In 1992, The Robert Wood Johnson Foundation launched Building Health Systems for People with Chronic Illnesses (BHS) to address deficiencies in the nation's health care system for individuals with chronic physical or mental impairments. Many of the BHS projects have yielded operational insights into the common characteristics of successful managed and/or integrated long-term care programs. This retrospective review of five innovative projects outlines six broad recommendations to guide investments in integrating long-term care.