This is done by having a case manager monitor client situations and coordinate the services between the two systems. This is the strategy of many HMOs today with regard to high cost cases or high risk care management. The PACE model seeks to integrate the delivery of services as much as possible at the adult day center using a multi-disciplinary team to provide services. The team meets to conduct evaluations of individuals and to agree on their plan of care. Not surprisingly, PACE sites have had high physician turnover.
Some consumers find the integrated adult day center team approach too rigid and unresponsive.
Accordingly, some PACE programs are modifying the original PACE design by not requiring adult day care attendance. The difficulty in achieving an adequate number of enrollees at the PACE sites suggests that other models of care and a broader target market need to be explored. An example is the development of Home-First, a Brooklyn, New York based organization for the over 65 that qualify for Medicare as well as adults with serious or disabling conditions. This comprehensive program will use one's home as the predominant site for care and allow individuals to retain their existing physician. It probably will be harder to control utilization and cost with this consumer driven model, but the enrollment potential seems greater.