As the number of older people with complex chronic medical needs increases, so does the demand for integration of care, and personalized medical treatment will grow. Whether there will be a provider response to such demand is likely to depend on the reform of provider payment mechanisms, particularly for secondary care. At present, these usually reward discrete episodes of care. In the future, payment mechanisms are increasingly likely to reward ‘bundles’ of care, or indeed a whole year of care, for people with complex needs.