1. Long-Term Care: Exploring the Possibilities Improving Medical and Social Service Coordination for Persons with Chronic Illness Mark R Meines, Ph.D. George Mason University Alliance for Health Reform and The Scan Foundation Roundtable, March 9, 2009

2. Challenges in Our Health System The health care system is increasingly complicated and difficult to use; Insurance complexity often controls access to services; Increased cultural and social diversity challenges traditional acute and long-term care practice effectiveness; The emergence of chronic illness is the major reason for medical encounters rather than acute care. Seniors over age 65 fear placement in a nursing home and loss of independence more than death

3. 3March 19, 2008Team San Diego GMU Module 1 Draft 3

4. Number of Chronic Conditions per Medicare Beneficiary Number of Conditions Percent of Beneficiaries Percent of Expenditures 0181 1194 22111 318 41221 5718 6313 7+214 63% 95%

5. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Delivery System Design Decision Support Clinical Informatio n Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Chronic Care Model Improved Outcomes Figure 1 from Wagner, E.H. Chronic Disease Management: What Will It Take to Improve Care for Chronic Illness? Effective Clinical Practice, 1998; 1:2-4 5

6. Six Foundational Principles Uphold Personal Preference Enhance Self-Care through Improved Coordination Encourage Community Integration and Involvement Expand Accessibility of Services and Supports Empower People to Participate in the Economic Mainstream Invest in Improved Technology