Across the great divide. Integrating acute, post-acute and long-term care

The importance of integrating acute, post-acute and long-term care is underscored by analyses of the extent of medical complexity among the SHMO enrollee population that qualified for a long-term care benefit on functional (not medical) criteria. In the SHMO programs, initiatives to promote integration of services at all levels of care have largely come from the care management units. Integrative practices will vary in different organizational settings. Examples from two very different SHMO sites illustrate how integrative practices are implemented. It is concluded that in order to serve adequately a medically complex and functionally impaired elder population a key function of care management is to develop cooperative relationships, and mechanisms for information exchange, with providers at all system levels, reaching across the great divide between the acute and long-term care systems.