Comprehensive care C. cost control D. all of above. The result of these trends is that for-profit HMOs are now the majority in the industry. Physician decision making: Effects of HMO model type and characteristics of medical practice on utilization. This is of particular concern as the Health Care Financing Administration considers the further expansion of managed care options available to Medicare and Medicaid beneficiaries. Chapter 11 & 12 Managed Care Plans: Intro. and HMOs - Chegg A Synthesis of research findings on the operations and performance of health maintenance organizations. A primary method HMOs use to achieve these goals is to coordinate health services and care provided to patients. Most often the medical group was serving the HMO membership exclusively and was paid on a capitation basis for providing its services. Generally speaking, HMOs are cheaper than other types of plans, including PPO and EPO health insurance. HMOs provide medical care for their patients for a prepaid fee. Christianson JB, Wholey DR, Sanchez SM. in the 1980's and 1990's managed care grew rapidly while traditional indemnity health insurance declined. Accountable care organizations (ACOs), including the similar concept of clinically integrated organizations (CIOs), represent one such innovation in the managed care space. they often have pre-certification requirements for many types of hospitalizations, outpatient procedures, and medical supplies. 65 percent were federally qualified compared with 57 percent of all HMOs. Concurrent utilization review (51 percent). Bethesda, MD 20894, Web Policies GHAA (1989) reports higher average premiums in federally qualified plans but somewhat lower rates of increase in premiums from 1987 to 1988. However, the decline in funding for HMO start-up loans from the Federal Government and the competitive disadvantage of community rating and mandatory benefit packages have caused Federal qualification to be perceived as less desirable over time. These results suggest that financial incentives are related to physician decisionmaking and to overall HMO performance. Elizabeth Rivelli is a freelance writer who covers various insurance topics. GHAA (1988) reports that among all HMOs that responded to their 1987 annual survey, the distribution of utilization management activities included: By contrast, Langwell, Carlton, and Swearingen (1989) report that PPOs responding to a survey of interest in Medicare contracting indicated that PPO utilization management activities included: A recent study by Nelson et al. Despite (or perhaps because of) the rapid changes occurring in HMO model types over the past 15 years, it is difficult to document the current mix of HMOs by model. 3.) Adm. Care Flashcards | Quizlet Physician education and feedback on practice patterns compared with those of other physicians in the HMO and market area are ongoing activities in many HMOs (. In this section, each organizational issue is examined, followed by a discussion of the relationship between organizational structure and performance. When using these physicians, the HMO enrollee is subject to traditional insurance arrangements, including possibly a deductible and coinsurance of some fixed percentage. Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. Some doctors choose not to take HMOs at their practice for administrative or financial reasons. The many diverse HMO structures and the mixture of these elements of managed care systems make it exceedingly difficult to disentangle the effects of utilization management methods, provider selection, and financial incentives to determine which specific mechanisms are most effective. FOIA If youre someone who visits the doctor frequently, you may find that an HMO doesnt offer enough coverage for your needs. 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. An HMO typically only covers medical services received from in-network healthcare providers and facilities. The term "moral hazar " refers to which of the following? Which of the following statements concerning prescription drug plans is correct?
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