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Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces.

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans.Key Words: Pharmacy utilization management, seniors, cost-sharing mechanisms, administrative restriction tools. P harmacy utilization management (PUM) measures are used extensively in health care delivery systems throughout the industrialized world Bloor, Maynard, and Freemantle 1996;Freemantle and Bloor 1996). The most widely used strategies are policies that require financial contributions from patients (e.g., copayments, coinsurance, deductibles, and drug benefit caps) and policies that restrict the number and particular kinds of medications prescribed (e.g., formularies and (Soumerai et al. 1993;Thomas et al. 2002). The intentions and benefits for such policies are to control expenditures on drugs and to improve their efficiency by reducing inappropriate prescriptions, overutilization, and iatrogenic risks (Levy 1992;Soumerai et al. 1993). PUM initiatives may also, however, limit patients' access to needed medications and promote the use of medications that are less effective or more likely to cause adverse events. From an economic perspective, therefore, the short-term drug cost savings realized from PUM measures may be offset by long-term increases in overall health care utilization (Soumerai et al. 1993). Furthermore, the unintended effects of PUM programs may be magnified in a sensitive, vulnerable patient population such as seniors, many of whom have few financial resources but many medical needs.Access to appropriate pharmaceutical treatment for seniors has become a major health policy issue in the United States (Iglehart 2001). In fact, persons aged 65 and older represent about 13 percent of the population but consume approximately 30 percent of all prescription medications (AARP 1999;Arnett et al. 1990). On average, a person in this group receives 20 prescriptions per year (Poisal and Murray 2001), which can be a severe financial burden.In 1998, seniors spent an average of $537 (representing 3.55% of family income) on out-of-pocket prescription drugs, much more than the out-of-pocket average of $192 (representing 1.25% of family income) for working-age adults (Xu 2003). The disproportionate financial burden of prescription drugs for seniors versus nonseniors was found across all family income levels. The continued aging of the population, the expanded numbers and types of available medications, and the rise in the cos...

Rural Aging in America: Proceedings of the 2017 Connectivity SummitAlexis Skoufalos, EdD, Janice L. Clarke, RN, BBA, Dana Rose Ellis, BA, Vicki L. Shepard, MSW, MPA, and Elizabeth Y. Rula, PhDEditorial: Creating a Movement to Transform Rural Aging David B. Nash, MD, MBA, with Donato J. Tramuto, and Joseph F. Coughlin, PhD   S-3Introduction   S-4Summit Proceedings   S-5  Roundtable 1: The Power of Community – Enabling Social Connections and Access to Health Resources Through Community-Based Programs   S-5  Roundtable 2: Technology and Rural Health: Innovative Solutions to Bridge the Distance, Improve Care, and Deliver Programs   S-7  Roundtable 3: An Integrated Experience: The Exponential Potential of a Collaborative Approach to Rural Aging   S-8General Discussion and Recommendations   S-8Post-Summit Debriefing   S-9  Strategy and objectives   S-9  6–12 month action plan   S-9Conclusion   S-9

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