New Project Seeks to Align Primary and Specialty Care for Older Adults with Complex Chronic Conditions

New York, NY and Washington, DC (May 20, 2014)  -- The John A. Hartford Foundation and the Patient-Centered Outcomes Research Institute (PCORI) have joined together to invest nearly $750,000 in CaRe-Align, an initiative to develop a new model of care that could better meet the complex needs of older patients with multiple chronic conditions.

The Hartford Foundation will provide $497,000 and PCORI will provide $250,000 to support the development of this new model that seeks to realign care around older patients’ self-identified health goals and potentially lead to improved health outcomes and lower care costs for this population, which is the major user of health care services in the country.

The new model will aim to incorporate the best available evidence for involving patients in their own care and facilitating communication and coordination between and among primary care and specialty care clinicians.

The CaRe-Align initiative is led by MacArthur Fellow Mary Tinetti, MD, of Yale University and Caroline Blaum, MD, of NYU School of Medicine, geriatricians who are experts in the care of older adults with multiple chronic conditions.

Under their leadership, the initiative has convened a group of more than 50 older individuals, clinicians who care for such patients, family caregivers, and other health care stakeholders to gain their insights and perspectives on the new care model.

The critical need to realign care for older adults with complex conditions

Medicare patients see an average of seven different physicians, including two primary care providers and five specialists, multiple times over the course of a year. This care is difficult to coordinate and generally has not focused on needs or concerns that matter most to patients. The Institute of Medicine reports that up to 30 percent to 40 percent of all health care may be unnecessary or even harmful.

“More care does not equal better care,” says Corinne Rieder, EdD, executive director of the John A. Hartford Foundation. “The fragmentation in our health care system means a person could receive care from several physicians whose treatments may actually conflict.” The worsening of one condition by treatment of a coexisting one is common. Twenty percent of older adults receive medication recommended by guidelines that adversely affects a co-occurring condition.

“Patients need to be at the center of their health care, and they should expect to be able to work in partnership with a team of clinicians that coordinates its efforts to meet the goals that are most important to each patient and his or her family,” says Joe Selby, MD, MPH, PCORI's executive director. “As we build a potential new care model for these patients, we must engage and involve them at every stage of the development process.”

Patients and caregivers are represented on the CaRe-Align steering committee, and on each advisory panel set up to guide the initiative’s work, along with clinicians and representatives from major primary and specialty provider organizations.

Advancements in health information technology and new payment and delivery system reforms that encourage care coordination will provide a platform on which the model will be built.

Following the CaRe-Align model development phase, the Hartford Foundation plans to initiate a large-scale demonstration project intended to support the implementation and evaluation of the model in practice. If it is shown to be successful in improving health outcomes and reducing costs, the model will be promoted for widespread adoption.