Abstract

This article reviews research on some of the more visible long-term care case-management sys-tems. In particular, the two generations of the Social Health Maintenance Organization (SHMO) and Program of All-Inclusive Care for the Elderly (PACE) models are described, and alternative state-level mod-els are also examined. The potential applicability of these models to rural set-tings is explored. Some elements of the SHMO and PACE programs that rely heavily on a well-developed provider infrastructure may not be applicable to rural settings. However, the models share some components that are directly applicable to rural settings, including integration of social, commu-nity-based, and medical services. The article concludes with a case study from a rural case-management model in Illinois that has evolved over time and with various rural populations. Health care in rural America has been particularly susceptible to the vola-tility of financing and delivery of services in the past two decades. Many aspects of rural areas contribute to the vulnerability of health care organiza-tions. The purpose of this article is to describe the development and imple-mentation of a rural care-management model. First, the article provides a brief overview of changes in rural health care delivery in the past twenty years, including hospitals, clinics, and managed care organizations. These changes have highlighted the continued need for development and imple-mentation of rural case-management systems, particularly with regard to coordination with medical systems. Finally, the article will describe a study