The original concept was motivated by a desire to manage increasing health care costs by employers, insurance providers, and the public. It doesn’t quite seem to be working yet. Managed care groups either directly offer medical care or work with a select group of providers of health care. Depending on their own personal management types, these insurers are further subdivided. As you have had to choose between them when choosing your insurance, you can be familiar with many of these sub-types.If you’re looking for more tips, Norman Home Health Care Agencies has it for you.
Preferred Provider Organization (PPO) / Exclusive Provider Organization (EPO): This is the closet-managed care that comes with many of the same features as a Fee-for-Service arrangement such as deductibles and co-payments of the Fee-for-Service model. PPO’s & EPO’s deal with a set list of providers with whom they have negotiated set (read discounted) treatment fees (we’re all familiar with these lists). Yeah, if they continue to treat patients with these health policies, individual physicians have to charge less for their services. An EPO has a list of physicians that is smaller and more strictly regulated than a PPO, but otherwise the same. By requiring pre-authorization for several programmes and second opinions for major procedures, PPO’s control costs. All this aside, many customers think that with PPO’s they have the greatest amount of control and versatility.
Health Management Organization (HMO): HMO’s combine health care delivery with insurance. This model is not going to have deductibles, nor co-payments. In an HMO, the company employs physicians to provide treatment and either establishes its own hospital or contracts within the community for a hospital’s services. In this model, the doctor actually works for the insurance company (aka a Staff Model HMO). Kaiser Permanente is an instance of a very large HMO that we have often heard of in recent debates. Since the organisation paying the bill also offers treatment, HMO’s emphasise preventive medicine and primary care heavily (enter the Kaiser “Thrive” campaign).
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