From Seattle to New York: Reflections on NPA 2025
Three years ago, I attended my first NPA conference in Seattle. I was new to the PACE world, learning how this model fits within the broader healthcare system and why it matters so deeply.
This year in New York City, I spoke with a few people who agreed that the energy felt different. The conversation has evolved from explaining what PACE is to exploring how to grow it. How can we take it from a niche program to a model that every older adult, family, and policymaker recognizes?
There’s a shared belief that PACE is more than one of many healthcare options for older adults. PACE is outcomes-focused at a core. There has been rapid growth over the past 3 years in both total participants and number of centers.
Delivering care to vulnerable older adults in order to support their goal of living independently in their communities is one of the hardest jobs out there. Everyone there — from clinicians to executives — is committed to the same goal: helping older adults stay independent, connected, and cared for. This growth shows that their hard work is paying off, but we need to do more
Alongside the optimism, the uncertainty surrounding HR-1 and its potential impact on federal and state funding weighed heavily in conversations. Everyone knows how vital ongoing support is. As NPA President Shawn Bloom put it, support for PACE isn’t a blue-state or red-state issue. Legislators from both sides of the aisle see its value. What’s needed now is more awareness that PACE isn’t a fringe alternative but a proven model that keeps people healthy and at home.
This year’s sessions reinforced why I’m passionate about this work: transparency, operational discipline, and policy stability are what make PACE thrive.
CenterLight: Leading Through Transparency
CenterLight’s story stood out as a master class in leadership under pressure. In 2020, the organization was losing $40M a year, membership was shrinking, and compliance issues piled up.
The turning point came when leadership stopped hiding the problems. They leveled with staff and partners about what was broken, what needed to change, and what the path forward would require.
That honesty created alignment. The team rebuilt its systems, replaced underperforming vendors, modernized its technology, and re-established trust across the organization.
For healthcare founders, the takeaway is clear: leadership transparency is a growth strategy. People commit when they understand the truth — even when it’s uncomfortable.
Seen Health: Building Systems That Reflect Reality
The Built from Scratch session from Seen Health was one of the most honest looks at what it takes to launch a PACE program. There was no glossing over the messy parts, just straight talk about building operations, managing regulations, and keeping the team grounded through the process.
What impressed me most was how deliberately they tied technology to operations. Instead of forcing workflows to fit generic software, they built tools that fit the way their teams actually deliver care. Their reporting, scheduling, and data systems all connect — giving them a single, accurate view of performance.
They also developed a clear prioritization framework to decide what gets attention and when. That structure helps them stay focused and avoid the “fix-everything-at-once” trap that derails so many startups.
The lesson applies beyond PACE: clarity beats speed. Growth doesn’t come from doing more — it comes from doing the right things, in the right order, with visibility.
Opportunities and Worries: A Field in Motion
The Opportunities and Worries session led by Shawn Bloom and Harold Urman captured the pulse of the industry. Across the country, sentiment among PACE leaders is optimistic, but cautious.
Nationally, satisfaction with program growth has reached 74 percent, with the West region reporting the strongest confidence at 87 percent. Having worked extensively in California, I’m not surprised. The state’s progressive approach to PACE expansion and its vast unmet need among older adults are producing real results. Programs are growing, and more communities are gaining access to coordinated care.
Still, challenges remain. Funding stability, workforce shortages, and rate adequacy topped the list of concerns. Many leaders pointed to difficulty recruiting nurses, physicians, and home-care staff — a problem that threatens long-term scalability.
The discussion on Medicaid rate setting was especially telling. Several leaders shared that reimbursement increases haven’t kept pace with inflation or rising operating costs, squeezing even well-run programs.
Yet despite those headwinds, optimism is holding. Two-thirds of respondents said they feel confident about the next 12 months. That mix of hope and realism defines where PACE is today — proven, effective, and ready to grow, but in need of sustained policy support.
As Shawn Bloom reminded everyone, bipartisan support already exists. What’s missing is visibility. The mission now is to tell the story, to show policymakers and the public how PACE delivers better outcomes, lowers costs, and strengthens communities. The more PACE programs do to collect data and
The Road Ahead
From Seattle to New York, what stands out is how far the field has come. The tone has shifted from explanation to expansion.
A few themes cut across every conversation:
Transparency builds resilience. Teams rally when leaders are direct about what needs to improve.
Operational clarity drives results. Systems aligned with reality prevent inefficiency and burnout.
Policy and awareness will shape the future. PACE works — and it’s time more people knew it.
The takeaway from this year’s conference is simple: PACE doesn’t just need to survive; it deserves to thrive. The model works. The outcomes are clear. The opportunity is now to move PACE from niche to necessary, and to keep building a system where older adults can age with dignity, independence, and connection.