HMO stands for Health Maintenance Organization. It is a type of organized health coverage plan that is separate from a traditional health insurance company. HMO plans can be quite structured and often require patients to use specific physicians. Members of an HMO pay a fixed amount to the company for health coverage, then the HMO pays the physicians it either employs or contracts with.
Staff Model
In a staff model, an HMO directly employs doctors and nurses who have offices in the HMO building. Members can only use a physician that works in the HMO building. This makes choosing a doctor a limited process for patients, which can be a positive or negative. On the plus side, patients need only visit one building and they do not have to choose a physician from a phone book or other random method. On the negative side, if a patient already has a physician, then becomes a member of an HMO, she will have to switch doctors. Also, if a patient is not satisfied with any of the physicians employed by the HMO, she does not have any other choices.
Network Model
The network model is the most common model HMOs use. The HMO contracts with independent physicians or a group of physicians to provide coverage for their members. By providing physicians with additional patients (HMO members), the doctors often give the HMOs special rates in return. As with the staff model, members who participate in a network model HMO must use physicians that are approved by the HMO, even though they are not direct employees. It is possible that a patient's established physician is contracted by the HMO, so when someone becomes an HMO member, she will may not have to switch doctors. If a physician does not work with an HMO, the member patient will not be covered when using that doctor. Physicians who network with HMOs can also see their own, non-member patients.
Group Model
The group model is similar to the network model in that an HMO contracts with a group of physicians to see its patients. Sometimes the group is independently formed, and other times the HMO may have formed the group. Even if the HMO forms the group, the participating physicians are not direct employees. They will often see patients who are not HMO members as well. The HMO pays the group in a lumps sum and the group decides distribute the money to each physician. As with the other HMO models, members must only use physicians approved by the HMO. The HMO will provide its members with a list of physicians they contract with.
Tags: contracts with, becomes member, becomes member will, direct employees, group physicians