Introduction to Quality Assurance

According to the Public Policy Institute Report for the AARP , Social Health Maintenance Organizations have been existing since 1985 , and have been responsible for acute and long-term care to elderly people with low income . SHMOs have been largely funded by Medicaid and Medicare , along with other sources of funding

Although , differing in scope and focus in operations , one thing that 's present in a majority of SHMOs is care management , which involves assessments of chronic care needs , service authorization for its members , and even getting services and benefits that are not covered

by the plan

The report has pointed out that SHMOs are cost-efficient , with a "modest administrative cost . Yet , after years of existence , the SHMOs have a need for better policies and processes , as well as streamlining its coordination and assessment of Medicare care with community care

This will justify the existence of SHMOs , and will argue that there is a special need or benefit from it

The United States has an aging population . The Congressional Budget Office has projected that the people in nursing homes will increase by 50 from 1990 to 2010 , that number will double by 2030 , and consequently triple twenty years later . The costs associated with elderly care is rising , in the mid-1990s , the cost of nursing home care had been estimated at 46 ,000 a year , while most people needing its care have incomes that are below the poverty line (Binstock Spector , 1997 ,

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All these numbers reflect one thing : the urgent need to have SHMOs operating for the benefit of elderly people who cannot otherwise receive much-need care . While some may argue that the government has programs that offer assistance in terms of payment , SHMOs are special in the way that claims are fully-reimbursed . The patient has nothing to worry about

At this point , politicians and other people may say that the Medicare and Medicaide are spending too much money on subsidized health care Indeed , in a seven-year frame from 1987 , Medicaid and Medicare expenditures for the elderly in nursing homes increased 153 while home care expenditures increased 543 . These expenditures may result in a lower quality of care (Binstock Spector , 1997 ,

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This has not happened with SHMOs . In fact , as the report stated , SHMOs have been cost-efficient , at least in the area of administration Moreover , a 2004 study revealed that there was lower use and expenditures for patients under SHMOs while there was a greater integration of primary care (Newacheck , et . al , 2004 , Abstract

While it is difficult to merge medical and social care , it is not impossible . It may take years before the benefits are developed and the linkages are created , but we have seen successes . A case in point is the Health Plan of Nevada , a second-generation SHMO demo program , where researchers had found extensive development in the areas of geriatric services , communication and support , care coordination , while increases in room visits , day care , and respite care was observed and decreases in hospital days and discharges...