The Promise of Care Coordination

EXECUTIVE SUMMARY
Numerous studies have documented that the relatively small percent of Medicare
beneficiaries with multiple chronic conditions account for the vast majority of Medicare
spending, all too often due to inadequate care, poor communications, and weak adherence by
patients. A decade of research and demonstrations has developed evidence regarding “care
coordination” interventions that are effective in achieving both improved beneficiary outcomes
and reduced Medicare expenditures. This experience has demonstrated that “the devil is in the
details,” that many apparently promising approaches have not proven to be effective, and that
careful attention to implementation and targeting is essential if “care coordination” is to fulfill its
potential for both Medicare beneficiaries and the Medicare program.
To promote better coordinated health and social services for older adults with multiple
chronic conditions, the National Coalition on Care Coordination (N3C) was formed in 2008 by
leading social, health care, family caregiver, and professional organizations. This paper was
commissioned by N3C to synthesize the evidence on cost-effective interventions and their
essential components, identify key issues that still must be resolved for ongoing research, and
present recommendations for care coordination policies in health care reform that can be
supported by the currently available evidence base. The paper draws heavily on Chad Boult’s
(2008) recent comprehensive survey of the literature, supplemented with findings from several
recent Medicare demonstration evaluations, especially findings from the Medicare Coordinated
Care Demonstration (Peikes et al. 2009).