HMO health care is a common type of health care that is offered throughout the United States. Directly related to a Managed Care Organization (MC), HMO health care is generally supplied by companies with more than 25 employees. HMOs differ from other health care plans due to the fact that all doctors and specialists seen by an HMO patient must agree to specific terms set forth by the HMO.
There are various forms of HMO health care plans in operation. Staff models, group models, and network models are all part of the larger HMO health care category, yet the specifics of each plan differ drastically. Staff models include physicians that work exclusively with an HMO provider. Group model HMO plans are not directly linked to individual physicians, but they are linked to a team of specialized HMO physicians. Network models allow HMO patients to contact any group, individual medical professional, or IPA (Independent Practice Association).
Almost all HMO members are required to select one primary care physician (PCP). These individuals usually consist of interns, general practitioners, pediatricians, or family doctors that act as a main source for all medical referrals. In order for an HMO patient to seek specialized medical attention, they must first consult with their chosen PCP.
In turn, this selected individual will then refer a patient to a specialist according to specific HMO guidelines. Some HMOs also offer a form of preventative care in lieu of specialized care with the goal of preventing a serious illness from occurring. A PCP does not need to be contacted if the HMO patient is in instant need of emergency medical attention.
Many HMO health care providers also conduct regular utilization reviews. These reviews exist to ensure that all primary care physicians are constantly and consistently abiding by HMO guidelines. This system ensures that all primary care physicians are performing the same services and tasks when it comes to HMO patients.
HMO patients that have a serious illness, such as diabetes, cancer, or asthma, may be assigned a specific case manager. In this instance, a case manager will monitor an individual in order to ensure that a specific medical condition does not worsen. Case managers also check with all medical professionals associated with an HMO patient.
HMO health care laws and plans can vary from state to state. Some states have strict guidelines that all HMOs must follow, while other states do not attempt to regulate HMO plans in any manner.