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Defining Terms and Concepts
By Staff Writers
An HMO is a legal corporation that offers health insurance and medical care. It is a health care delivery system that provides comprehensive services for subscribing members in a particular geographic area. Most HMO care is provided through a managed network made up of MD/DOs, hospitals, and other allopathic/osteopathic professionals selected by the HMO. HMO enrollees are required to obtain care from this network of providers in order for their care to be covered, except in cases of emergency. All the care the members may need is paid for by the single monthly fee, plus nominal co-payments. HMOs typically offer a range of health care services at a fixed price (capitation).
Different Types
The types of HMOs are:
1. STAFF MODEL: Organization owns its clinics and employs its doctors.
2. GROUP MODEL: Contract with medical groups for services.
3. INDEPENDENT PHYSICIAN ASSOCIATION (IPA) MODEL: IPA contract that in turn contracts with individual physicians.
4. DIRECT CONTRACT or NETWORK MODEL: Contracts directly with individual physicians.
5. MIXED MODEL: Members get options ranging from staff to IPA models.
6. OPEN-PANEL MODEL: A managed care plan or HMO where members can see any provider for an extra premium cost.
Assessment
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Conclusion
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Filed under: "Ask-an-Advisor", Book Reviews, Career Development, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care | Tagged: david marcinko, Dctionary of Health Insurance and Managed Care, DDS, DO, DPM, Group Model HMO, health maintenance organization, HMO, hope hetico, IPA, Managed Care, MD, medical network, mixed model HMO, open panel HMO, staf model HMO, www.healthdictionaryseries.com |
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I think it’s a misnomer to state that “all the care the members may need is paid for by the single monthly fee …” In too many cases it’s paid for if the HMO feels it was needed.
Lynn Kanzer
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