Use the filters below to learn about programs across the country that are working to care for people with complex medical, behavioral health, and social needs. Learn more about how this map was developed. The Playbook also welcomes submissions from the field — learn how to submit your program.

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Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Clanton, AL
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Little Rock, AR
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
North Fork, CA
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Lake George, CO
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Dover, DE
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Brooksville, FL
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Ames, IA
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Avon, IN
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Claflin, KS
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org

Program of All-inclusive Care for the Elderly (PACE)

National PACE Association
Marksville, LA
PACE
Target Population:
  • Adults Under 65 with Disabilities
  • Frail Older Adults
  • People with Multiple Chronic Conditions
  • People with Serious Illness
Insurance:
  • Medicare
  • Medicaid
  • Medicare / Medicaid
  • Uninsured
  • Commercial
Care Program Elements:
  • Individualized care plan
  • Ongoing care plan review
  • Interdisciplinary care team
  • Active care coordination
  • Assesses behavioral health care needs and coordinates services
  • Addresses social determinants of health
  • Shares information across care team/health providers
  • Education for providers and patient
  • Engages in performance measurement/quality
Replicated Sites:

PACE has been replicated in 233 locations in thirty-one states (AL, AR, CA, CO, DE, FL, IA, IN, KS, LA, MA, MD, MI, NC, ND, NE, NJ, NM, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WI, WY).

Outcome Notes:

Studies have shown: reduced hospital readmissions; lower ED utilization; reductions in the use of institutional care; cost savings; and high levels of enrollee satisfaction.

Point of Contact:
Robert Greenwood, Senior Vice Presient of Public Affairs
703-535-1522
Robertg@npaonline.org