Medicare is the federally-administered health insurance program that serves individuals over 65 who meet eligibility requirements. The solvency ofthis program has become a topic of much debate within health policy circles. As the number of Medicare beneficiaries is expected to increase significantly during the coming decades, emphasis has been placed on cost containment and quality improvement. A significant number of elders reports functional and cognitive impairments. Furthermore, the vast majority of beneficiaries reports at least one chronic illness. Chronic illness and functional impairment both increase the risk for future disability. Functional decline and disability are directly responsible for short- and long-term health care costs, and certain health and lifestyle characteristics such as heart disease, diabetes, smoking, body mass index, and physical activity have been shown to predict future disability. Thus, Medicare must transition from an acute care focus to alternative methods of chronic care management, disease and disability prevention. Community-based interventions to promote lifestyle modifications and chronic disease management have been evaluated and proven effective in decreasing disability and health resource use. These community-based efforts will need to be developed in conjunction with office-based chronic care management strategies. This paper reviews effective community-based interventions in order to recommend a new model of community-based health promotion for Medicare beneficiaries. In order for this type of model to be successful, Medicare will need to change its reimbursement policies that currently promote office-based, procedurallyoriented care to policies that enhance a team approach to disability prevention and health promotion among seniors.Master of Public Healt
