Ambulatory and community-based services

The shift in the site of service delivery from inpatient and institutional to ambulatory and community settings has been prompted by concerns over cost and the prospect for improving the quality of life. In response to these concerns, Medicare has implemented several demonstrations that emphasize ambulatory and community-based services. In this issue, articles are presented on four demonstrations, which focus on the extent to which coordinated care models reduce health care costs, and the cost effectiveness and beneficiary outcomes of disease-specific programs. Two articles are included on home health. One examines home health care in relation to the other Medicare post-acute benefits, and the other focuses on the use of home health care in the treatment of end stage renal disease (ESRD). Finally, two articles report on Section 1915c Medicaid home and community-based waiver programs.