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Designing Healthcare Systems That Work for People With Chronic Illnesses and Disabilities

Organizing Care Systems


John Selstad, Senior Vice-President, National Chronic Care Consortium, Bloomington, MN.

Care systems that are being developed by providers in cooperation with States include some of the best examples of care integration anywhere in the country. Examples such as PACE (Program of All-inclusive Care for the Elderly), Wisconsin's Partnership Program, and Minnesota Senior Health Options are leaders in care integration for frail seniors and increasingly younger disabled persons. However, researchers recommend that to successfully meet the challenge of the demographic imperative of the next century, integrated care system development will need to move more aggressively to mainstream healthcare.

State and local governments are in a position to initiate, encourage, or cooperate with efforts to improve chronic care capabilities of healthcare providers. Integration is essential because the problems of the person with chronic illness are multidimensional, interdependent, disabling, interpersonal, and ongoing, and mainstream healthcare providers are not always prepared to serve this population as well as they could.

The National Chronic Care Coalition (NCCC), composed of 38 healthcare provider networks in 20 States, developed the Self-Assessment for Systems Integration (SASI) tool to assist in creating and evaluating seamless chronic care systems that cross settings, providers, and financing. The SASI tool could also be used by States developing purchasing specifications. The tool has guidance and materials pertaining to nine objectives:

  • Governance: The governance structure supports the goal of improving the ability of providers to work as a seamless system, regardless of whether this is one mega-entity or a loose coalition. Mr. Selstad noted that this responsibility is greater than ever because the turmoil in the current healthcare environment has resulted in individual providers having little or no time to work on coordination issues.
  • Management: Management strategies and structures support interdisciplinary integration efforts, e.g., budgeting, quality assurance, marketing, advocacy, and research and development efforts.
  • Information technology: Systems allow for sharing information on clients, costs, and operations. Mr. Selstad noted that this is the area in which the least progress has been made by NCCC members.
  • Financing: Financing systems promote systemwide management of costs tied to care outcomes. Integrated financing is necessary but not sufficient for full integration. Full attention should be directed to care components and the new and flexible methods to achieve improved outcomes over time and across settings.
  • High-risk populations: The needs of high-risk populations are identified and documented, allowing resources to be appropriately targeted.
  • Service array: A full array of effective and efficient services is provided, taking clients' needs and preferences into account. Mr. Selstad added that HCBS services are the least likely to be integrated into total healthcare systems.
  • Care management/disability prevention: Care management is focused on disability prevention at all stages of chronic illness and organized around defined populations.
  • Seamless care: Seamless care is provided across settings and over time, by using care management tools and interdisciplinary teams linked across sites.
  • Client involvement: Clients are involved in care management and self-care activities. The system rewards healthy behavior.

According to the NCCC, these nine care system components should be built into systems designed and managed by government programs for the chronically ill and disabled. Mr. Selstad asserted that government health policy leaders should encourage the adoption of these concepts by their local mainstream healthcare provider systems in order to help our communities be better prepared for the quest for chronic care competence in the next century.


National Chronic Care Consortium. Health networks for the chronically ill in turmoil: unintended consequences of the balanced budget act of 1997. Bloomington (MN): The Consortium; 1999 Oct.

National Chronic Care Consortium. Developing baseline capabilities for integrated care for a dually eligible population. Bloomington (MN): The Consortium; 1999 Sep.

Current as of December 1999

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Internet Citation:

Designing Health Care Systems That Work for People with Chronic Illnesses and Disabilities. Workshop Brief, December 1-3, 1999. User Liaison Program, Agency for Health Care Policy and Research, Rockville, MD.


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