Enhancing managed care's role in long-term care: building on the aging network.

As Medicare managed care organizations grow, they will likely enroll more functionally impaired older people, as well as individuals with special linguistic and cultural needs. Traditional aging network service providers have special expertise to serve these populations. To date, however, the aging network has only been integrated into the operations of managed care on a very limited basis, primarily by demonstration projects. This article highlights program examples of collaboration between the aging network providers and managed care organizations for case management, screening, assisted living, and adult day care. The steps managed care organizations should take to build on the expertise of the aging network are described.

Strategic management of a continuum of care.

Why would an organization want to undertake the changes required to be a continuum of care? Because providers of residential and long-term nursing care that continue to function in isolation may survive, but they will not thrive in the 21st century.

Creating a continuum. The goal is to provide an integrated system of care.

The idea of a continuum of care is hardly new. In its purest form, it is simply the essence of good patient care. Today, the complex U.S. healthcare organization has emerged as a highly sophisticated but fragmented collection of service providers. We now must put energy and resources into rebuilding the comprehensiveness and continuity that represent high-quality care. The rationale for a continuum of care is that it is appropriate for patients' needs, demanded by today's consumers, an organized way of maximizing use of healthcare resources, and cost-effective for providers, patients, and payers. A continuum of care comprises services and integrating mechanisms. The services can be broken into seven basic categories: extended care, acute hospital care, ambulatory care, home care, outreach, wellness, and housing. The four basic integrating mechanisms are interentity planning and management, care coordination, case-based financing, and integrated information systems. Shaping a continuum mandates translating broad principles into pragmatic application suitable for the organization and community. The organization should define goals and objectives, identify a target population, assess services, evaluate integrating mechanisms, communicate, and prepare a business plan.

Members program targets the senior market.

Senior membership programs offer hospitals an opportunity to achieve strategic positioning among older adults, the highest users of health-care services. Initially, older consumers are linked with the hospital through a variety of services. Over the long term, the hospital expects to gain financially as members use inpatient and other services.

Hospitals and the provision of care to the aged: a cluster analysis.

As the American population ages, the hospital industry will undergo substantial restructuring to meet the increased demand for geriatric and long-term care services. Understanding this important trend, however, has been inhibited by limited research and the vast range of services that currently exists. This investigation develops empirically a classification schema of hospitals that reflects the mix of geriatric services they provide. The study also identifies the organizational and environmental characteristics of hospitals providing these geriatric service categories. Factor analysis, clustering, and analysis of variance were performed on a sample of 416 hospitals. Seven distinct groupings of hospitals that differed systematically on geriatric service mix and other contextual factors were identified.

The role of group practice in the distribution of physicians in nonmetropolitan areas.

The geographic maldistribution of physicians persists as a major obstacle to improving the availability of health services in rural areas. This study looks at group practice as a potential factor in the location of physicians in nonmetropolitan areas. The basic assumptions are 1) the expected conditions of practice are critical to a physician's decision about where to locate, and 2) a group practice form of organization alleviates many of the deterrents to rural practice. The sample for the study is 287 nonmetropolitan trade areas in eight geographic regions of the U.S. Stepwise multiple regression is used to evaluate the relationship of demographic and health system variables, including group practice, to the physician/population ratio. Analyses are done for 1960 and 1970 and then for the change over the ten-year time period. The regression outcomes show that income, population over age 64, and urbanization are most helpful in explaining physician distribution in 1960. In 1970, hospital facilities also contribute. However, the percentage change in the physician/population ratio between 1960 and 1970 is explained by the 1960 physician/population ratio and the per cent of physicians in group practice in 1960. The findings suggest that attractive practice arrangements may be one way to alter the geographic maldistribution of physicians.