Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 1
Lecture:Payors in the U.S. Health Care System
Slide content:MCO Models Health Maintenance Organization (HMO) Prototype MCO Newer MCO s Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) Point of Service Plan (POS) Newer MCOs Use: Mix and match reimbursement methodologies Greater patient choice Increased costs 14
Slide notes:HMO plans were the prototype MCOs, and provided care to members during sickness, and encouraged prevention and wellness. Original HMOs used an episode of care reimbursement methodology called capitation, and limited member access only to designated plan providers. The newer models of MCOs listed on this slide developed as concerns grew that care was being withheld at the expense of patients. The new models mixed-and-matched reimbursement methodologies, permitting greater patient choice of providers, but increased the cost of care from the original HMO model. These four MCO models will be discussed in more detail later in this lecture. 14