diane rowland, in our capacity, both at kaiser family foundation and mack pack, you've been thinking about high-cost patients and challenges to delivering coordinated care, improving health outcomes and lowering the costs. so tell us about that thinking. >> thank you, susan. i think i can just do it with this. this arrow? >> well, i always come to these forums and we talk a lot about the medicare program and sometimes we talk about private insurance and we don't always when we talk about health care costs bring the medicaid program into perspective. i just wanted to remind us about why medicaid takes care of lot of people with chronic illness and why it spends a lot of its resources on that population. and of course, this is our most classic slide, showing that one in four beneficiaries on the medicaid program are disabled and elderly but account for two-thirds of the spending. and a large reason for that, of course, is that there is a lot of long-term care expenditure on behalf of the populations. but let's focus for just one minute on that under 65 disability population for medicai

we heard from diane rowland about the very important fact that the high spenders in the medicare program are different from the high spenders in the medicaid program. which is a recipe for us developing a much more nuanced understanding about how to restrain excess costs in those two pockets of the population. we heard from bruce chernof, again, much on that same theme that half of the medicare enrollees with chronic conditions also have functional limitations, and half of them are dual eligibles but half are not. and we have to be very mindful, he said, of the problem that we're trying to solve. the problem as many patients see it, is that they lack all of those words that he put up in his wonderful word cloud. they're not spending a lot of time thinking about how to get access to surgical robots, they're spending more time thinking about how to have a independent, dignified existence, independent of as many health care providers as possible, very often. then we heard from susan reinhard that patients and care givers sense that a lot of the issues that they face in health care is due to

diane rowland, in our capacity, both at kaiser family foundation and mack pack, you've been thinking about high-cost patients and challenges to delivering coordinated care, improving health outcomes and lowering the costs. so tell us about that thinking. >> thank you, susan. i think i can just do it with this. this arrow? >> well, i always come to these forums and we talk a lot about the medicare program and sometimes we talk about private insurance and we don't always when we talk about health care costs bring the medicaid program into perspective. i just wanted to remind us about why medicaid takes care of lot of people with chronic illness and why it spends a lot of its resources on that population. and of course, this is our most classic slide, showing that one in four beneficiaries on the medicaid program are disabled and elderly but account for two-thirds of the spending. and a large reason for that, of course, is that there is a lot of long-term care expenditure on behalf of the populations. but let's focus for just one minute on that under 65 disabilty population for medicaid

we heard from diane rowland that high spenders in medicare program are different from those in the medicaid program. a recipe for as developing a much more nuanced understanding about how to restrain excess costs in those two pockets of the population. we heard from bruce chernof on the same theme that half of the medicare enrollees with chronic conditions have functional limitations and half of them are dual eligibles but half are not. mindful of the problem we are trying to solve, the problem as many patients see it is they lack of words he put up in his wonderful word cloud. they are not spending a lot of time thinking about how to get access to surgical robots. they are thinking about how to have independent dignified existence, independent of as many health-care providers as possible very often. then we heard from susan reinhart that patients and caregivers, a lot of the issues they face in health care is due to factors like for communication. they don't feel they are empowered sufficiently to make decisions with their health care providers. they are also clearly lacking in help litera