PACE model.

Program of All-Inclusive Care for the Elderly (PACE) versus Other Programs: A Scoping Review of Health Outcomes

“…After excluding duplicates, 402 records were screened, from which 380 were excluded since the titles and/or abstracts were unrelated to the study objective or were not conducted in the US. Therefore, 22 records were reviewed in full, of which six met the eligibility criteria and were included in this scoping review [ 6 , 12 , 13 , 14 , 15 , 16 ]. The majority of the articles that were excluded did not compare the health outcomes of PACE participants with participants in other caregiving programs for older adults ( Figure 1 ).…”

“…These three studies reported mixed results for PACE participants relative to their respective comparators. For instance, Nadash (2013) [13] reported a significant improvement in the IADL and ADL limitations in PACE participants compared to VCP participants, and Nadash (2004) [12] reported significantly fewer ADL and IADL limitations in PACE participants compared to MMLTC participants, suggesting that PACE is superior to VCP and MMLTC for managing functional disability among older adults. However, Kane et al (2002) [14] reported a significant proportion of PACE participants needed help with various measures of ADL and IADL limitations compared to WPP participants.…”

“…Specific and all-cause mortality rates among older US adults is often assessed in studies regarding this population [27][28][29][30]. Three (50%) of the six studies included in the current review assessed mortality risk and the proportion of deaths in PACE versus other programs [13,15,16]. Wieland et al (2010) reported PACE participants survived longer (4.2 years) than the 5-year median survival for those in a nursing home (2.3 years) and (3.5 years) in a waiver program [16].…”

“…However, Nadash (2013) [13] reported that 20% of participants in PACE died compared to 10% in VCP after 18 months, although this may be because PACE participants were sicker than VCP participants and the risk of death for participants who received treatment for all causes was lower (HR = 0.55) in VCP compared to PACE. However, when propensity scores were used to match the groups, there was no significant difference between PACE and VCP groups [13]. Weaver et al (2008) [15] found that 34% of PACE participants died compared to 28% of participants in the VA sole-provider model and 28% of participants in the VA + PACE model in a 36-month post-enrollment study, although the study did not report any significance tests.…”

“…Therefore, many risk-of-bias domains were not applicable, were unclear, or had no information and thus were marked as "no information". Bias due to confounding was considered high risk in both studies by Wieland (2010 and2013) [6,16]. However, Wieland (2010) used an established mortality risk index to address cohort risk imbalances and assessed 5-year survival rate based on these risk stratifications [16].…”