Independent Living

It's one of only four social HMOs in the country, and its mission centers on enabling its frail elderly population to live independently in lieu of more costly nursing homes. To get an idea of the difference the social services have made, consider some of SCAN's recent statistics, compiled in July.

The plan covers 62,000 people, and 16,000 of them, or 26%, are nursing-home-certifiable. In July, 516 people-just 0.8% of its members-were residing in nursing homes. While the average member is 77 years old, within the nursing-home-certifiable population, the average member is over 80 years old, and most of them are living independently.

"Our mission is focused on independent living in addition to healthcare," he says. "We do things that other plans don't. We're focused on the psycho-social aspect of diseases and how people live. Because we add that dimension, it changes the dynamics of what's important."

Based in Long Beach, Calif., SCAN was founded in 1977 by 12 frustrated senior citizens who felt the services available to them didn't meet their needs. They built the original Senior Care Action Network around social and community-based services they thought were necessary to maintain independent living, with the help of experts in medicine, gerontology, psychology and social service.

"The idea of staying independent at home wasn't particularly top of mind then," Schmidt says. "Then there was legislation in 1982 creating the social HMO, of which we are still technically a demonstration project."

A group of researchers from Brandeis University and the Health Care Financing Administration proposed the structure for the new social HMO that added uncovered social services to the existing Medicare HMO, which was already considered to be an improvement over fee-for-service. The goal of the social HMO project was to demonstrate that by providing the added services, the plans would help seniors avoid nursing home placement and would do so in a manner that remained budget neutral when compared with fee-for-service Medicare.