The good news.

HMOs have potential to improve primary care

INNOVATIVE HMO NURSING HOME PROGRAMS may have the potential to keep more nursing home residents out of emergency rooms and hospitals, ultimately providing better care at a lower cost than traditional fee-for-service (FFS) programs.

A study of three innovative HMO nursing home programs revealed that residents enrolled in the HMOs received more primary care than their fellow fee-for-service residents. In one of the programs emergency room visits and hospital admissions dropped significantly.

"Like it or not, we are headed toward the capitation of care for nursing home residents," says co-author John Schnelle, PhD, director of the Boren Center for Gerontological Research at the School of Medicine at the University of California, Los Angeles. "The goal of our study was to examine three HMO programs that are ahead of the tide and compare the processes of these programs with FF5 programs."

The study, "Primary Care of Long-Stay Nursing Home Residents: Approaches of Three Health Maintenance Organizations," was published in the February issue of the Journal of the American Geriatrics Society. Funded by the Robert Wood Johnson Foundation, the study evaluated care received by 215 HMO and 187 fee-for-service residents at 20 community-based nursing homes in three regions of the U.S.: east, west, and far west.

The three were selected because they had dedicated nursing home programs with written policies to address advance directives and acute events, including emphases on managing acute problems in the nursing home and on discussing care goals and advance directives with residents and their families. The study examined how HMO programs responded to two acute problems: falls and fevers.

Assuming one additional nurse practitioner or physician assistant visit per month for the HMO programs, with the visit lasting one hour and a rate of $88 an hour, the additional cost of the intervention would be $1,056 per year, according to the study. But the HMO program would result in a savings of $884 per resident each year, assuming 1.9 fewer days of hospitalization among HMO residents compared with FFS residents, at $1,000 per hospital day.