Commonwealth Care Alliance. A new approach to coordinated care for the chronically ill and frail elderly that organizationally integrates consumer involvement.

While medical care is becoming more effective, our health care system is becoming increasingly fragmented from both a care and a financing perspective. This article summarizes our experience with integrating the delivery of care for catastrophically ill and frail elderly. We argue that true integration can only be done within a framework of a financing mechanism that gives all providers the financial incentive to deliver integrated care. Under such a financial arrangement, nurse practitioners and social workers provide much of the care within the home environment. This results in a higher quality care delivery system within a limited budget.