Health Maintenance Organization Model

Better Essays
Various HMO models (Staff, Group, & Network)
Health Maintenance Organizations (HMO) have been around since the 20th century. They were not made to operate as they do currently in today’s world until the Health Maintenance Organization Act of 1973 set federal rules on how the operations of HMO should be conducted. HMO’s have various models, but despite the model, in each HMO, the employer pays the monthly premium for the HMO service, which reduces the overhead for employees seeking medical help. This is only the case as long as the medical help received is from a doctor or physician within the HMO. The different models of HMO’s consist of staff model, group model, and network model.
Staff model of an HMO is “the physicians and medical professionals
…show more content…
With this model the HMO “…contracts with multi-specialty medical group practice and provide all physician services to the HMO’s members. The physicians in the group are employed by the group practice and not by the HMO” (Kongstvedt, 2013). The physicians in the group model HMO also share facilities, equipment, medical records and support staff. The HMO is in charge of paying the group in bulk, and the physicians are in charge of deciding how the funds are distributed.
The other type of HMO model is the network model. This model also contains some of the characteristics of the group model. This type of HMO sets contracts with a “…combination of multi-specialty physician group practices, independent practice associations and fully independent physicians to provide medical services” (Kongstvedt, 2013). This model is currently one of the more popular and/or preferred models out all of the HMO choices.
Importance and applicability of the various levels of emergency department trauma
…show more content…
Physicians many times believed they knew what their patients needs and that they have the answers to what good patient care is for the patient. Patient- centered care though “is an understanding that patients must be asked to rate or judge their health care…” (Rickert, 2012). To put it in simple terms, patient centered care is a transition from doctors asking what’s wrong to asking what matters to the patients. The other part to patient centered care is about the relationship between healthcare providers and their patients. This type of care helps physicians determine what is important to the patient as well as the best preference of care to best help the patient. This is the important to healthcare delivery because it allows the physician to better and more accurately assess patients’ needs and properly administer a treatment or other course of action. By establishing this relationship with the patient through the patient-centered care, the patient and doctor have a more personal connection, thus creating a more trusting relationship between physician and patient. A “…lack of relationship significantly influenced her health decisions in the same way it impacts all patients” (Rickert,

Related Documents

  • Decent Essays

    It allows healthcare providers to learn from each other in different situations and they are able to observe, help and ask each other questions. All healthcare providers have responsibilities with inter-professional practice, some responsibilities include gathering correct and accurate information from the patient and other healthcare providers, giving the correct information to patients and other health care providers. Other roles include giving and receiving information from patient’s families or carers. If inter-professional practice was not used in the healthcare system it wouldn’t be an efficient system for the patient, there wouldn’t be the chance to learn from one another as healthcare providers, the health and wellbeing of the patient wouldn’t be as accurate if there were not inter-professional practice. It would be harder for healthcare providers to gain rapport and consent from the patient, as well as gaining information from colleagues and other healthcare providers.…

    • 789 Words
    • 4 Pages
    Decent Essays
  • Decent Essays

    They are responsible for outlining the rules and regulation recommended by the governing body - Ex- officio committee: This committee includes Chief of Staff, Chief Executive Officer, Chief Operating Officer or their respective designees, and the Physician Executive. They help in creating other committee in the hospital. 9. The credentialing committee does the credential verification process. This committee include the physician representative and hospital administration.…

    • 896 Words
    • 4 Pages
    Decent Essays
  • Decent Essays

    Banneh Clinic Center Administrative Policy concerning Records Leaving the Facility Units 1. PURPOSE a. The medical record is the property of the clinic center. They can be accessed for patient care, education, and research. The Medical Record Services Department is in charge of the care of the patient record.…

    • 587 Words
    • 3 Pages
    Decent Essays
  • Decent Essays

    The wording of the questions was appropriately worded in a way that patients would comprehend the questions. I thought that use of examples would have been useful to better provide constructive understanding of patient responsibilities. Medication errors interests me since this has been an occurring problem since the start of healthcare. This problem affects me as a future nurse, and it provides insight that patients can hold responsibility in this issue as well. The information provided was useful for both the patient and the caregiver.…

    • 838 Words
    • 4 Pages
    Decent Essays
  • Decent Essays

    Abstract Health Information Exchange is tremendously important in the healthcare field. It enables the opportunity for medical staff to be able to share between providers within Health Insurance Portability and Accountability Act (HIPAA) policy. Thus making hospitals become more efficient and effective with proving quality of care, but it widespread and be able to interoperate depends on patients allowing healthcare providers to be share their health records throughout the world. We must show patient they can trust facilities with their information and build a bond between the physicians and patients. Not having the bond between physicians and the patients it may result in having medical errors in their records and having patient to do a procedure…

    • 3447 Words
    • 14 Pages
    Decent Essays
  • Decent Essays

    ED In Nursing

    • 1192 Words
    • 5 Pages

    The (ED) commonly have a various range of patient population as well as being culturally diverse. The consistent care received is also congruent with helping the patient feel comfortable with the providers of care and this in turn increases the caring dynamic. Within the (ED), the case method is the utmost successful delivery care model due to the nature of the reason for visiting the hospital. In an emergency situation the stress level of the patient would rise, and if the nursing professionals caring for the patients were to alternate frequently this would increase the patient anxiety and decreasing the patient’s success of recovery. This type of delivery care model also helps with patient satisfaction, ensuring they have consistent care and the need for repeating information to the nursing staff is eliminated.…

    • 1192 Words
    • 5 Pages
    Decent Essays
  • Decent Essays

    Stakeholders In Nursing

    • 702 Words
    • 3 Pages

    The CNO is the leader of the hospital and could help in enforcing and encouraging people and help get understanding from other on the implication and the purpose on decreasing morbidity and mortality in pregnant women within the hospital. The NP believes in the concepts of the study, willingness, and ability to advance the use of EBP with other healthcare disciplines (Melnyk & Fineout-Overholt, 2014). The authors’ evidence based project involves full participation from the obstetric physician because, the project involves though assessment and medication administration and it is important that providers are aware of the impact as well as the risk involved with their patients. The final stakeholders…

    • 702 Words
    • 3 Pages
    Decent Essays
  • Decent Essays

    This is also known as the credentialing process. There are regulations and interpretive guidelines outlined for the medical staff, retrieved from §§https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf , ” Interpretive Guidelines § 482.22(2) (a) There must be a mechanism established to examine credentials of individuals perspective members (new appointments or reappointments) by medical staff. The individual’s credentials to be examined must include at…

    • 951 Words
    • 4 Pages
    Decent Essays
  • Decent Essays

    Travel Desk Case Study

    • 1025 Words
    • 5 Pages

    1. Dedicated Travel Intermediation Service: Medical tourists constitute a niche market with exclusively distinct profiles and henceforth there is plentiful scope for devoted travel agents and tour operators. 2. Travel Desk in Hospitals: Hospitals that want to sell medical tourism services should have a dedicated travel desk in the hospitals. Such a travel desk should act as a comprehensive marketing arm of the hospital with regard to medical tourism.…

    • 1025 Words
    • 5 Pages
    Decent Essays
  • Decent Essays

    In addition, Harpham adds that having an optimistic attitude and trust in family and the health care team are essential to Healthy Survivorship (Harpham 301). In terms of choosing a physician to treat an illness, Harpham states that patients need to find a doctor who will respect their values rather than someone who shares their values because values change over time (Harpham 74). This will ensure that the patient has a good working relationship with the doctor throughout the healing process. Groopman and Hartzband strive to help patients decide what is right for them;…

    • 1546 Words
    • 6 Pages
    Decent Essays