Integrating healthcare for older populations (Reprinted from New Ways to Care for Older People, 1998)

The complex array of needs posed by older adults has frequently produced fr agmentation of care in traditional fee-for-service systems. Integration of care components in newer health systems will maximize patient benefits and organizational efficiency. This article outlines the major issues involved in integration of care for older populations. A health system must integrat e its care of older adults in many ways: among providers, both in primary c are and specialty services; with community-based sources of care; and acros s sites of care (clinic, hospital, emergency department, and nursing home). Integrating reimbursement structures for various services will serve to cr eate a client-oriented system, as opposed to a finance-centered system, the reby enhancing coordination of care. The extent to which two experimental c omprehensive systems, PACE (Program of All-inclusive Care of the Elderly) a nd SHMO II (Social Health Maintenance Organization), have achieved clinical and financial integration are discussed in detail. Healthcare organization s are encouraged to create integrated models of care and to study the effec ts of integration on patient outcomes.