The U.S. health care system is not set up to improve the quality of life of the most vulnerable, chronically ill, elderly people, especially those who are poor. Older poor people often face loneliness, depression, a lost sense of purpose, and an inability to live independently in their homes. They also encounter many health service hurdles, including inadequate care coordination, fee-for-service reimbursement that often reflexively encourages medical treatment over other forms of care, and a dysfunctional nursing home industry. [Harvard Business Review]

To help improve services for these patients, we analyzed the design and implementation of a national program called PACE: Program of All-Inclusive Care for the Elderly. We focused on this program because all PACE participants are vulnerable: They require nursing home–level care, and 90% are eligible for both Medicare and Medicaid. Few integrated-care programs serve this dual-eligible population, which now numbers 12.5 million Americans.

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