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The number of chronically ill and disabled elderly people with complex medical, psychosocial and financial needs is rapidly growing. The elderly population has been steadily increasing in the United States due to the efforts of modern medicine and disease prevention techniques. The elderly will now live for three to six years prior to death with increasing levels of disability (Fried, 2002).

Palliative Medicine is gradually being recognized as an invaluable clinical service. Currently there is a growing national interest to establish palliative medicine programs. A forward-looking, detailed business plan outlining the operational and financial projections over a period of time is key to the survival of a program. This chapter describes the business planning and program development implemented at the Cleveland Clinic, the first integrated and comprehensive palliative medicine program in the United States.

Over the past decade, efforts to define, build, and improve palliative care and care for complex chronic illness have been commonplace at both the micro—or organizational—and macro—or healthcare organization, payment, and regulatory policy—levels. Having grown largely out of the hospice movement, palliative care for many represents all that hospice does so well, and by extending hospice’s reach offers a promise of comfortable and compassionate care earlier in the disease process than hospice is often able to.