ABSTRACT
This chapter discusses the Social Health Maintenance Organization (SHMO) model and its experience after 5 years of operation. The SHMO model for formal service delivery has been successful in delivering a wide range of formal services, including case management and long-term care services. The chapter examines the SHMOs as organizations in terms of the financing, management, enrollment, case management, and other features. The SHMOs reported good relationships with the members and caregivers with whom they were working and reported general high levels of satisfaction with the chronic care and case management services. The SHMO disenrollment rates were slightly lower than those for HMOs. The rates varied across projects, and were lower for the SHMOs sponsored by established HMOs, and higher for the SHMOs sponsored by long-term care organizations. In general, the financial losses experienced by the SHMOs were not related to the delivery of long-term care services, but rather were primarily related to acute care utilization and costs.
