Institute: ONC | Component: 1 | Unit: 4 | Lecture: d | Slide: 17
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:HMO Models Lowest cost Various types: Staff model Group model Open-group model Independent physician association (IPA) Network model Mixed model Reimbursement to HMO providers only 17
Slide notes:HMOs represent the lowest cost managed care organization. There are various types of HMOs, with the differences depending mainly on the working arrangement providers have with the organization. In a staff model HMO, the physicians are salaried employees. They see only patients who are enrolled in that HMO, and they see patients in a clinic operated by the HMO. In a group model HMO, the physicians are employed by an independent, physician-owned group practice, and the HMO contracts with them for services. In this arrangement, HMO patients are the bulk of a physicians business, and again, patients are seen in a clinic run by the HMO. In an open-group HMO, the organization contracts with individual physicians, who are free to contract with multiple plans. Patients are often seen in a clinic operated by the HMO. In an independent physician association, or IPA, the HMO contracts with physicians who are organized into a group such as a corporation, partnership, or foundation. The physicians retain their independence to see other patients, and they see patients in their own offices, not a clinic operated by the HMO. The IPA model is now used in the majority of HMO plans. In a network model, the HMO contracts with multiple independent physicians, group practices, and/or IPAs. In a mixed model, the HMO is a mix and match of any of the above models. Reimbursement is made only to providers within the HMO. No reimbursement is available for health care services from providers outside the HMO. 17