Health Maintenance Organizations (HMOs)

Distinguishing factors of HMO’s: Relationship exclusivity Risk bearing (by the physician) Financial relationship Doctors must be cost conscious Network of providers HMO = no out of network services (providers) are covered Staff model Think Kaiser Doctors are employees of the HMO Group model Plan contracts exclusively with one group of providers Network model Nonexclusive Many … Continue reading

Managed Care Overview

Managed care (most commonly PPO’s)- prearranged discount for a network of physicians Synonyms for managed care: Health plan MCO Plan HMO Managed care all the efforts to influence behavior of patients (through financial incentives to get most cost effective care) and HC providers An entity involved in both the financing and delivery of HC Managed … Continue reading