brookings-logoToday is Thursday, January 28, 2010, and I am in Washington, DC, at the Brookings Institution. Along with the SCAN Foundation, we are sponsoring a forum on an issue fundamental to our mission to improve health and health care for older adults: changing how health care is delivered to achieve better chronic care at lower costs.

We have been working on these issues for decades, and we are excited to co-host this opportunity to inform the discussion of proposed mechanisms such as accountable care organizations, medical homes, and bundled payments with the expertise of many long-time grantees who actually provide care to older adults. As nearly everyone knows, it is the 20 percent of the population scan-logo1with multiple chronic illnesses who drive 80 percent of U.S. health care costs.  However, policymakers and the public are only recently starting to understand that nearly all of this 20 percent are frail older people.

Older adults represent some 50 percent of hospital occupancy and have an average readmission rate of 19.6 percent within 30 days--a failure of startling magnitude both for the patients and families involved and for its financial impact. Older adults represent about 30 percent of outpatient visits to the average general internist, yet the care delivered for geriatric issues like falls, incontinence, and dementia meets, on average, only 30 percent of indicators of quality care. This is substantially lower than the 50 percent overall rate of quality treatment that is already a cause for national concern.

We can do better. We are ready to do better. Today, we convene foundation colleagues, researchers, and public-policy experts to gain a greater understanding of how the innovative programs and ideas we and others have helped develop over the last few decades can serve as a starting point for reforming care delivery. Together, we can work to implement these and other promising programs so we can make a real difference in changing health care outcomes for chronically ill older adults.