Evidence-based tools and resources are currently being crafted with the intent of sharing with health system leaders and other stakeholders later this year. In an article in The New England Journal of Medicine, the leaders of these foundations outlined three main goals of the collaboration: to help health system leaders and other stakeholders develop a deep understanding of this diverse population and its needs; to identify effective ways to deliver higher-quality, integrated care at a lower cost to this population; and to accelerate the spread of these approaches across the nation.

This project will help chronically ill individuals, who are estimated to account for only 5% of the U.S. population but half of all health care spending. Dr. David Blumenthal of The Commonwealth Fund described the necessity of focusing on the needs of these patients, as it is not only critical to their well-being but is crucial to making their care affordable. Similarly, Dr. Bruce Chernof of The SCAN Foundation emphasized the need for a radical rethinking of care models to deliver coordinated medical and supportive services to these high-cost, high-needs individuals. Promising programs have focused on managing transitions of care, extending primary care teams by integrating nonmedical services or emphasizing interdisciplinary, person-centered primary care. In addition, chronically ill individuals often have complex health and social needs, as Dr. John Lumpkin of the Robert Wood Johnson Foundation highlighted. Thus, obstacles to better care include complex and novel programs, new information technology capabilities, new tasks, and high costs. One way these foundations aim to reduce obstacles is by increasing providers’ accountability for the quality and cost of care. Lastly, Dr. Terry Fulmer of The John A. Hartford Foundation stressed the moral imperative to provide better care for older adults and others with complex health and social needs, while Mr. Jeffrey Selberg of the Peterson Center on Healthcare reiterated the importance of collaborating with these foundations to achieve quality health care at an affordable cost.