This month’s Inc. Magazine has an interesting article about Cambridge, MA based Senior Whole Health (SWH).  Journalist Leigh Buchanan writes about how this years fastest growing private company is changing how seniors are using Medicaid and Medicare to keep themselves out of nursing homes.  While the article doesn’t talk about reverse mortgages, it caught my attention because like reverse mortgages, most of Senior Whole Health’s business takes place at the kitchen table.

Back in 1995, the state of Massachusetts began looking at what bureaucrats call “dual eligibles”.  These are seniors who qualify for both Medicare, the federal program for seniors; and Medicaid, the state and federal program for those with limited means.  Since Medicare doesn’t pay for long term care, when this group of people land in a nursing home, states are the ones left to pay most of the bill.

States hate paying for nursing homes. Seniors hate living in them. "I’ve never met anyone who wants to be in a nursing home," says State Senator Richard Moore. "They see it as the end of the road." In 2002, 10 years after Massachusetts started researching the problem, Moore championed legislation to create Senior Care Organizations, or SCOs, with the goal of keeping people in their homes or in the least restrictive setting possible. SCOs are "a wraparound service providing all the support needed to do that," Moore says.

These SCOs are a lot like traditional manager care in a sense that they work with networks of primary physicians.  They differ in three ways, according to Diane Fladers, director of coordinated care systems for the MassHealth Office of Long Term Care.

1. SCOs are funded jointly by Medicaid and Medicare and include every benefit offered by both agencies, including treatment for substance abuse, exercise programs, and transportation.
2. SCOs make nurses available by phone around the clock and arm them with a constantly updated database of enrollees’ medical records.\
3. SCOs contract with community organizations to provide clients with services, including housekeeping and family support.

Currently SWH is doing business in Massachusetts, New York, and Connecticut.  To read a copy of the article click the link below.

Managed care, the human version, at Senior Whole Health