Chronic Disease Care: Rearranging the Deck Chairs

The care of patients with chronic disease is one of themost urgent medical challenges in the United States. Chronic illness accounts for most of the demand, expense, and investments in scientific discovery. The well-docu-mented shortcomings in medical quality and safety fall heavily on the shoulders of patients with these conditions (1). Meanwhile, the Medicare program moves steadily to-ward insolvency (2). Two major trends will seriously ag-gravate the current situation. Over the next 20 years, de-mographic changes will drive a substantial increase in the prevalence of chronic diseases. Moreover, scientific ad-vances will greatly expand our ability to diagnose, to treat, and to monitor chronic diseases (3). Our imperative, there-fore, is to find models that can reliably and consistently deliver high-value care (highest possible quality and lowest possible cost) for patients with chronic illnesses