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[9]Lastly, staff model HMOs generally employ their providers directly and own the facilities where care is delivered.[9]. Under this variation, an HMO enrollee is permitted to use providers (usually physicians) who are outside the HMO provider network. In contrast, the development of an IPA Model HMO or teaming with a fee-for-service medical group requires minimal capital investment since the physicians' existing private offices are to be used for serving prepaid patients. When you receive care within the HMO network, your insurance company pays for the covered service, minus your copayment or coinsurance if applicable, once youve met the deductible. Gruber LR, Shadle M, Polich CL. If public program enrollees constitute a relatively small share of most HMOs' members, then studies that attempt to understand the dynamics of HMO participation and the impacts of HMOs on the Medicare and Medicaid markets by focusing on these lines of business exclusively may produce incomplete results. What structures and policies generally result in better performance? Which of the following is NOT mentioned in the text as a reason an employee may elect medical expense coverage under a managed care plan? Older HMOs have been changing over this period in response to the growing competitiveness of the health services market. False. The close involvement of HMO management and the medical group and the fact that the medical group has no fee-for-service practice suggest that the medical group's practice style will be more consistent with the approach developed and monitored by the HMO. and transmitted securely. Under these conditions, a change in the program that resulted in increased revenues to the HMO might only be subsidizing less efficient HMOs. [10] Additional reasons contributing to the financial collapse of some HMOs include underpricing of medical services provided, mergers, and a lowered ability to cost-shift. The https:// ensures that you are connecting to the A relatively small number of studies have been done that attempt to examine the relationship between utilization controls and HMO performance and/or financial incentives and HMO performance. Of the 92 plans enrolling Medicaid beneficiaries in 1986 (Oberg and Polich, 1987): Differences exist between the organizational characteristics of HMOs that participate in Medicare and Medicaid risk contracting and those that choose not to enter these public program markets. Some examples of plan types you'll find in the Marketplace: Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency). Bethesda, MD 20894, Web Policies Health Maintenance Organization (HMO): A type of health insurance plan that usually limits . If, for example, Medicare risk contracting HMOs are losing money only on their Medicare line of business, then this fact may suggest a problem with the terms of the risk contract arrangements. If they are, then the Medicare experience is simply an additional component of the IPAs' overall experience. C. In a point of service plan, participants select at the time medical treatment is needed whether to receive treatment with in the plan's network or outside the n etwork. Managed care: Whoever has the data wins the game. 4.) C. Most plans have a co-payment for each prescription. 4.) Physicians are offered financial incentives that are intended to increase their awareness of the impact of their practice patterns on costs of care. [2]The motivation for the emergence of HMOs was a desire to align financial and care-quality incentives.
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commonly recognized types of hmos include all but: