HMOS' continuum of care. How HMOs target their services to meet the needs of the elderly

As healthcare organizations begin to expand their services to serve the elderly, they can learn from the experience of managed care providers. Kaiser Permanente in San Diego, a health maintenance organization (HMO) integrates healthcare providers with more traditional hospital services such as discharge planning and placement coordination, as well as social services, care management, and rehabilitation. Having all these services in the same office facilitates good patient care and planning. When a patient goes into hospice, home care, or a skilled nursing facility, one of four physicians takes on sole responsibility for his or her treatment and continuity of care. Group Health Cooperative of Puget Sound, Seattle, is a consumer-governed HMO. Group Health makes decisions based on data about enrollees plus input from medical staff and senior groups. It emphasizes putting the right services with the right consumer using subgroupings based on functional status: healthy, moderately frail, and frail. Seniors Plus, a social HMO in Minneapolis, integrates acute and long-term care. Providers determine who needs functional assessment and care management by looking first at the diagnosis, then the severity of impairment and comorbidity, other medical problems such as depression and falling that indicate a need, and finally limitations in function and ability to perform activities of daily living.