Why PACE Loses Participants: A Breakdown In The Funnel

Most PACE organizations don't have a demand problem. Referrals are coming in from hospitals, SNFs, and community organizations. Families are calling. Interest exists. The problem is what happens after that first point of contact. Every PACE program has an enrollment funnel, whether or not it’s ever been mapped out, and it goes something like this: referral, intake, assessment, enrollment. Somewhere in that sequence, qualified candidates are falling out, not because they weren't interested, but because the process lost them. Here's how that often happens, and how it can negatively impact the entire organization.

1. The referral that never gets logged

A discharge planner mentions PACE to a family. A social worker hands over a name. But if there's no consistent system for capturing that referral (which is very common), such as a shared tracker, no CRM entry, no follow-up trigger, the referral lives only in someone's inbox or on a sticky note. It never officially enters the funnel, so it's never counted as lost. It just disappears.

This is the most invisible breakdown because there's no data showing it happened. Programs that rely on informal referral tracking (email threads, verbal handoffs, personal notebooks) are almost always losing more referrals than their reporting shows, and is in many ways the lowest hanging fruit to be addressed.

2. Slow speed-to-contact

Once a referral is logged, the clock starts. Families considering PACE are often evaluating multiple options at once, and often times they're in a moment of urgency after a hospital discharge, a caregiving crisis, or a health decline. If your team doesn't reach out within a day or two, that family has often already moved to whatever option responded first.

Speed-to-contact is one of the few enrollment metrics that has a near-linear relationship with conversion. The longer the delay, the lower the odds of enrollment. Perhaps second only to tracking referrals, it’s also one of the easiest things to fix once it's visible because it's usually a process gap, not a resourcing one.

3. Assessment and care team bottlenecks

This is where enrollment stalls even after a family is engaged and motivated. Home visits need to be scheduled. Care team members need to coordinate calendars. If that coordination isn't tightly managed, candidates wait, and waiting families lose momentum, get talked out of it by a relative, or simply choose a faster-moving alternative like a Medicare Advantage D-SNP.

The fix here is rarely "hire more staff." It's usually building a repeatable scheduling process that doesn't depend on informal coordination between departments. Once properly deployed, then staff increases should be considered to keep up with real demand. But eliminating process bottlenecks should come first, and can be more difficult to see at first.

4. Unclear ownership between intake and enrollment

In many programs, intake and enrollment are handled by different people or even different teams. When a candidate moves from one stage to the next, responsibility for following up can become ambiguous, and each group may assume the other is the one still running the show. This is where warm, engaged candidates go cold without anyone noticing until enrollment numbers come in low for the month.

Another facet to this problem is if there’s tension between teams internally that might result in either side looking out for their own interests. This doesn’t mean your staff doesn’t care about the participants - hopefully anyone choosing this line of work has deep empathy for those being cared for, but human nature to protect oneself can override those principles.

Why this matters more than adding new referral sources

It's tempting to respond to slow enrollment growth by looking for more referral sources or spending more on outreach. But if 20-30% of your existing qualified referrals are being lost to these breakdowns, adding volume at the top of the funnel just means losing more people, faster. Fixing the leaks is almost always the higher-leverage move before investing in new demand generation.

The first step to solving these problems is visibility. Mapping your actual enrollment journey stage-by-stage and identifying exactly where candidates are dropping off, and why, can solve a huge portion of the problem in and of itself. Most programs are surprised by what they find once they look.

Not sure where your program is losing participants? That's where we come in. Schedule a free 45-minute consultation, here.