Taking a SCAN of social HMOs. Projects fill in the gaps left by Medicare

In an effort to solve the nation's long-term care crisis, Congress authorized a demonstration project of social health maintenance organizations (SHMOs) in 1984. The SHMO expands coverage of community and nursing home care in a controlled manner and links these services with a complete acute care system. The project represents an integrated, community-based approach to acute and long-term care for the elderly. SCAN Health Plan, Long Beach, CA, is one of four organizations involved in the project. It is the only one whose primary acute care contract is with a Catholic-sponsored provider, St. Mary Medical Center. The plan provides full acute medical and ancillary benefits, similar to high-option HMOs, and prepaid expanded care benefits for chronic conditions excluded by Medicare, HMOs, and private insurance. At the heart of the chronic care benefit within the SHMO are case managers who assess each client's needs and coordinate care, purchase of services, and ongoing evaluation. The SCAN demonstration is achieving three important goals: reducing nursing home admissions, giving severely impaired enrollees the opportunity to remain at home as long as possible, and providing respite care.