---
type: claim
domain: health
description: "PACE's primary value is avoiding long-term nursing home placement while maintaining or improving quality, not generating cost savings"
confidence: likely
source: "ASPE/HHS 2014 PACE evaluation showing significantly lower nursing home utilization across all measures"
created: 2026-03-10
last_evaluated: 2026-03-10
depends_on: ["pace-restructures-costs-from-acute-to-chronic-spending-without-reducing-total-expenditure-challenging-prevention-saves-money-narrative"]
challenged_by: []
---

# PACE averts long-term institutionalization through integrated community-based care, not cost reduction

PACE's primary value proposition is not economic but clinical and social: it keeps nursing-home-eligible seniors in the community while maintaining or improving quality of care. The ASPE/HHS evaluation found significantly lower nursing home utilization among PACE enrollees across all measured outcomes compared to matched comparison groups (nursing home entrants and HCBS waiver enrollees).

## How PACE Restructures Institutional Care

The program provides fully integrated medical, social, and psychiatric care under a single capitated payment, replacing fragmented fee-for-service billing. This integration enables PACE to use nursing homes strategically—shorter stays, often in lieu of hospital admissions—rather than as the default long-term placement pathway.

The evidence suggests PACE may use nursing homes differently than traditional care: as acute care alternatives rather than chronic residential settings. The key achievement is avoiding permanent institutionalization, which aligns with patient preferences for aging in place and with the epidemiological reality that social isolation and loss of community connection are independent mortality risk factors.

## Quality Signals Beyond Location

Some evidence indicates lower mortality rates among PACE enrollees, suggesting quality improvements beyond just the location of care. However, study design limitations (potential selection bias—PACE enrollees may differ systematically from those who enter nursing homes or use HCBS waivers in unmeasured ways) mean this finding is suggestive rather than definitive.

## Evidence

- ASPE/HHS 2014 evaluation: significantly lower nursing home utilization across ALL measured outcomes
- PACE may use nursing homes for short stays in lieu of hospital admissions (care substitution, not elimination)
- Some evidence of lower mortality rates (quality signal, but vulnerable to selection bias)
- Study covered 8 states, 250+ enrollees during 2006-2008
- Matched comparison groups: nursing home entrants AND HCBS waiver enrollees


### Additional Evidence (extend)
*Source: [[2025-03-17-norc-pace-market-assessment-for-profit-expansion]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*

NORC (2025) provides updated scale data: 90,580 enrollees as of end-2025 (12% annual growth, fastest in recent years), 198 programs across 33 states + DC. Geographic concentration remains extreme: over half of enrollees in California, New York, and Pennsylvania; only 13 states have 1,000+ enrollees. Nearly half of all enrollees served by 10 largest parent organizations. For-profit organizations are beginning to enter the market, bringing capital and operational scaling capacity. This extends the existing claim by quantifying current scale, documenting the 2025 inflection point (for-profit entry + 12% growth), and identifying geographic concentration as a persistent structural barrier to national scaling.

---

Relevant Notes:
- [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]]
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]
- [[social isolation costs Medicare 7 billion annually and carries mortality risk equivalent to smoking 15 cigarettes per day making loneliness a clinical condition not a personal problem]]

Topics:
- [[health/_map]]
