tci Medicare Compliance & Reimbursement - 2003 Issue 35

Medicare+Choice: MEDPAC: FOLD S/HMOs INTO M+C

The so-called social health maintenance organizations - with which Medicare has experimented for nearly two decades - should be folded into the Medicare+Choice program when the S/HMO demonstration officially ends this December. That's the word from the Medicare Payment Advisory Commission, based on repeated findings that S/HMOs haven't had much more success with integrating care, cutting institutionalization rates, and improving outcomes for frail elderly people than have other Medicare health plans. The S/HMO demonstration was established in 1985 and revised in 1996 to test a service-delivery and financing model that would provide acute, chronic, and long-term care, especially community-based...

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