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Program of All-Inclusive Care for the Elderly (PACE) is a capitated health plan that provides comprehensive Medicare and Medicaid covered services to frail, older adults in the community who are eligible for nursing home care. New research from ATI explores the latest enrollment trends and highlights latest opportunities for PACE growth.

Beginning January 1, 2030, Dual Eligible Special Needs Plan (D-SNP) enrollment must be fully aligned with Medicaid plan enrollment, and beneficiaries will no longer be able to stay in their current D-SNP. Building on a previous ATI resource, this brief outlines a transitional strategy for states subject to the impending D-SNP enrollment alignment requirements to consider.

The Kim Frailty Index (KFI) is a validated, peer-reviewed measure of frailty that uses only healthcare claims data to measure frailty with sufficient accuracy for population-level decision making. The CMS Innovation Center is embedding KFI data into its Long-term Enhanced ACO Design (LEAD) Model as one of the factors used to assess whether a beneficiary qualifies as "High Needs."

New research from ATI shows that in 2023, Institutional Special Needs Plan (I-SNP) enrollees had lower mortality risk and fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP MA beneficiaries. This brief investigates the association between I-SNP enrollment and mortality, healthcare utilization, spending, and quality outcomes for long-term care residents enrolled in Medicare who had one or more nursing facility stays of 90 days or longer during the year.

ATI’s latest resource draws on analysis of CMS enrollment data to map where C-SNP growth is happening and which populations and conditions represent the highest-value opportunities. The tool provides considerations for building a high-performing plan, walking through five critical decision points and a six-phase launch roadmap while identifying common pitfalls.

Medicare’s hospice benefit provides comprehensive palliative care for Part A beneficiaries with terminal illnesses who elect to forgo curative care. Hospice was designed to prioritize pain management, comfort, and patient choice, but it may also generate Medicare savings by replacing costly treatments and intensive hospital care at the end of life. Drawing from high-quality studies of hospice value and timing, ATI modeled the potential effect on Medicare spending if beneficiaries currently enrolling in the eight weeks before death were to elect hospice five days earlier.