Author Question: What are the major differences between HMO staff, group, and network ... (Read 10 times)

jparksx · **on:** Jul 12, 2018

What are the major differences between HMO staff, group, and network models?

Question 2

Name and describe the types of managed care organizations.

jazzlynnnnn · **Reply #1 on:** Jul 12, 2018

Answer to Question 1

HMO staff model: HMO entity owns the facilities and employs the health care providers. Health care providers are paid a fixed salary, and any profits go directly to the HMO.
Group model HMO: operates on a contractual basis with health care provider medical groups and facilities that provide services to members.
Network model HMO: contracts with more than one physician group, hospital, and other facilities to provide a comprehensive health care package. Health care providers may share in some of the profit or loss of the HMO according to contract terms but are not required to provide care only to the patients of a specific HMO.

Answer to Question 2

Health maintenance organizations, preferred provider organizations or networks, point of service organizations, and managed indemnity insurance plans. Health maintenance organizations arrange for or provide health services to an enrolled population; individuals pay a fixed sum of money monthly or annually. Preferred provider organizations allow the member to decide which physician they will go to, but if using a physician in the PPO, patients pay a discounted rate. Managed indemnity plan is the industry term for traditional health insurance in which the insured patient is reimbursed for expenses after the care has been given; patients pay a deductible and coinsurance fees.