Social Health Maintenance Organizations' Service Use and Costs, 1985-89

By Harrington, Charlene; Newcomer, Robert J. | Health Care Financing Review, Spring 1991 | Go to article overview

Social Health Maintenance Organizations' Service Use and Costs, 1985-89


Harrington, Charlene, Newcomer, Robert J., Health Care Financing Review


Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to $12,000 chronic care benefit in addition to the basic HMO benefit package, had higher startup costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors.

Introduction

After more than a decade of research and demonstrations on long-term care programs, the need and demand for community long-term care services by those who are disabled have been well documented. In previous demonstrations, community-based long-term care services have been found to improve the quality of clients lives and to provide needed support for informal caregivers (Kemper, Applebaum, and Harrigan, 1987). The value of case-management services, which provides assessment of needs, plans of care, arrangements for services, and ongoing monitoring of clients, has also been documented (Kemper, Applebaum, and Harrigan, 1987). Even though positive outcomes have been identified, unfortunately, long-term care demonstrations have generally not been found to control costs and are likely to increase overall costs (Hamm, Kickman, and Cutler, 1982; Kemper, Applebaum, and Harrigan, 1987; Weissert, 1985; Weissert, 1988; Zawadski, 1983). Thus, the search has been for cost-effective long-term care financing and service delivery models.

The social health maintenance organization (S/HMO) model was designed as an innovative new approach to control costs while expanding long-term care services. This demonstration model, designed by Brandeis University in 1980, was sponsored by the Health Care Financing Administration (HCFA) with waivers from the Medicare and Medicaid programs (Leutz, Greenberg, and Abrahams, 1985). The S/HMO model includes the following basic organizational and financing features. First, a single organizational structure provides a full range of acute and chronic care services to Medicare beneficiaries who enroll on a voluntary basis and pay a monthly premium for services. The benefits include nursing home, home health, homemaker, transportation, drugs, and other such services beyond the basic Medicare benefits.

Second, a coordinated case-management system was established to authorize long-term care services for those members who met specified disability criteria and were within a fixed income limit of about $6,250-$12,000 per year. The case-management system was also designed to improve access to and appropriateness of services delivered. Third, S/HMOs were designed to serve a cross-section of the elderly populatioin including both the functionally impaired and the unimpaired elderly, unlike most demonstrations that have been targeted only to the impaired elderly. The goal of S/HMOs is to keep individuals healthy and perhaps to reduce or slow the rate of impairment and disability. Fourth, financing was accomplished through prepaid capitation by pooled funds from Medicare, Medicaid, and member premiums. The initial financial risks were shared by S/HMOs and by HCFA, but only S/HMOs assumed full financial risk for service costs at the end of the first 30 months of the demonstration. The design feature was developed to provide an overall financial incentive to S/HMOs to control total program costs while allowing greater flexibility in the services provided. For a full discussion of the initial goals and plans for S/HMOs, see Leutz, Greenberg, and Abrahams (1985); Harrington and Newcomer (1985); and Greenbert et al., (1988).

After a delayed start, S/HMO demonstration projects became operational in 1985. The S/HMO demonstration model was tested by four different organizations in different market environments. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Social Health Maintenance Organizations' Service Use and Costs, 1985-89
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.