A unique social HMO for Medicare eligibles, SCAN goes beyond medical benefits and is able to offer its members access to community-based services such as transportation, housecleaning and home-delivered meals-dessert included.
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.
Bridging the Diversity Gap in Rare Disease Clinical Trials with Harsha Rajasimha of IndoUSrare
November 8th 2023Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare.
Listen
Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series.
Listen
Air Pollution May Negatively Affect Male Reproductive Health
November 30th 2023A potential mechanism by which air pollutants may affect reproductive health is by endocrine disruption. Air pollutants are made up of mixtures of particulate matter that may include endocrine disruptors, such as polycyclic aromatic hydrocarbons (PAHs) and heavy metals.
Read More
35th World AIDS Day Marks 20 Years of PEPFAR: Challenges and Strategies to Combat HIV/AIDS
November 29th 2023PEPFAR, having invested $100 billion and saved 25 million lives in the global fight against HIV/AIDS, faces Congressional hurdles in its reauthorization due to abortion debates. Despite widespread support and no evidence of abortion-related activities, the legislative process is at a standstill. Members of PEPFAR and authors of a recent editorial stress the significance of PEPFAR and advocate for integrating behavioral and social science into healthcare programs to achieve UNAIDS targets and address barriers in HIV/AIDS testing and treatment.
Read More