Health Affairs

Posting date: April 26, 2005

This Article Reprint (PDF) HTML Version Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gold, M. Articles by Smith, M. Search for Related Content PubMed PubMed Citation Articles by Gold, M. Articles by Smith, M. Related Collections Access To Care Health Philanthropy Health Reform Medicare Chronic Care Consumer Issues Elderly

Health Affairs, 10.1377/hlthaff.w5.199
Copyright © 2005 by Project HOPE

Web Exclusives

Challenges In Improving Care For High-Risk Seniors In Medicare

Marsha Gold ^1*, Timothy Lake ², William E. Black ³, Mark Smith ⁴

¹ Marsha Gold is a senior fellow at Mathematica Policy Research in Washington, D.C.
² Timothy Lake is a senior researcher at Mathematica Policy Research.
³ William Black is a research analyst at Mathematica Policy Research.
⁴ Mark Smith is president and chief executive officer of the California HealthCare Foundation in Oakland.

^*Corresponding author.

Abstract

Despite strong interest in improving care for high-risk elders, demonstration projects typically show negative results. This paper examines one large foundation-sponsored initiative to gain insight on why success often is so elusive. The findings indicate that specific flaws in concept, design, and implementation each make it more challenging for demonstrations to achieve their intended goals, especially those involving cost and utilization reductions. We speculate that part of the reason for this is that organizational and political processes lead to fundamentally conservative demonstrations that assume that small amounts of resources directed at incremental change can be effective in generating substantial change in organizations and can do so rapidly.

Key Words: Access To Care, Chronic Care, Consumer Issues, Elderly, Health Philanthropy, Health Reform, Medicare

                      What's this?

This article has been cited by other articles:

				J. L. Wolff and C. Boult Moving beyond Round Pegs and Square Holes: Restructuring Medicare To Improve Chronic Care Ann Intern Med, September 20, 2005; 143(6): 439 - 445. [Abstract] [Full Text] [PDF]