Challenges and accomplishments of the second-generation social health maintenance organization.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Newcomer
Robert
R
Department of Social and Behavioral Sciences, University of California-San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA. rjn@itsa.ucsf.edu
Harrington
Charlene
C
Kane
Robert
R
D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D008484:Medicaid; D006278:Medicare; D009505:Nevada