An
HMO is a health care system that assumes or shares both the financial
risks and the delivery risks associated with providing comprehensive
medical services to a voluntarily enrolled population in a particular
geographic area, usually in return for a fixed, prepaid fee. Pure HMO
enrollees use only the prepaid capitated health services of the HMO panel
of medical care providers. Open-ended HMO enrollees use the prepaid HMO
health services but, in addition may receive medical care from providers
who are not part of the HMO panel. There is usually a substantial
deductible, copayment, or coinsurance associated with use of nonpanel
providers. Group
Model HMO
An HMO that contracts with a single multi-specialty medical group to
provide care to the HMO's membership. The group practice may work
exclusively with the HMO, or it may provide services to non-HMO patients
as well. The HMO pays the medical group a negotiated per capita rate,
which the group distributes among its physicians, usually on a salaried
basis. Staff
Model HMO
A type of closed-panel HMO (where patients can receive services only
through a limited number of providers) in which physicians are employees
of the HMO. The providers see members in the HMO's own facilities. Network
Model HMO
An HMO model that contracts with multiple physician groups to provide
services to HMO members; may involve large single and multi-specialty
groups. Individual Practice
Association (IPA) A type of
healthcare provider organization composed of a group of independent
practicing physicians who maintain their own offices and band together for
the purpose of contracting their services to HMOs, PPOs (preferred
provider organizations), and insurance companies. An IPA may contract with
and provide services to both HMO and non-HMO plan participants. MixedAn
HMO that combines features of more than one HMO model.