© 2000 by Taylor and Francis Group, LLC. All rights reserved. This chapter examines the trends and organizational changes that will lead to better organized systems of care. It also examines the changing roles of institutional providers and their likely contributions to integrated delivery systems. Gerontological and health services research has helped to understand the causes and effects of chronic illness on the population. The Medicare and Medicaid programs form the backbone of the payment system for persons with complex chronic illnesses and disabilities. Medical decisions are fraught with uncertainty. Organization theory is valuable in helping to understand the evolution of the healthcare system. Chronic disease affects persons of all ages and presents the single most important challenge to the healthcare system—i.e., organizing and financing services given a resource base that is growing at a slower rate than healthcare resource use. The value of program of all-inclusive care for the elderly is that it provides sponsoring organizations with important lessons in financial risk and health management for vulnerable and high-risk population.