Seven case studies of provider organizations implementing innovative approaches to care coordination and disease management of patients with one or more serious chronic conditions and to the homebound frail elderly demonstrate a range of issues that need to be addressed to produce rapid dissemination of these approaches throughout the health care system. Study participants all describe perverse incentives within fee-for-service environments that frustrate chronic care-oriented activities. Nevertheless, innovative programs, some providing an important role for hospitals working collaboratively with physicians and others featuring geriatric home visiting, appear to be models for expansion.