income, and behavioral risk factors. These factors, and others, impact health status, accentuate disparities, and can lead to costly, preventable diseases (IOM, 2001b). Furthermore, the disease-driven approach to medicine and health care has resulted in a fragmented, specialized health system in which care is typically reactive and episodic, as well as often inefficient and impersonal (IOM, 2007b; Snyderman and Williams, 2003).

In health terms, the consequences of this fragmentation can be serious. Chronic conditions now represent the major challenge to the U.S. health care system. Five chronic conditions—diabetes, heart disease, asthma, high blood pressure, and depression—account for more than half of all U.S. health expenditures (Druss et al., 2001). Among Medicare recipients, 20 percent live with five or more chronic conditions and their care accounts for two-thirds of all Medicare expenditures (Anderson, 2005). Many of these conditions are preventable, but only about 55 percent of the most recommended clinical preventive services are actually delivered (McGlynn et al., 2003).

Care coordination that emphasizes wellness and prevention, a hallmark of integrative medicine, is a major and growing need for people both with and without chronic diseases. Those with chronic diseases rarely receive the full support they need to achieve maximum benefit. A patient’s course of care may require contact with clinicians and caregivers and may require many transitions, for example from hospital to home care. However, these transitions often are poorly handled, leading to adverse events that result in rehospitalizations 20 percent of the time (Forster et al., 2003). The IOM report To Err is Human concluded that half of all adverse events are caused by preventable medical errors. Indeed, it estimated that medical errors are responsible for some 44,000 to 98,000 deaths per year, ranking errors among the nation’s leading causes of death (IOM, 1999).

Disconnected and uncoordinated care amplifies the economic burden of the health care system. The costs of U.S. health care are driven in large part by the inefficiencies, redundancies, and excesses of the current fragmented system and are considered by many economists and policy makers to be unsustainable, either for individuals or for the nation. In 2009, nearly $2.5 trillion will be spent in the United States in a health care system that is underperforming on many dimensions. The current trend will drive expenditures to $4.3 trillion by 2017 (Keehan et al., 2008) unless changes are made. Despite per capita expenditures that are at least twice as high as the average for other Western nations, the United



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