Question

No duplicate please. What regulatory agencies or organizations govern HMO's? Describe the different aspects of their governance.

Answer 1

Ans) The Health Maintenance Organization (HMO) Act provides that HMO's or health service plans are regulated by the states.

- Health maintenance organization (HMO) – a health system providing insurance and service to enrolled members. The traditional group model HMO is based on the prepaid group practice in which the HMO employs or contracts with physician groups to provide comprehensive care. Payment is on a capitation payment basis to enrolled members, usually in health centers operated by the HMO and in hospitals owned or contracted with the HMO.

- Group HMOs may be partnerships that share in the incentive payments. Staff model HMOs are plans which employ physicians and other providers in HMO-owned facilities. Network model HMOs contract with multiple physician groups including single or multi-specialty medical groups.