title: Managed care for the elderly in the United States: outcomes to-date and potential for future growth.
abstract: With the growth in frail elderly populations, health providers and policymakers are exploring new models of caring for and financing the care of disabled elders. This paper reviews innovative care programs directed toward maintaining elders with dependency-producing physical and mental disabilities in home and community-based programs, and toward minimizing the use of acute and long-term institutional care. These programs represent improvements over the traditional fragmented care and financing mechanisms by integrating patient management responsibilities into one provider organization. Some programs integrate only primary and acute care, while others integrate only the continuum of long-term care services. A third set of programs, the key focus of this paper, integrate the full continuum of care from primary through acute and long-term care services. Coupled with service integration is financial consolidation, with control over all sources of funds transferred to the managing provider along with some level of financial risk. Outcomes in terms of lowered acute care utilization and successful site duplication are described, and future prospects for program adoption on a national scale are addressed.
authors.affiliation: East Boston Neighborhood Health Center, MA 02128, USA. doylea@ebnhc.org
authors.forename: A
authors.initials: A
authors.lastname: Doyle
authors.forename: J
authors.initials: J
authors.lastname: Masland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D016330:Frail Elderly; D018166:Health Care Reform; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007353:Insurance, Long-Term Care; D008484:Medicaid; D006278:Medicare; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D014481:United States