The Hartford Change AGEnts Initiative, like most of the investments in the Foundation’s new strategic direction, has only just begun. We are inspired by the energy and creativity of the Change AGEnts featured here, as well as by their colleague AGEnts around the country—all of whom are engaged in the hard work of improving health care delivery through redesign or policy reform 365 days a year. Of course, there is much work to be accomplished in our rapidly changing health care environment. And while clear-eyed about the challenges before us, we remain optimistic about the opportunities that continue to arise.

Most of the public debate about health care during the last five years has centered on the Affordable Care Act’s individual mandate, the state and federal health insurance exchanges, and Medicaid expansion. Inside health systems, there has been a parallel discussion around how to transform the way care is delivered so it generates greater value for patients, for health care organizations, and for our society. This conversation—and the innovation that it drives—is, at its core, about the needs of an aging patient population and creates increased urgency for our work.

Even if we are successful in implementing more effective preventative care and improved management of chronic conditions, older adults are and will remain an enormous part of the high-cost, non-preventable demand for health care. In providing care for this population, our health system has been on a kind of auto-pilot, delivering procedures and drugs because it can to individuals who, if engaged thoughtfully, may not want or even need them. The system has been built on a set of assumptions and incentives that can make it hard to support the right kind of care. We remain underinvested in things like in-home supports and palliative care services that meet many older adults where they are. We need to reshape the health care system to take care of a growing patient population that will not be cured, but needs critically important care that will help its members continue to lead meaningful and productive lives.

The good news is that the aging community (including the thousands of leaders the Foundation has invested in during the last three decades) has been developing tools and interventions that can help. We know a lot about how to provide care to older adults that is more cost effective, higher quality, and person-centered. Our network knows how to structure the higher touch, lower tech, geriatrically expert care that patients want, but that health organizations and systems are only now figuring out how to deliver.

In the chaos and excitement of health care delivery redesign today, there is tremendous space, even demand, for experimentation. There is an appetite for geriatrics expertise that didn’t exist just a few years ago.

And just as systems are starting to change, so must we. Geriatrics has been a predominantly academic (as opposed to a clinical) discipline. This means we have faculty to prepare the next generation of clinicians, and we have a talented cadre of researchers. It also means that in order to respond to the needs of older people in health systems and communities, many in geriatrics will have to develop a much deeper interest in large-scale practice and policy change. This will require a certain boldness, and a tolerance—even an appetite—for risk.

Looking forward, the Foundation will continue to rally our network and like-minded partners toward these new roles, providing encouragement, support, and, of course, funding. We would like to expand the number of Change AGEnts who have heard the call to lead in this more applied way, helping to arm committed leaders with new skills and approaches to drive the process of health care delivery redesign. Our field does not have large numbers of people, so we need geriatrics experts to have the “strength of ten,” wherever they work.

We fully expect that this new leadership will both contribute to and benefit from the results of our other strategies. Developing good models of care that are the core of redesign efforts, identifying the right quality metrics and health information technologies to deliver care that older people really want and need, expanding educational opportunities that enhance practice, and formulating and advocating for public policies that promote better care is the substantive work we hope our leaders will undertake with us.

We should remember, this is about providing the best possible health care for our parents and our grandparents (and ultimately for all of us). It is about creating care that is comprehensive, continuous, and well-coordinated, care that balances the medical and social needs of patients, care that reflects the best geriatrics knowledge we have. Fundamentally, we are active participants in a societal shift that recognizes our changing demographics and seeks to respond, not out of a sense of crisis, but because it is the right thing to do.

We believe this is the road to health care transformation. For the John A. Hartford Foundation, this is our map every day and for years to come.