From 1994 to 1997, a project team at the University of California, Los Angeles, School of Medicine, studied the long-term care being provided to nursing home residents using different models of HMO primary care. They conducted case studies of three HMO programs covering 402 nursing home residents.

The project was part of the Robert Wood Johnson Foundation (RWJF) Chronic Care Initiatives in HMOs national program.

Key Findings: Researchers found two basic models of providing care:

• The "dedicated team" model, which relies on a cadre of four physicians whose responsibilities are limited to nursing home, hospice and home care, and who are paired with full-time nurse practitioners or physicians assistants.
• The "augmentation" model, which uses physicians who perform more conventional roles and provide primary care to nursing home residents in addition to their usual responsibilities, and whose capabilities are augmented by nurse practitioners who also provide nursing home care.

Their study of these models found:

• Total primary care visits per month were higher among HMO residents than fee-for-service residents.
• The use of the "dedicated team" approach provided more care than the other plans.
• In the plans using the "dedicated team," model nursing home residents were transferred less often to the emergency department and a smaller number of residents were hospitalized compared to fee-for-service Medicare residents in the same nursing homes.
• The plan that used the "augmentation" model had similar health care utilization compared to fee-for-service in the same homes.