MEDICARE HMOS AND HOME HEALTH-CARE - A CASE-STUDY

This article examines how HMOs provide home health care for Medicare enrollees and presents findings from a case study of a mixed group/ network HMO-"HMO-One." The research is based on 29 interviews with staff from HMO-One, three affiliated medical groups and three home care agencies, which are affiliated with HMO-One. These data are supplemented by interviews with 38 "experts" in home health care-i.e. researchers, health care providers, and governmental agents. The case analysis reveals the fluidity and vulnerability of the home care market, the diffusion of control over utilization in home care, the lack of formal mechanisms to evaluate the quality of home care, and several inefficiencies in the delivery of home care services through the HMO. This study also suggests that the exclusive focus of both HMOs and Medicare on acute care seriously limits the ability of HMOs to provide "continuity of care" to Medicare enrollees. The report concludes with recommendations for public policies: that provisions for long-term care be developed through Medicare; that training for HMOs in Medicare guidelines be mandated for HCFA intermediaries; and that appropriate mechanisms be developed for measuring and monitoring quality of care. © 1990.