Commonwealth Care Alliance

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Abstract
While medical care is becoming more effective, our health care system is becoming increasingly fragmented from both a care and a financing perspective. This article summarizes our experience with integrating the delivery of care for catastrophically ill and frail elderly. We argue that true integration can only be done within a framework of a financing mechanism that gives all providers the financial incentive to deliver integrated care. Under such a financial arrangement, nurse practitioners and social workers provide much of the care within the home environment. This results in a higher quality care delivery system within a limited budget.