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Parallel community surveys conducted by the HCFA evaluator confirm the general similarity of SHMO members in terms of severe disability.
The representative population and prepaid financing allow the SHMO to establish an insurance risk pool to pay for the expanded chronic care benefits.
Being NHC qualifies a member for SHMO LTC benefits.
Core SHMO benefits include all Medicare-covered services, a range of ancillary medical services (e.
1988); and SHMO quarterly reports to HCFA show that only 10 to 20 percent of those using the LTC benefit have exceeded the cap (usually in nursing homes).
Several factors whould be considered in assessing SHMO losses.
Second, because Elderplan and SCAN Health Plan are new SHMO models, they carry higher interest, depreciation, and amortized startup costs than do the other plans.
The only clear differences is that the two news SHMO models--SCAN and Elderplan--spent lower proportions on physician and hospital services than did the HMO-based sites.
Are these LTC costs affordable in the context of SHMO financing?
Except at Kaiser Permanente, it has been expensive to persuade Medicare beneficiaries to join the SHMO.
No comprehensive analysis of marketing problems is available, but factors that may distinguish Kaiser Permanente are its strong reputation in Portland, its large internal market of Medicare eligibles (more than one-half of its SHMO members), and its decision not to market its regular Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) plan in competition with the SHMO.