ries with chronic conditions (e.g., heart failure, coronary artery disease, or diabetes) see an average of 13 physicians annually (IOM, 2007). As a result, the care that these beneficiaries receive from physicians and other health care providers is often fragmented and not well coordinated. The lack of coordination stems from a variety of factors, including poor definitions of accountability, misaligned financial incentives (including the inability to reimburse for care coordination under FFS), lack of connection among information systems, and minimal training of providers in cross-site collaboration (Coleman, 2003; Coleman and Berenson, 2004; IOM, 2006b). In the 2007 IOM report Rewarding Provider Performance, the committee recommended that Medicare, in order to reduce fragmentation of services, encourage beneficiaries to identify a primary accountable source of care to act as that patient’s care coordinator and guide the patient through the health care (IOM, 2007).

Many new models of care strive to improve care coordination, and these efforts can affect the use and development of the health care workforce. Some models, for example, require a geriatric care manager who helps patients navigate the health care system (see Chapter 4). Additionally, many efforts to improve care coordination call for enhancing communication among providers; this enhancement of communication among providers—and also between caregivers and patients—will require providers to change their practice patterns in a variety of ways. Furthermore, as patients and their families assume more responsibility in care delivery, it will be essential to involve these individuals in the coordination of care, which in turn will make it necessary to recognize the barriers to effective communication that some older adults experience, including hearing and vision deficiencies. (See next section for more on self-management.) Finally, one of the easiest ways to improve the coordination of care will be to enhance the use of those information technologies that help to share important patient information.

Health Technology

Many models of care require an increased use of health information technology (HIT), such as electronic health records and personal health records, to facilitate the sharing of information among providers and to improve their ability to coordinate the complex care of older patients. Health information technologies may also be used to build databases on the health of older populations which may be very useful to practitioners and researchers in aging. Other technologies used in new models may reduce the need for certain types of workers. For example, remote-monitoring technologies can extend the reach of health care professionals into the home.



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