The All-Inclusive Senior Care Program is a program that provides comprehensive health services to individuals age 55 and older who are frail enough to be classified as “home-care eligible” by their state’s Medicaid program. Services include primary and special health care, nursing, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor home modifications to accommodate the disabled, and anything else the program determines is medically necessary to improve the health of the member. PACE programs are designed to provide health care and directly employ a comprehensive group of health care workers to care for frail seniors—they are paid a fixed monthly fee per member and, in exchange, are responsible for providing all health services, sometimes including transportation. Because only the most severely frail and incapacitated are enrolled in PACE programs, they are precisely the patient population for whom prevention and health care will make a real difference. Most PACE patients receive multiple diagnoses, with an average of more than seven diagnoses per member. Among the most common diagnoses are heart problems, diabetes, hypertension, and vascular disease. PACE programs have strong incentives to help keep their members as healthy as possible—patients enrolled in these programs, if left unattended, are likely to require extensive nursing home care, which is very expensive. PACE programs therefore tend to provide high levels of preventive services, such as very frequent checkups, exercise programs, nutritional monitoring, strength and balance programs, etc. PACE programs also organize their services into “PACE Centers.” These centers tend to have a day health center, doctors’ offices, nursing, social services, rehabilitation services, and administrative staff, all in one location. Members’ visits to these centers are determined by their care plans. Care is planned with the member, his or her care team, and appropriate family members; most members attend two days a week. PACE was developed by OnLook Premium Health Services, a nonprofit organization that originated in the early 1970s in San Francisco’s North Beach Chinatown neighborhood. With research and administrative funding from the federal Administration on Aging, OnLock opened a day health center in 1972, modeled after the British Day Hospital Program. In 1978, they expanded this model to include full health care and social support for the frail elderly, and in 1979 they obtained federal waivers that allowed reimbursement for all outpatient and health-related services. In 1980, inpatient services were added, including skilled nursing care and hospitalization for acute illness. Amendments to the Social Security Act in 1983 gave OnLock authority to test a risk-based financing system that would include Medicare, Medicaid, and private pay. Major grants from the Robert Wood Johnson Foundation, the John Augustine Hartford Foundation, and the Retirement Research Foundation ensured that research and development activities could be established to support this model program. Congress extended OnLock’s waivers indefinitely, and provided waivers for similar programs at 10 sites. This support enabled OnLook to provide technical assistance to help new sites create and develop a cross-site database to track performance. In 1990, the first such sites received Medicaid and waivers as model programs, and this model became known as the All-Inclusive Senior Care Program, or PACE. The Balanced Budget Act of 1997 made PACE programs a permanent part of the Medicare program and an option under state Medicaid programs. The current PACE model programs became PACE providers by 2003. The Deficit Reduction Act of 2005 authorized the Rural PACE Initiative, and in 2006 the Centers for Medicare and Medicaid Services announced 15 rural PACE grantees. As of August 2010, 76 PACE programs and 5 pre-PACE programs operated in 30 states. The largest of these programs had more than 2,500 frail seniors enrolled, but most served a few hundred on average.