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.
the geriatric medical group that Elderplan formed for the SHMO experienced increasing staff turnover and operating deficits that were absorbed by Elderplan.
Because marketing SHMOs has proven to be so problematic and expensive, it is important to assess how many members a SHMO needs to break even financially.
Although exact numbers are not available, it appears that the two HMO-based plans could break even at around 2,000 members or less, but the two new SHMO models may need 3,000 to 5,000 members each.
The SHMO demonstration has been a more expensive venture than anticipated by government agencies and most provider sponsors, with deficits especially high at the two sites that formed new HMOs.
Even so, if tests of the SHMO concept are expanded, it is doubtful that the government would grant the same open-ended financial support.
Although the problems of losses and slow enrollment represent important learning, they may be overshadowed by other contributions that the SHMO demonstration can make in shaping policy and practice.
The central goal of the SHMO Consortium's research agenda is to study and improve the methods for managing expanded care services in a manner that furthers quality, equity, and efficiency.
Has the performance of the SHMOs improved since assuming full risk?