design, others may be hard to diffuse because of administrative or financial barriers.

The committee concluded that innovative models of care for older patients generally fall into the latter category—models that are difficult to diffuse because of administrative or financial barriers—and that these administrative and financial barriers should be addressed.

Recommendation 3-1: Payers should promote and reward the dissemination of those models of care for older adults that have been shown to be effective and efficient.

Incentives to adopt new models of care should include enhanced payments for services under these models; provision of capital for infrastructure, such as health information technology; the streamlining of administrative and regulatory requirements; and the elimination of existing impediments to the use of innovative models by older patients, such as Medicare’s copayment disparity for mental health and other services.


The committee’s commissioned review of models of care revealed several types of models that hold promise for providing high-quality and cost-effective care for older adults at several points along the care continuum. The committee supports the continued development of models in these areas. Still, as discussed previously, the evidence base on models of care for older adults remains somewhat limited, and the information regarding which models are most suitable for dissemination needs to be improved. Considering the current relative lack of investment in research and demonstration programs for new models of care, especially in comparison to annual spending on health care services, much more funding is needed to develop this evidence base. In particular, efforts should target those areas of care that demonstration programs have traditionally overlooked and should look for the most efficient ways to use the workforce in staffing new models of care.

Recommendation 3-2: Congress and foundations should significantly increase support for research and demonstration programs that

  • promote the development of new models of care for older adults in areas where few models are currently being tested, such as prevention, long-term care, and palliative care; and

  • promote the effective use of the workforce to care for older adults.

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