Health Maintenance Organization Analysis

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Health Maintenance Organization (HMO) There are four basic types of managed care plans that fall under the umbrella of a Managed Care Organization. The first type is a Health Maintenance Organization (HMO). An HMO is the most common type of MCO and it mainly focuses on wellness (Stark 2014). HMOs contract with different health care providers who become part of a network that provides health services to HMO patient members at a fixed, prepaid fee regardless of actual medical costs or the amount of times they are seen in the office (Stark 2014). In return, the HMO guarantees a steady flow of patients to the providers. The major goal of HMOs is to provide quality health care while reducing health care costs and administrative complications (Stark…show more content…
The first is the staff model. In this type of HMO, physicians are directly employed by the organization on a salary basis (2013). Since medical care is not reimbursed in a fee-for-service basis, physicians have very little personal financial incentives to over utilize medical service (2013). Then there is a group model. This type of HMO provides physicians services by contracting with group practice. Normally the group is compensated on a capitation basis. As a result, physicians in the group face a strong disincentive to over utilize medical services (2013). Next is the Network model. The only difference in between the group model and the network model is that in the network model, the HMO contracts with more than one group practice for physician services (2013). Also, similar to the group model, compensation is generally on a capitation basis. Finally, there is the Individual Practice Association (IPA) model. This form of HMO contracts with a number of independent physicians from various types of practice settings for medical services. In this situation, physicians generally provide care in a traditional office setting and are normally compensated in a fee-for-service basis, but at a discounted rate. In return, the HMO promises a large and continuous volume of patients…show more content…
The designation of POS refers to the fact that the amount of co-payment an insured pay is dependent upon the “point of service.” If an insured member goes outside of the plan network to receive care, the co-payment is higher, as network providers have agreed to accept a discounted rate for services in return for patient volume and patient
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