In 2000 and 2001, PDF Incorporated (now PDF, LLC), Chevy Chase, Md., prepared a policy paper on improved coordination between the fee-for-service Medicare program and community-based social services.

Many health maintenance organizations (HMOs) participating in the Medicare system have instituted processes to identify elderly patients at risk for deteriorating health and to help them access community-based social services.

Standard (non-HMO) fee-for-service Medicare historically has restricted its focus to medical care and has not developed a link to social service agencies. The principal investigator is a consultant and an author specializing in managed care.

Key Results:

• For this project, the principal investigator:
  • Interviewed HMO representatives, geriatric care professionals, and personnel from community, state, and federal agencies serving the elderly.
  • Reviewed health-care-related publications, HMO policies, and government documents, including the budget of the federal Administration on Aging (AOA).
  • Met with 20 people knowledgeable in the field to discuss his paper's first draft. That meeting was held November 3, 2000, in Washington under the auspices of the Health Insurance Reform Project, a separate RWJF-funded initiative at George Washington University in Washington, D.C. (ID#s 030390, 035292, 041223, and 041828).
• The result was a 22-page paper—Medicare and Community-Based Social Services: A Tale of Two Silos.
• A modified version of the paper has been published in Innovations: The Journal of the National Council on the Aging. In October 2000, the author briefed the American Association of Retired People's (AARP) legislative council on improving care for the chronically ill.