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Month: April 2025

5-Slide Series

PACE Landscape

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This edition provides an overview of the PACE model, which delivers comprehensive, community-based care for adults aged 55+ who need nursing home-level of care. As of March 2025, 184 organizations operate over 300 PACE centers in 33 states and DC, serving 82,000 participants—most of whom are dually eligible and medically complex. PACE enrollment has grown 53.1% since 2020, far outpacing the 6.3% growth in the 55+ population. Most PACE programs are operated by standalone PACE organizations, larger health systems, long-term care organizations, and FQHCs. There are opportunities for geographic and operational expansion, though barriers to scalability remain.

Publication

Assessment of the Pharmacy Carve-In Model for Utah’s Medicaid Program

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Utah’s Medicaid program contracts with four Accountable Care Organizations (ACOs) to coordinate care for most of the state’s Medicaid enrollees. This October 2024 report examines the fiscal and programmatic impacts that transitioning to a prescription drug carve-out model, where the pharmacy benefit would be managed under a single-payer system using the fee-for-service payment methodology, would have on Utah’s Medicaid program. Our key recommendations include preserving the current pharmacy carve-in model, piloting a hybrid Preferred Drug List that allows the Utah Department of Health and Human Services and the ACOs to jointly guide utilization towards the most cost-effective drugs for specified drug classes, and exploring potential revisions to supplemental rebates collection and capitation rates for the pharmacy benefit.

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