An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study has found. The results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors, and sometimes get conflicting medical advice. The study also showed how hard it is to change the habits of older patients and their sometimes inflexible doctors, and points to the challenges the Obama administration will face in trying to reform healthcare for an aging nation.