HMO plans typically require members to select a primary-care physican.
Health maintenance organizations, commonly known as HMOs, negotiate treatment costs with a network of health-care providers and typically require members to visit doctors and facilities within the network. HMOs are available from employers and to individuals; plans vary based upon model type and other factors.
Independent Practice Association
Individual private-practice doctors may contract with an independent practice association, or IPA, which acts as a middleman between the doctors and the HMO. The IPA contracts with the HMO organization, and the physicians receive a preset amount per patient or a general fee to care for members of the IPA. This is also called an open-panel model, because the doctor keeps his own office and can also see patients who aren't affiliated with the HMO.
Staff Model
When a doctor works directly for an HMO, they're part of a staff model. This means they're paid directly by the HMO organization and most likely have offices in the HMO's building. This is considered a closed-panel HMO, because the doctors can only see patients who belong to their affiliated HMO program.
Group Model
As with the IPA model, the physicians in a group model HMO are independent employees. In a group model, the doctors have their own contract with an HMO and earn a negotiated fee for every HMO program member they treat. Unlike the IPA model, the group decides how the money is distributed to the group members; it's also a closed-panel model. However, in a group model, the physicians do have oversight over medical staff and other employees, unlike in the staff model.
Network Model
The network model, or mixed model, combines more than one type of model into its plan. For example, a network model HMO may offer patients care through their staff model, as well as an option to select a doctor from an IPA. This is common with HMO groups, as it allows for more patient choice.
Tags: staff model, contract with, group model, model physicians, network model
