Challenges and accomplishments of the second-generation Social Health Maintenance Organization

Robert Newcomer, Charlene Harrington, Robert Kane

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Purpose: This study traces the implementation of the second-generation Social HMO demonstration program within the Health Plan of Nevada among more than 35,000 Las Vegas members. Design and Methods: This case study uses health plan reports, claims data, and administrator and clinician interviews covering the years 1999-2001. Results: Care coordination, geriatric services, communications, and support infrastructure development has been extensive. Implementation has occurred at different rates among staff model and network practice physicians. Hospital days and discharges were fewer among clinic than network participants; physician and emergency room visits were more frequent, as were day care, respite care, and home help. Implications: Integrating medical and social care is difficult. Despite great efforts, it took several years before key benefits could be adequately developed and linkages created. Evaluations that target start-up rather than steady-state operation may not capture these accomplishments. Further, federal government efforts to encourage experimentation and innovation in care for aged and disabled individuals may require programs other than time-limited demonstrations.

Original languageEnglish (US)
Pages (from-to)843-852
Number of pages10
JournalGerontologist
Volume42
Issue number6
DOIs
StatePublished - Jan 1 2002

Keywords

  • Aged
  • Care management
  • Managed care
  • Medicare

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