Geriatric Care Approaches in Health Maintenance Organizations

Abstract

The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.

Rationale and Design of a Multi‐Center Randomized Trial of Comprehensive Geriatric Assessment Consultation for Hospitalized Patients in an HMO

“…By 1992, the number of Medicare‐risk enrollees had risen to 1.4 million, and another 650,000 were enrolled under cost‐based contracts 48 . Because of the increasing enrollment in and importance of HMOs, additional research on CGA to determine its effectiveness in this setting is necessary 22 …”

“…Consensus statements from recent national conferences on CGA and GEM have called for multi‐center, randomized, controlled clinical trials, evaluation of the components of geriatric assessment and management to identify features most critical to outcome, testing of different screening methods and targeting criteria, and increasing research in HMOs because of the current emphasis on managed care and capitated payment 17, 18, 22 . While multi‐center and multi‐institutional trials are not unique in medical research (eg, experimental drug trials), these approaches are an advance in the field of CGA/GEM research and should enhance the generalizability of findings to different settings and patient populations.…”

Projecting the Need for Physicians to Care for Older Persons: Effects of Changes in Demography, Utilization Patterns, and Physician Productivity

“…This component alone accounted for approximately a 10% reduction in physician supply needs. Coupled with the tendency of HMOs to utilize nurse practitioners in providing care to elderly persons, 15 this method of health care delivery might substantially decrease the need for physicians.…”

Interdisciplinary Collaboration in Gerontology and Geriatrics in Latin America: Conceptual Approaches and Health Care Teams

“…Thus, this type of multidisciplinary team evokes a juxtaposition of various professionals and competences interacting on a limited and transient basis. Nowadays, most geriatric consultation teams function in this manner (Kramer, Fox, & Morgenstern, 1992).…”