on behalf of the HMO Care Management Workgroup

care across different settings. 2. Structure their delivery systems to promote seam-less transitions across care settings. 3. Review benefits coverage and limitations with patients and/or practitioners prior to a transfer, and explain to patients what they should expect at the next care setting(s). Statement of Problem Payment mechanisms commonly lack incentives for assuring that optimal care coordination occurs across set-tings. Per-stay (or per-case) payment mechanisms can pro-mote premature patient transfer without adequate focus on the patient’s needs at the next setting. Yet reducing the length of stay in one setting may negatively influence care as well as costs in a subsequent setting. Furthermore, each additional care transition provides another opportunity for an adverse transition-related event or error to occur. Structural barriers may also impede the provision of optimal care for patients in transition. For example, HCOs that attempt to create an affiliated or contracted continuum of care for a variety of acute and post-acute services often encounter differences among providers with respect to their mission, staffing, internal incen-tives, and professional cultures. These differences can contribute to poor communication, insufficient infor-mation transfer, and inadequate preparation of the patient and caregiver. Further, the continuum of care may be incomplete or lack the capability to care for cer-tain subsets of patients, such as those who require venti-lators, have antibiotic-resistant infections, or have mod-erate-to-advanced dementia. Finally, tensions may arise within HCOs between clinicians who desire to affiliat