Imagine a 10-year-old child with severe, medication-dependent asthma. In the past year, she missed 10 days of school, was seen in the emergency department 5 evenings, was admitted to the hospital for 36 hours twice, and was seen in a medical clinic 15 times. It’s the same exhausting struggle across the United States for thousands of individuals and their families—people with diabetes, arthritis, obesity, heart disease, neurologic disorders, cancer, AIDS, hepatitis C, transplantation, and renal failure, to name just a few. More patients are now living with multiple chronic conditions, but the health care system today is not equipped, nor has it evolved, to provide the integrated and coordinated care that meets the needs of patients of the 21st century.1
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