Elder Law FAX The July 16,, 2007, issue of Elder Law FAX, a free newsletter published every other Monday by the Elder Law Practice of Timothy L. Takacs.   The Chronic Care Model for Health Care Delivery What is the Chronic Care Model for health care delivery? It was developed by staff working at the MacColl Institute for Healthcare Innovation and "identifies the essential elements of a health care system that encourages high-quality chronic disease care." The model has the following elements: the community, the health system, self-management support, delivery system design, decision support and clinical information systems. Ultimately, the model envisions productive interactions taking place between "informed, activated patients" and "prepared, proactive practice teams." How these interactions take place is where the true elder care advocate enters the scene. (For a graphic of the Chronic Care Model, go here: http://www.improvingchroniccare.org.) According to Dr. Ed Wagner, developer of the Chronic Care Model, "[w]hen properly applied to well-informed patients, newer treatments can lead to major reductions in suffering and avoid complications, including death." Even so, in an on-line lecture series, Dr. Wagner said the model suffers from several problems, the chief one being a lack of informed, activated patients. Where do activated patients come from and how do they get informed? Conversely, how do informed patients get activated? One answer is through education. Patients need to understand the long-term care continuum and how to interact with prepared proactive practice teams. Caring for incapacitated individuals, however, is not intuitive; most families do not know the questions to ask and find themselves dependent on the system to guide them through the process.   A second problem with the current health care model is that financing is largely "stuck" in a third-party payor model. In this model, providers are paid on a fee for service basis that is linked to a diagnosis code. The current model assumes a limited face-to-face contact between the patient and the health care provider. Good chronic care management, on the other hand, typically takes place between visits. A third problem, less talked about by the health care community, but apparent to lawyers, is accountability. The Chronic Care Model, like the acute care model, envisions relationships developing between patient and provider, but frequently health care providers feel more accountable to third-party financiers than to their patient. This market model has been likened to an almost adversarial relationship between patients and providers. In this climate, one rightly asks "who stands with the patient?" Who will press for all of the options available, and not just those paid for by Medicare, Medicaid or insurance? Last year a group of lawyers developed an organization called the Life Care Planning Law Firms Association to empower patients and caregivers who are on the Elder Care Continuum. This organization grew out of a workshop developed by the Elder Law Practice. One of the principal questions asked by those attending this workshop is "who stands with the informed activated patient on the left side of the model?" We believe it is a lawyer who develops an interdisciplinary staff that includes health care professionals trained to identify how patients can find, get and pay for good care.   Law firms adopting this view of patient advocacy are now spread across the country. Like traditional elder law firms, these law firms assist clients with issues relating to Medicare, Medicaid, special needs trusts, but they also bring to the table the ability to guide patients and their families in finding the right resources at the right time to age in-place.