title: Integrating acute and long-term care for high-cost populations.
abstract: The inadequacies of our fragmented acute and long-term care financing and delivery systems have been well recognized for many years. Yet over the past two decades only a very small number of "boutique" initiatives have been able to improve the financing and the delivery of care to chronically ill and disabled populations. These initiatives share most of the following characteristics: prepaid, risk-adjusted financing; integrated Medicare and Medicaid funding streams; a flexible array of acute and long-term benefits; well-organized, redesigned care delivery systems that tailor these benefits to individual need; a mission-driven philosophy; and considerable creativity in engaging government payers. The experience of these "boutiques" illustrates both the obstacles to, and the opportunity for, meaningful, widespread care delivery reform for vulnerable chronically ill populations.
authors.affiliation: Neighborhood Health Plan and Boston University School of Public Health, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Master
authors.forename: C
authors.initials: C
authors.lastname: Eng
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D018672:Community Health Planning; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006233:Persons with Disabilities; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D014481:United States