Comprehensive Care Coordination for Chronically Ill Adults E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 887

Veröffentlichungsjahr: 2011

Beschreibung

Breakthroughs in medical science and technology, combined with shifts in lifestyle and demographics, have resulted in a rapid rise in the number of individuals living with one or more chronic illnesses.  Comprehensive Care Coordination for Chronically Ill Adults presents thorough demographics on this growing sector, describes models for change, reviews current literature and examines various outcomes.

Comprehensive Care Coordination for Chronically Ill Adults is divided into two parts.  The first provides thorough discussion and background on theoretical concepts of care, including a complete profile of current demographics and chapters on current models of care, intervention components, evaluation methods, health information technology, financing, and educating an interdisciplinary team.  The second part of the book uses multiple case studies from various settings to illustrate successful comprehensive care coordination in practice.  Nurse, physician and social work leaders in community health, primary care, education and research, and health policy makers will find this book essential among resources to improve care for the chronically ill.

Leseprobe

Contents

Cover

Title Page

Copyright

Editors and Contributors

Editors

Contributors

Acknowledgments

Introduction

Part 1: Theoretical concepts

Chapter 1: Chronic illness

Introduction

What is a chronic illness?

A profile of adults aged 55 years and over

A profile of older adults aged 65 years of age and older

The burden of chronic illness

Summary

Chapter 2: Overview

Introduction

Comprehensive care coordination defined

Barriers to comprehensive care coordination

Summary

Chapter 3: Promising practices in acute/primary care

Introduction

Conceptual framework

Earlier reviews of the literature

Findings from medicare demonstrations

Successful programs/models

Transitional care

Self-management

Care coordination

Selected studies on medicaid and commercial populations

Conclusions

Notes

Chapter 4: Promising practices in integrated care

Introduction

Evidence for integrated care coordination programs

Ten programs for analysis

Analysis of outcomes and program effectiveness

Common elements of successful programs

Other programs of interest

Conclusions and policy implication

Chapter 5: Intervention components

Introduction

The Chronic Care Model

Care coordination teams

Care coordination process

Guideline development/implementation

Care planning

Care plan implementation and monitoring

Information technology and quality reporting

Care coordination evaluation

Ongoing care management coordination challenges

Conclusion

Chapter 6: Evaluation methods

Introduction

A primer on evaluation designs

Performance & effectiveness studies

Centers for medicare & medicaid services integration of care demonstration activities

Lessons from the field

Closing thoughts

Notes

Chapter 7: Health information technology

Introduction

Problems addressed through effective HIT use

Definitions

HIT functions to support effective care coordination

HIT system care coordination standards

Implementation of HIT systems: facilitators and barriers

Conclusion

Chapter 8: Financing and payment

Overview

The challenges (and occasional successes) of financing care management under current policy

Current approaches to paying providers for care management/care coordination

Financing and payment initiatives in the patient protection and affordable care act of 2010 and other recent federal initiatives

Conclusions and recommendations, near and longer term

Notes

Chapter 9: Education of the interdisciplinary team

Introduction

Competency-based educational initiatives and interdisciplinary training

Competencies for care coordinators

Care coordinator qualifications

Conclusion

Part 2: Promising practices

Section 1: Primary care models

Chapter 10: Coordination of care by guided care interdisciplinary teams

Introduction

Background

Rationale

Intervention

Case studies

Lessons learned

Summary

Acknowledgments

Chapter 11: Care management plus

Introduction

Care management plus in primary care

Outcomes and dissemination

Curriculum

Case discussion

Summary

Chapter 12: Medicare coordinated care

Introduction

Similarities and differences across program interventions

Programs’ process features

Summary of promising practices

Case study

Conclusion

Notes

Section 2: Transitional care models

Chapter 13: The care transitions intervention

Introduction

Background

Outcomes

Rationale

Intervention

Case studies

Lessons learned

Summary

Chapter 14: Enhanced Discharge Planning Program at Rush University Medical Center

Introduction

Background

Rationale

Intervention

Lessons learned

Summary

Section 3: Integrated models

Chapter 15: Summa Health System and Area Agency on Aging Geriatric Evaluation Project

Introduction

The beginning: a new model of acute care for chronically ill older adults

The SAGE project

Outcomes from SAGE

Barriers

Generalizability

Conclusion

Chapter 16: Program of All-Inclusive Care for the Elderly (PACE)

Introduction

The PACE model

Best practice elements of the PACE model

Examples of best practice: urban and rural PACE organizations

Summary

Acknowledgments

Notes

Section 4: Medicaid models

Chapter 17: Introduction to Medicaid care management

Introduction

Who are Medicaid's highest-need, highest-cost beneficiaries?

Core elements of care management

Summary

Notes

Chapter 18: The Aetna Integrated Care Management model: a managed Medicaid paradigm

Introduction

The Aetna Integrated Care Management Model: a managed Medicaid perspective

ICM model overview

ICM foundational care components

Additional care strategies: surveillance, field-based assessments, and flow control

Application of the ICM process

Chapter 19: King County Care Partners: a community-based chronic care management system for Medicaid clients with co-occurring medical, mental, and substance abuse disorders

Introduction

The KCCP model

The KCCP clinical team

Selection, engagement, and assessment of clients

Managing clients

Evidence of program success

Program challenges

Conclusions

Chapter 20: Predictive Risk Intelligence System (PRISM): A decision-support tool for coordinating care for complex Medicaid clients

Introduction

Background

Innovation #1: Predictive risk scores

Innovation #2: Integration of comprehensive cross-agency data

Innovation #3: Easy to use display of administrative information

Uses of PRISM

Strengths/weaknesses of PRISM

Issues for states considering in-house development of predictive modeling tools

The future

Chapter 21: High-risk patients in a complex health system: coordinating and managing care

Introduction

How did we get to where we are? use of evidence-based policy and management (EBPM) strategies

New York State Department of Health chronic illness demonstration project: hospital to home (H2H)

Chapter 22: The SoonerCare Health Management Program

Introduction

The HMP program

Future directions

Section 5: Practice change

Chapter 23: Introduction: practice change fellows initiatives

Program overview

Intended outcomes

Program eligibility

Program activities

Practice meets policy

Chapter 24: Interdisciplinary care of chronically ill adults: communities of care for people living with congestive heart failure in the rural setting

Introduction

Background

Project plan

Preliminary results

Future plans

Chapter 25: Collaborative care treatment of late-life depression: development of a depression support service

Introduction

Background

Program design

The HRC experience, facilitators and barriers

Dissemination: A statewide project

Future directions: An expanding role for collaborative care depression treatment in the HSL system

Future directions: Support of collaborative care for late-life depression on a national level

Summary

Chapter 26: Geriatric Telemedicine: supporting interdisciplinary care

Introduction

Telemedicine solutions

Systemic support

Project implementation

Results

Lessons learned

Policy implications

Chapter 27: Integrated Patient-Centered Care: the I-PiCC pilot

I-PiCC pilot overview

Areas of focus

Patient selection

I-PiCC components

I-PiCC results

Lessons learned

I-PiCC case study

Summary

Section 6: Medicare managed care

Chapter 28: Longitudinal care management: High risk care management

Introduction

Background

Rationale

Intervention

An unanticipated secondary impact: Staff performance

Case studies

Key learnings in high risk care management

Summary

Acknowledgments

Section 7: International care coordination

Chapter 29: The experiences in the Republic of Korea

Background information

Current programs for care coordination

Summary and future challenges

Index

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Library of Congress Cataloging-in-Publication Data

Comprehensive care coordination for chronically ill adults / editors, Cheryl Schraeder, Paul Shelton. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8138-1194-9 (pbk. : alk. paper) ISBN-10: 0-8138-1194-5 1. Chronically ill–United States. 2. Chronic diseases–United States. 3. Integrated delivery of health care–United States. I. Schraeder, Cheryl. II. Shelton, Paul. [DNLM: 1. Chronic Disease–United States. 2. Comprehensive Health Care–United States. 3. Delivery of Health Care, Integrated–United States. 4. Health Services Needs and Demand–economics–United States. 5. Socioeconomic Factors–United States. WT 30] RC108.C647 2011 616.02′8–dc23 2011018145

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9780470960868; ePub 9780470960875; Mobi 9780470960882

Editors and Contributors

Editors

Cheryl Schraeder, RN, PhD, FAAN Clinical Associate Professor College of Nursing University of Illinois at Chicago Chicago, IL USA

Paul Shelton, EdD College of Nursing University of Illinois at Chicago Chicago, IL USA

Contributors

Kyle R. Allen, DO, AGFS Professor of Internal and Family Medicine Northeastern Ohio Universities Colleges of Medicine & Pharmacy Medical Director, Post Acute & Senior Services Chief, Division of Geriatric Medicine Summa Health System Akron, OH USA

Robert M. Atkins, MD, MPH Senior Medical Director-Integration Aetna-Schaller Anderson Indianapolis, IN USA

Emma Barker, MSW Associate Program Officer New York Academy of Medicine New York, NY USA

Robert Berenson, MD Institute Fellow The Urban Institute Washington, DC USA

Carrie Berger, BA, MSW Candidate College of Nursing University of Illinois at Chicago Chicago, IL USA

Michael K. Berkes, BS, MSW Candidate Visiting Research Specialist College of Nursing University of Illinois at Chicago Chicago, IL USA

Chad Boult, MD, MPH, MBA Professor and Director The Lipitz Center for Integrated Health Care Department of Health Policy and Management Bloomberg School of Public Health Johns Hopkins University Baltimore, MD USA

Randall S. Brown, PhD Mathematica Policy Research Princeton, NJ USA

Cherie P. Brunker, MD Associate Professor Division of Geriatric Medicine University of Utah Chief of Geriatrics Intermountain Healthcare Salt Lake City, UT USA

Eric A. Coleman, MD, MPH Professor of Medicine Division of Health Care Policy and Research Department of Medicine University of Colorado Denver, CO USA

Beverly J. Court, MHA, PhD Research Manager Washington State Medicaid Purchasing Administration Olympia, WA USA

Meg Cristofalo, MSW, MPA University of Washington Seattle, WA USA

L. Gail Dobell, PhD Measurement and Evaluation Specialist Residents First - Advancing Quality in Ontario Long-Term Care Homes Ontario Health Quality Council Toronto, ON Canada

David A. Dorr, MD, MS Associate Professor Primary: Department of Medical Informatics & Clinical Epidemiology Joint: Department of Internal Medicine & Geriatrics Oregon Health & Science University Portland, OR USA

Mark E. Douglas, JD, MSN, RN Director of Clinical Project Coordination Aetna-Schaller Anderson Indianapolis, IN USA

Linda Fahey, RN, MSN Decatur Memorial Hospital Decatur, IL USA

Sandee Ferguson, RN, BBA, MS, Fellow Manager, Long Term Care Access & Integration Community Long Term Care Division Ohio Department of Aging Columbus, Ohio USA

Angela M. Gerolamo, PhD, APRN, BC Nurse Researcher Mathematica Policy Research Princeton, NJ USA

Arkadipta Ghosh, PhD Researcher Mathematica Policy Research Princeton, NJ USA

Robyn L. Golden, LCSW Director of Older Adult Programs Rush University Medical Center Chicago, IL USA

Lee Greer, MD, MBA Chief Quality and Safety Officer North Mississippi Health Services Tupelo, MS USA

Carol Groves, RN, MPA Senior Director of Continuing Care Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. Rockville, MD USA

Beth A. Hale, PhD, RN Director of Admissions Hospice of the Valley Phoenix, AZ USA

Allison Hamblin, MSPH Center for Health Care Strategies Hamilton, NJ USA

Susan Hazelett, RN, MS Manager HSREI Summa Health System Akron, OH USA

Lynda Hedstrom, MSN, APRN, NP-C Senior Director Professional Practice and Clinical Training UnitedHealthcare Medicare and Retirement Mike Herndon, DO Medical Director Health Care Management Oklahoma Health Care Authority Oklahoma City, OK USA

Ida Hess, MSN, FNP-BC Visiting Nurse Practice Specialist Institute for Healthcare Innovation College of Nursing University of Illinois at Chicago Mahomet, IL USA

Carolyn Holder, MSN, RN, GCNS-BC Manager, Transitional Care Post Acute and Senior Services Summa Health System Akron, OH USA

Adjunct Faculty, College of Nursing Kent State University Kent, OH USA

Julianne R. Howell, PhD Independent Technical Consultant Centers for Medicare & Medicaid Services Baltimore, MD USA

Krista L. Jones, DNP, MSN, ACHN, RN Clinical Instructor College of Nursing University of Illinois Urbana, IL USA

Molly M. King, BA Research Assistant II Oregon Health & Science University Portland, OR USA

Antoinette Krupski, PhD Associate Director, CHAMMP Research Associate Professor Department of Psychiatry and Behavioral Sciences University of Washington at Harborview Medical Center Seattle, WA USA

Daniel S. Lessler, MD, MHA Professor of Medicine School of Medicine, University of Washington Associate Medical Director, Harborview Medical Center Seattle, WA USA

David Mancuso, PhD Senior Research Supervisor Washington State Department of Social and Health Services Research and Data Analysis Division Olympia, Washington USA

Eran D. Metzger, MD Assistant Professor of Psychiatry Harvard Medical School Associate Director of Psychiatry at Hebrew SeniorLife Boston, MA USA

Robert Newcomer, PhD Professor Institute for Health & Aging University of California San Francisco, CA USA

Tracy Novak, MHS Associate Director Director of Communications The Lipitz Center for Integrated Health Care Department of Health Policy and Management Bloomberg School of Public Health Johns Hopkins University Baltimore, MD USA

Joo-bong Park Oh, MN, MS, PsyD, RN Supervisor LAC USC Medical Center Los Angeles, CA USA

Anthony J. Perry, MD Director, Johnston R. Bowman Health Center Associate Professor of Internal Medicine Rush University Medical Center Chicago, IL USA

Maria C. Raven, MD, MPH, MSc Assistant Professor Department of Emergency Medicine Division of General Internal Medicine New York University School of Medicine Bellevue Hospital Center New York, NY USA

Carolyn J. Reconnu, RN, BSN, CCM Manager Health Management Program Oklahoma Health Care Authority Oklahoma City, OK USA

Daniel A. Reece, MSW, LCSW PeaceHealth Oregon Region Strategy, Innovation and Development Eugene, OR USA

Karyn Rizzo, RN, CHPN, GCNS Executive Director Notre Dame Hospice Worcester, MA

Benjamin Ronk, BA Visiting Research Specialist College of Nursing University of Illinois at Chicago Chicago, IL USA

Madeleine Rooney, MSW, LCSW Program Coordinator, Transitional Care Older Adult Programs Rush University Medical Center Chicago, IL USA

Susan Rosenbek, RN, MS Division of Health Care Policy and Research Department of Medicine University of Colorado Denver, CO USA

Joseph L. Ruby, BA, MA President & CEO Area Agency on Aging Uniontown, OH USA

Jennifer Schore, MSW, MS Mathematica Policy Research Princeton, NJ USA

Gayle E. Shier, MSW Program Coordinator Rush University Medical Center Chicago, IL USA

Stephen A. Somers, PhD Center for Health Care Strategies Hamilton, NJ USA

Brenda Sulick, PhD Vice President Congressional Affairs & Advocacy National PACE Association Alexandria, VA USA

Chandra L. Torgerson, RN, BSN, MS SVP Quality Management and Chief Nursing Officer UnitedHealthcare Medicare & Retirement Christine van Reenen, PhD Senior Vice President for Public Policy National PACE Association Alexandria, VA USA

Patricia J. Volland, MSW, MBA The New York Academy of Medicine Senior Vice President, Strategy and Business Development Director, Social Work Leadership Institute New York, NY USA

Valerie Waldschmidt, BSE Visiting Research Coordinator College of Nursing Institute for Healthcare Innovation University of Illinois at Chicago Chicago, IL USA

Nancy Whitelaw, PhD Senior Vice President Healthy Aging National Council on Aging Washington, DC USA

Adam B. Wilcox, PhD Assistant Professor Department of Biomedical Informatics College of Physicians and Surgeons Columbia University New York, NY USA

Mary E. Wright Program Associate, Social Work Leadership Institute, and Executive Assistant New York Academy of Medicine New York, NY USA

Phyllis Yoders, RN, BSN Long Term Care Nursing Consultant Area Agency on Aging Uniontown, OH USA

Weon-seob Yoo, PhD, MPH, MD Assistant Professor College of Medicine Eulji University Joong-Gu, Daejeon Republic of Korea

Chad Zhu, MS Research and Data Analysis Division Washington State Department of Social and Health Services

Acknowledgments

There are a number of people we would like to thank that have contributed to and helped shape our thinking and understanding of coordinated health care for adults with chronic illnesses. We thank Sandra Reifsteck, at the time an administrator with the Carle Clinic Association, Urbana, IL, who fostered a vision that primary care desperately needed to be improved for patients with chronic illness and provided opportunities for moving that vision forward. We thank Anna Bergstrom, when she was with the Medical Group Management Association, for her help and guidance with a case management project within multispecialty group practices that targeted chronically ill adults. We thank Donna Regenstrief and Christopher Langston, with the John A. Hartford Foundation, who provided the opportunity to expand a collaborative coordinated care intervention in primary care, and Dennis Nugent and Cindy Mason, with the Centers for Medicare & Medicaid Services, who worked with us for a number of years on different demonstrations to improve the health management of chronically ill Medicare beneficiaries. We thank Kelly Cunningham and Jean Summerfield of Healthcare and Family Services for the opportunity to improve the management of Medicaid beneficiaries transitioning from nursing facilities to the community. We thank Patricia Volland and Robyn Golden, at the New York Academy of Medicine Social Work Leadership Institute, for their continuing efforts to improve the care coordination for chronically ill older adults. We thank Eric Coleman, MD, Mark Sager, MD, and David Dorr, MD, for sharing their vast clinical insights and research experiences accumulated from working in the health management of chronically ill adults within primary care, and to Robert Newcomer of the University of California at San Francisco and Randall Brown of Mathematica Policy Research for sharing their unique perspectives and viewpoints on different aspects to consider when evaluating chronic care delivery models. We thank Ida Hess and Donna Dworak for their commitments to help define and advance nursing roles in a collaborative practice with physicians, patients, and their families, and to Robert Kirby, Robert Parker, Curtis Krock, Paul Schaap, and John Stoll, primary care physicians at the Carle healthcare system, Urbana, IL, who had the foresight and interest to work in collaborative care teams with nurses and who contributed to quality efforts to improve the care of their chronically ill patients. Our heartfelt thanks goes out to Cynthia Fraser, director of our coordinated care programs; she is a unique individual with exceptional organizational and interpersonal skills that were integral to providing necessary and needed services to chronically ill adults. A big debt of gratitude is owed to Senator Richard Durbin from the state of Illinois and his legislative director, Dena Morris, for the commitment, time, and insight they shared in advocating for and advancing the care of the chronically ill at the federal level. And most importantly, this book would not have been possible if not for the thousands of patients and their caregivers who have participated in the coordinated care programs that we have conducted over the past 20 plus years. It is because of their interest and commitment in helping others through sharing their stories, their insights concerning the frustrations and successes of managing their illnesses, and their experiences in navigating the fragmented health care system that makes the effort that much more worth while. Also, a special thanks goes to our spouses, Claire and Thomas, and our children for their endless encouragement and support.

Introduction

Cheryl Schraeder and Paul Shelton

One of the most frequently noted criticisms of the U.S. health care industry is the fragmented nature of its delivery system and payment structure. This fragmented disconnect has resulted in excessive duplication and overuse of medical services, a lack of access to essential services, and patients who are not fully engaged in their care. Our health care industry is especially deficient in providing high quality, coordinated, and cost effective care to adults with multiple chronic health conditions.

Despite these limitations of the current health care system, a number of policymakers, health care professionals, and researchers are engaged in developing and testing new models of care for patients with co-morbidities. Many of these models involve physicians, nurses, and other professionals working in collaborative relationships with patients and their caregivers, implementing evidence-based best practices and comprehensive coordinated care. The primary goals of these programs are to reduce unnecessary emergency department visits and avoidable hospital admissions, and to improve patients’ quality of life and satisfaction with care.

These program results to date have demonstrated success in improving processes of care, quality of life, and satisfaction with care for multi-morbid patients, but have produced limited success in reducing their use and cost of health services. However, the results suggest that certain components are integral to and have the potential to be cost effective when included in comprehensive efforts to manage the health care needs of adults with multiple chronic illnesses.

This book is intended for medical, nursing, allied health, and social service professionals, and students who are interested in and/or involved in providing care and the coordination of health and community services for chronically ill adults. It presents concise information drawn from a number of disciplines and sources that has been learned over the past two plus decades from pilot studies, randomized clinical trials, and federal demonstrations that can be used as a resource and starting point for improvements in the delivery of chronic care.

These lessons learned are presented in two major sections. The first section presents background on the theoretical concepts of comprehensive care coordination, including: the demographic and health characteristics of chronically ill adults; relevant coordinated care practices in the acute, primary, and community setting; intervention components that have been successful and are essential in reducing hospital readmissions; different aspects and approaches to program evaluation; essential elements of health information technology systems; alternative payment methods for supporting chronic care management; and approaches to educating interdisciplinary team members. The second section uses a case study format to present a number of nationally recognized best practices that use different approaches in providing comprehensive care coordination, including: community-based primary care; transitional care; acute care discharge planning; and managed care and integrated health care systems. Programs are also described that provide services to Medicaid and Medicare populations, services for patients with specific chronic conditions, telemedicine services, and an example of a population-based approach to chronic illness in the Republic of Korea.

In the pages that follow we have tried to present a picture of some notions of what evidence-based, best practice comprehensive coordinated care might look like, as well as different ways it is currently provided and could be delivered in the future. Although the quest for the best pathway to high quality, cost effective chronic illness care remains elusive, the search will likely gain momentum, especially in an electrically charged atmosphere of health care reform, and the rapidly aging of America. It is our hope that the information contained in the following chapters makes some contribution to the development of innovative models that improve the quality of life and medical care of chronically ill adults.

Part 1

Theoretical concepts

1. Chronic illness Paul Shelton, EdD, Cheryl Schraeder, RN, PhD, FAAN, Michael K. Berkes, BS, MSW Candidate, and Benjamin Ronk, BA

2. Overview Cheryl Schraeder, RN, PhD, FAAN, Paul Shelton, EdD, Linda Fahey, RN, MSN, Krista L. Jones, DNP, MSN, ACHN, RN, and Carrie Berger, BA, MSW Candidate

3. Promising practices in acute/primary care Randall S. Brown, PhD, Arkadipta Ghosh, PhD, Cheryl Schraeder, RN, PhD, FAAN, and Paul Shelton, EdD

4. Promising practices in integrated care Patricia J. Volland, MSW, MBA, and Mary E. Wright

5. Intervention components Cheryl Schraeder, RN, PhD, FAAN, Cherie P. Brunker, MD, Ida Hess, MSN, FNP-BC, Beth A. Hale, PhD, RN, Carrie Berger, BA, MSW Candidate, and Valerie Waldschmidt, BSE

6. Evaluation methods Robert Newcomer, PhD, and L. Gail Dobell, PhD

7. Health information technology David A. Dorr, MD, MS, and Molly M. King, BA

8. Financing and payment Julianne R. Howell, PhD, Robert Berenson, MD, and Patricia J. Volland, MSW, MBA

9. Education of the interdisciplinary team Emma Barker, MSW, Patricia J. Volland, MSW, MBA, and Mary E. Wright

Chapter 1

Chronic illness

Paul Shelton, Cheryl Schraeder, Michael Berkes, and Benjamin Ronk

Introduction

The demographic landscape of the United States has changed significantly. Americans are living longer than ever before. The average life span has increased from 47 years for individuals born in 1900 to 78 years for those born in 2006 (National Center for Health Statistics [NCHS] 2010). The result has been an exponential growth in the number and percentage of older Americans, which is unique to our nation's history. This longevity is primarily due to advances in modern medical science that have produced new screening and diagnostic technologies, pharmaceuticals, and medical procedures, as well as comprehensive initiatives that have greatly diminished or eliminated infectious diseases and improved public health problems. Americans living in the twenty-first century can expect to live longer than any previous generation. Longer life expectancy combined with the baby-boom generation, individuals born after World War II from 1946 through 1964, will double the number of individuals who are 65 years and older during the next 25 years.

This aging of America has created problems and challenges for our health care system. As longevity has increased so have the numbers of Americans living with chronic illnesses. Chronic illnesses afflict people of all ages, and although a majority of individuals living with chronic illnesses are not elderly, the likelihood of having a chronic illness increases dramatically with advancing age. Current projections estimate that approximately 66% of Americans 18 years of age and older suffer from at least one chronic illness, and as much as 80% of individuals 50 years of age and older suffer from at least one chronic illness (Machlin et al. 2008). These individuals seek and receive health care in a system that is designed, structured, and financed for treating acute episodes of care. The current system has been extensively criticized for being overly deficient in providing coordinated care for individuals with chronic illnesses who are primarily insured through Medicare and Medicaid (Institute of Medicine [IOM] 2001), and who are not receiving optimum chronic illness care (McGlynn et al. 2003).

The new generation of older Americans, the baby boomers, will be distinctly different from previous generations. They will be more educated, have more discretionary income, be more racially diverse, have fewer children, and have less disability compared to their parent's generation (Federal Interagency Forum on Aging-Related Statistics 2008; IOM 2008). Their sheer numbers alone will dramatically affect the future of our health care system. During the next two decades the number of older adults will double, from approximately 37 million to over 70 million, accounting for an 8% overall increase within the total population, currently from 12% to 20% (IOM 2008). While this approaching demographic shift has been anticipated for over 50 years, our health care system is not prepared for its arrival. More providers with specialized training and resources, and new approaches to delivering chronic care are needed to meet the aging population's health care needs (Bodenheimer 2009; IOM 2008). Presenting a stark reality, the IOM (2008) asserted that providers are inadequately prepared in general knowledge of geriatrics, the health care workforce is not large enough to meet older patients’ needs, and the scarcity of workers currently specializing in geriatrics is even more pronounced. These shortages will become more pronounced in the future.