Considerations for accountable care organizations and medical homes

This is an exciting time for healthcare delivery worldwide. We have a burgeoning science that is helping us understand the origins of disease and improve treatment in our geriatric patients. This comes at a time of immense change in payment and delivery systems that is important for mental health clinicians to understand. This chapter provides a summary of the recent legal and administrative initiatives in the U.S. referable to the Affordable Care Act of great importance in providing clinical care to geriatric patients, particularly those diagnosed with borderline personality disorder (BPD), with an emphasis on the provision of psychiatric services in the U.S. We also include a discussion of institutional systems of care for older patients in the Canadian healthcare system both for international comparison and to illustrate other creative approaches to the worldwide growing challenges in care delivery in institutional settings.