Types of Managed Care Organizations 

Define and explain the following:

• Health Maintenance Organization (HMO): This is a type of managed care health insurance plan that provides health services through a network of doctors, hospitals, and other healthcare providers. HMOs typically focus on preventive care and aim to control costs by limiting coverage to care provided within the network.  It can require referrals from a primary care physician (PCP for specialist visits, and often using a gatekeeper model to manage treatments and referrals. 

  • Staff model: It delivers health services to physicians who the HMO employs.

  • Group model: A contract that works with a single multispecialty medical group. It provides care to its members. 

  • Network Model: A contract with multiple physician groups to provide services to members. 

  • Independent Practice Association (IPA) Model: It is a business that helps independent healthcare providers. 

• Preferred Provider Organization (PPO): a health insurance plan that connects with a network of medical providers to offer health care services at a lower rate to its members.

• Point-of-Service Plan: a health insurance plan that allows you to pay less when you use in-network providers. It also allows you to use out-of-network providers but for a higher pay.