Health Management Organization Essays

Health Management Organization Essays Health Management Organization Paper Health Management Organization Paper Health Maintenance Organization is a specific type managed care organization found in USA, it sets on guidelines for doctors to operate; on average it costs less care coverage then health insurance. It provides health insurance coverage on a group basis. HMO team comprises of a group of doctors and other professionals who charge a fixed monthly rate. By law, people who take part in HMO should be provided with a basic description of the plan, including what is covered and what is not and how to appeal a decision. History HMO started in early 20th Century when businesses wanted to offer prepaid medicine to their employees and HMO offered them low prices; with the main concept in mind to reduce medical cost by offering preventive medicine. However, its use dropped drastically in the late 1960s and early 1970s. The HMO Act of 1973, passed by the U.S. Department of Health and Human Services made HMO a part of American medical universe. The HMO Act of 1973 has main provisions: 1.   Loans and grants were provided to finance HMO. 2. If HMOs were federally certified then some state restrictions were removed. 3. Employers with at least 25 employees were required by offer federally certified HMO options. It started in 1910 when mill owners provided medical care facilities to their employees for a premium of $0.5 per member per month. However, the first HMO service considered by USA is by Ross-Loss Medical Group which was established in 1929. There are several different types of HMO; the closed panel plans are the earliest plans in which the members use physicians employed by the terms and conditions of the plan or the employer; closed panel plan allow members to select physicians from a list of physicians who are accepting new patients. Closed panel plans are generally small but account for almost 20% of HMO members. Staff model, group model and network model are all closed panel plans. On the other hand, open panel plan offers more flexibility in selecting physicians around 45% of HMO members are part of open panel plan. The rest of 35% generally receive their coverage in a variety of mixed model plans: Staff Model: In this specific model physicians are given salaries and have offices in the HMO building itself. Physicians are contract employees of the HMOs and can only see HMO patients. This model is an example of closed panel HMO. Group Model: In this typical model HMO pays salaries to a group of physicians and it’s up to the group to decide on how to divide the salary amongst them. It is also a closed panel HMO. Independent Practice Association: In this typical model, physicians maintain their own office and can come in contract with independent practice association which contracts with HMO. Maintaining own office allows physicians to see non – HMO members also. It is an open panel HMO. Network Model: In this particular model; HMOs are allowed to contract with any group – independent practice associations, individual physicians and a combination of them. It is most commonly used and allows HMOs to decide on to the members of network on the basis of skill sets and cost. Benefits HMO fixed a yearly premium for its members, which were patients; the aim was to keep these members as healthy as possible as fixed premium had to pay for all illness including serious illness as well. HMO was more convenient also as people can get health care for themselves and their families at one place without the hassle of filing complaints with the insurance companies.