Forum Session

Management of Chronic Care Needs: What Will It Really Take to Coordinate Care?
March 14, 2014


Lisa Sprague, MBA


Management of chronic care needs, including care coordination between primary and specialty care clinicians, has received much attention lately, especially from legislators and federal regulators where Medicare beneficiaries are concerned. Specifically, proposals on the sustainable growth rate issue call for creation of a payment code for care management for individuals with chronic conditions, and the Centers for Medicare & Medicaid Services (CMS) wishes to establish in 2015 additional payment codes for chronic care management services. Care for many older adults has long been fragmented, inefficient, and far from patient-centered. This Forum session explored the factors that have made patient-centered, cost-effective care coordination difficult to achieve; considered the tools and strategies being deployed in efforts to improve care coordination and outcomes; and assessed the outlook for further progress.


Mary Tinetti, MD (scheduled)
Gladys Phillips Crofoot Professor of Medicine and Epidemiology
Chief of Geriatrics
Yale School of Medicine

Kyle Allen, DO (bio)
Director of Geriatric Medicine and Lifelong Health
Riverside Health System (Newport News, Virginia)

David Kendrick, MD, MPH (bio)
Principal Investigator & Chief Executive Officer
MyHealth Access Network (Tulsa, Oklahoma)

Related Materials

Mary E. Tinetti, Terry R. Fried, and Cynthia M. Boyd, "Designing Care for the Most Common Chronic Condition--Multimorbidity" (Journal of the American Medical Association, vol. 307, no. 23, June 20, 2012, pp. 2493-2494).

David B. Reuben and Mary E. Tinetti, "Goal-Oriented Patient Care--An Alternative Health Outcomes Paradigm" (New England Journal of Medicine, vol. 366, no. 9, March 1, 2012, pp. 777-779).

Grace Jenq and Mary E. Tinetti, "The Journey Across the Health Care (Dis)Continuum for Vulnerable Patients: Policies, Pitfalls, and Possibilities" (Journal of the American Medical Association, vol. 307, no 20, May 23/30, 2012, pp. 2157-2158).

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