The systems required to provide coordinated health care to the chronically ill within a managed care contract are complex. As an integrated health care delivery system assuming shared financial risk of enrollees in a Medicare + Choice contract, many care processes need to be created to meet the needs of the clients and administrators. Nursing case management and physician partnering are integral to the creation of the care model. The fiscal data demonstrated, for clients in this model, that there was an overall decrease in the inpatient length of stay, hospital days per thousand, and 30-day readmission rates.