Related Experiment Videos
Social Health Maintenance Organizations: assessing their initial experience
R Newcomer1, C Harrington, A Friedlob
1Institute for Health and Aging, University of California-San Francisco 94143-0646.
Health Services Research
|August 1, 1990
Summary
Social/Health Maintenance Organizations (S/HMOs) faced enrollment challenges due to market factors and product differentiation issues. However, integrating chronic care into HMOs proved more efficient than adding HMO services to community care providers.
Area of Science:
- Health Services Research
- Gerontology
- Public Health Policy
Background:
- The Social/Health Maintenance Organization (S/HMO) program integrated Medicare Parts A and B with extended chronic care benefits.
- This initiative aimed to merge traditional Health Maintenance Organization (HMO) roles with long-term care case management.
Purpose of the Study:
- To report on the developmental period of the S/HMO demonstration, covering the initial 30 months of operation.
- To analyze enrollment, financial risk-sharing, and operational efficiency of S/HMOs compared to other Medicare plans.
Main Methods:
- Analysis of the initial 30-month operational data from four national S/HMO demonstration sites.
- Comparison of S/HMOs with newly formed and established Medicare HMOs regarding enrollment, cost, and service delivery.
Main Results:
- Lower-than-expected enrollment in S/HMOs attributed to market competition, marketing underfunding, limited service areas, and lack of product differentiation.
- S/HMO enrollees prioritized extensive benefits, while other Medicare HMO enrollees focused on cost.
- Health screening controlled nursing home-certifiable enrollees without creating excessively long waiting lists.
Conclusions:
- Integrating chronic care benefits into existing HMOs is more administratively efficient than adding HMO components to community care providers.
- Despite initial financial deficits common to start-up phases, S/HMOs managed service expenditures within planned levels.