Author Affiliations: Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco.
Frail older patients with multiple chronic conditions and complex health care needs receive services that are fragmented, incomplete, inefficient, and ineffective.1 Many of these patients are vulnerable to poor health outcomes because of age, multiple comorbidities, and poverty. Older adults with chronic health conditions spend a higher percentage of their income on health care.2 As a result, many frail elderly adults receive Medicare for physician and hospital care, and Medicaid, which covers some out-of-pocket costs and personal and social care services. Six million elderly adults are enrolled in both Medicare and Medicaid, also known as dual eligibles; they comprise 21% of Medicare beneficiaries.3
Chattopadhyay A, Bindman AB. Linking a Comprehensive Payment Model to Comprehensive Care of Frail Elderly PatientsA Dual Approach. JAMA. 2010;304(17):1948–1949. doi:10.1001/jama.2010.1634