What Is PACE? A Complete Guide to PACE Software Solutions

Continued PACE Success

PACE stands for the Program of All-Inclusive Care for the Elderly. It's a joint Medicare and Medicaid model that lets older adults who need nursing home-level care stay in their own homes and communities. A PACE organization coordinates nearly all of their medical and social support instead of a nursing facility. In Pennsylvania, the same model runs under a different name: LIFE, or Living Independence for the Elderly.

Some people search for it as the PACE program for all-inclusive care of the elderly, though the official name places those two words in the other order: the Program of All-Inclusive Care for the Elderly.

To enroll, a person generally must be 55 or older, live in an area served by a PACE organization, and be certified by a state Medicaid agency as needing a nursing home level of care. Most participants who join PACE are dually eligible for both Medicare and Medicaid. PACE organization receives one fixed monthly payment per participant to cover essentially every service those elders might need.

That last detail matters more than it sounds. PACE organizations don't bill piece by piece. They take on full financial risk for each participant's care, so every missed care gap or workflow inefficiency comes straight out of the program's own margin.

Why PACE Programs Are Under Growing Pressure

PACE isn't a niche program anymore. More than 200 PACE organizations now serve upward of 96,000 participants across 33 states and the District of Columbia, and that number keeps climbing as states approve new service areas and existing programs expand into rural communities. Research also found that for-profit PACE organizations grew far faster than nonprofit ones between 2016 and 2022. This shows how much investor and health system interest the model is now attracting.

Growth is good news for participants. It's a different story operationally. Running a PACE program means managing:

• Care coordination across a large interdisciplinary team.
  Every participant's plan touches a primary care provider, nurse, social worker, therapists, and a dietitian, all of whom need to stay on the same page.
  
  
• Data spread across multiple systems.
  Health records, pharmacy data, and claims often live in separate places, creating gaps and slowing decisions.
  
  
• Heavy CMS and state reporting requirements.
  PACE organizations answer to both Medicare and Medicaid rules, and manual tracking eats up staff time that should go toward care.
  
  
• Full financial risk on every participant.
  Capitation means the organization absorbs the cost of every service, so claims accuracy and utilization management directly affect the bottom line.
  
  

For a closer look at these operational hurdles, see our breakdown of the top challenges PACE programs face.

How Modern PACE Software Solves These Challenges

None of the four pressures above disappear on their own, but the right PACE software takes most of the manual burden off your staff.

Care coordination 

It gets easier when every discipline works from one shared care plan instead of separate notes and spreadsheets. Automated alerts flag at-risk participants, like a missed medication refill or a drop in vitals, so the interdisciplinary team can step in before a small issue becomes a hospital visit.

Data integration

Closing the gaps between EHRs, pharmacy systems, and claims data gives care teams one accurate view of each participant instead of four partial ones.

Compliance and reporting automation

Building CMS and state requirements directly into daily workflows, so audit readiness isn't a scramble every quarter. HEDIS quality measures are tracked as care happens, not reconstructed after.

Financial and utilization management tools

Handling capitation calculations, claims adjudication, and IBNR reporting automatically gives finance teams a real-time read on margin instead of a month-end surprise.

Participant and family portals round it out by giving families visibility into care plans and schedules, building the trust that keeps enrollment and satisfaction high.

Must-Have Features in the Best PACE Software

Not every platform marketed as PACE software fits how PACE organizations operate. When you're evaluating the best PACE software for your program, a few features separate genuine elder care management solutions from generic tools stretched to cover it:

EHR interoperability

The system should connect to your existing electronic health records, not force a rebuild.

Automated scheduling and transportation

Day center visits, home care, and transportation need to line up without daily manual coordination.

Medication management with MAR charting

Real-time tracking and refill alerts reduce missed doses and simplify documentation.

Capitation and claims automation

Look for accurate capitation calculations, claims adjudication, and appeals handling built specifically for full-risk contracts.

HEDIS and quality reporting

Built-in quality measures should track automatically, not requiring a separate spreadsheet at reporting time.

RAF and risk tracking

A risk adjustment factor dashboard helps you monitor participant needs and catch coding gaps early.

Usable design

Staff and caregivers need to use the system, so a clean interface matters as much as the feature list behind it.

The best PACE systems don't just digitize your existing paperwork. They fundamentally change how your team works.

The Real Impact of Better PACE Software

When PACE organizations put the right software behind their day-to-day operations, the payoff shows up in a few consistent places.

• Interdisciplinary teams spend less time chasing information across systems and more time managing participant care. 
• Claims and capitation get processed with fewer errors, which protects margin on a model where every dollar is already at risk.
• CMS and state audits shift from a scramble to a routine pull of already accurate data.
• Participants and families get a program that feels responsive instead of bureaucratic, which matters for retention in a model built on long-term relationships.
  
  

None of that requires a long technology overhaul. It requires a platform built around how PACE works: full-risk, interdisciplinary, and accountable to both federal and state regulators at once.

MedVision QuickCap v7: Built for PACE Program Excellence

MedVision built QuickCap v7 around how PACE organizations operate, not a generic care management template.

On the enrollment side, QuickCap v7 verifies health plan eligibility quickly and lets you customize assessments for case management and annual health reviews. It tracks each participant's status through a dedicated RAF dashboard.

Day-to-day, four capabilities do most of the work:

• Clinical Alerts
  modules, with customization, flag at-risk participants early by watching for changes in vitals, medication adherence, and behavior.
  
  
• Referral and Claims Administration
  automates authorizations and claims processing built specifically for PACE workflows, reducing denied claims and delayed reimbursement.
  
  
• Case Management
  gives your interdisciplinary team a shared space for assessments, goal tracking, and progress notes.
  
  
• HEDIS Quality Management
  keeps quality measures aligned with industry benchmarks as care happens, instead of being reconstructed at reporting time.
  
  

On the financial side, QuickCap v7 handles capitation calculations, provider reimbursement configurations, and IBNR reporting. Your finance team always has an accurate read on where the program stands. It's all inside QuickCap v7, the same platform MedVision already built for ACOs, MSOs, IPAs, and other value-based care organizations, adapted specifically for PACE and LIFE programs.

Frequently Asked Questions