engaging community health workers. Coordinated Care interventions encourage healthcare payers and providers to move toward a more accountable system, where a greater portion of reimbursement is tied to patient health outcomes. The study revealed significant evidence and policy activity on interventions related to care pathways and bundles, disease management programs, specialized units, discharge coordination and patient navigation, and coordinated delivery of primary and long-term care. The following topics had an extensive, rigorously conducted evidence base but received limited attention in the policy arena. Patient Self-Care and Self-Management initiatives encourage patients to work with their providers to preserve their health status and minimize avoidable complications. These initiatives utilize strategies such as patient education to encourage healthy decisions and behaviors as well as technology enabled self-care. Better management of chronic disease can help patients with complex, co-morbid conditions avoid unnecessary interactions with the healthcare system, such as costly trips to the emergency room. Palliative and End-of-Life Care refer to approaches that focus on relieving symptoms for patients with pain and terminal illnesses and providing support and resources for their family members. Approximately one-third of Medicare dollars are spent on patients in their last two years of life; these initiatives seek to reduce the suffering of patients at the end-of-life while creating considerable opportunities for healthcare cost reduction. Such initiatives hope to improve patient and caregiver satisfaction. Addressing the Health Needs of an Aging America | 6 Two topics were notable for a large number of policy recommendations within the sampled stakeholder organizations, but a lack of research evidence to support these recommendations. Medical Malpractice: A cost-effective, high-value healthcare system would ideally eliminate wasteful and unnecessary care associated with the practice of defensive medicine. Yet the study found considerable gaps in the evidence base on the potential consequences of malpractice reform on the costs and quality of care for the aging population Long-Term Care: While reforming the current long-term care system is a major policy priority for many stakeholder organizations in the study, the evidence base on the effects of proposals to reform the system for financing and delivering long-term care is limited, particularly at the federal level. A great deal of policy activity in long term care is happening at the state level, as state leaders use policy levers such as Medicaid waivers to deliver long-term services and supports in innovative ways. However, many significant gaps remain and additional evaluation and research are needed to provide an evidence-base for these policies. Policy Recommendations That Demand an Evidence Base Addressing the Health Needs of an Aging America | 7 The U.S. population is rapidly aging. By 2050, older adults, age 65 and older, will make up 20 percent of the total U.S. population, up from 12 percent in 2000 and just 8 percent in 1950. The number of people age 85 or older will grow the fastest over the next few decades, constituting 4 percent of the population by 2050, or 10 times its share in 1950 (see Figure 1). Figure 1. Growth in U.S. Aging Population, 1950-2060 (Projected) Source: U.S. Census Bureau Note: * indicates projection 2014 Population Projections The budgetary and policy implications of this demographic shift represent the greatest challenges faced by the government and the U.S. health system today. While the U.S. population of adults aged 65 and older currently account for only 13 percent of the population, this cohort consumes more that 34 percent of national health expenditures. On average, the older adult population spends $18,424 annually per person, with more than one-third of those expenditures occurring after the age of 85. The Medicaid program accounted for more that 40 percent of overall U.S. nursing home costs in 2012, and 65 percent of these costs in graying states like Pennsylvania. Together with Medicare, these programs comprise more that 31 percent of all U.S. health expenditures.1