Managed Care Research

Improved Essays
According to Henderson, “Managed care is a term used to describe any number of contractual arrangements that integrate the financing and delivery of medical care” (Henderson, 2012). There are three common types of managed care plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point-of-Service (POS) Plans. One of the key advantages of managed care plans is, they use of a variety of physicians and specialists in the provider network.
Health Maintenance Organizations (HMOs) are health care plans that negotiate with providers and facilities to provide services at a discounted rate. They provide medical care from an approved network of hospitals, doctors and pharmacies. In this plan, the patient pays
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In a Group Model HMO, the physicians are not paid directly, the payments are made to the group. According to Henderson a Group model HMO is a group of physicians that agrees to provide medical care to a defined patient group in return for fixed per captia payment or for discounted fees (Henderson, 2012). Within this group, they decide how to distribute the money to individual physicians. On the other hand, a staff model HMO is a managed care organization that serves as both payer and provider, owns its own facilities, and employs its own physicians (Henderson, 2012). Within a Staff Model HMO, the physicians are direct employees and salaried by the Health Maintenance Organization, for example, a group of physicians often practice within the same building or clinic. However, in a network Model HMO, an HMO works with any combination of physician groups and hospitals. Nevertheless, the Independent Practice association (IPA) is an organized group of healthcare providers that offers medical services to a specified group of enrollees of a health plan. (Henderson, 2012) . IPA contracts with independent doctors, some will call this doctor the neighborhood doctor, and they solely work by …show more content…
With Point-of-Service (POS) plans, you will not pay a deductible provided by the specific network in which you select; However, you do pay a small amount for each visit made. What is the enrollee costs if they go outside of the network? After reading and comparing all of the manage health plans, POS insurance policies are similar to HMOs but offer an abundance of

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