Providing complex (rather than complicated) chronic care.

With health care reform underway, the results of the study by Sharma et al emphasize the foundational role of primary care in our multimorbiditybased chronic care system. They found that the majority of patients with 14 high-cost chronic conditions saw general rather than specialist physicians. They suggest that the level of dependence that this chronically ill population has on primary care may not be appreciated and that the time needed to provide guideline-concordant care to these patients is unachievable. This raises serious issues for future health care delivery.