Healthcare Organization ’s - HMO vs. PPO Angela MacLeod‚ Ifeoma Jonathan HCS-413 April 17‚ 2011 Jeffery Dodd Healthcare Organization ’s - HMO vs PPO Introduction A health care system is the organization of people‚ institutions‚ and resources to deliver health care services to meet the health needs of target populations. There are two widely known and used healthcare organizations that deliver insurance to the vast majority of the population‚ Health Maintenance Organizations (HMO)
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Running head: INFLUENCE OF HMO ’S HMO’s University of Phoenix Abstract The term Health Maintenance Organization (HMO) was developed in 1970 as part of the Nixon Administration to promote the growth of prepaid plans as a way to improve the nation’s health system. The Health Maintenance Organization has an appearance on the outside of being very appealing to those with little money to spend on insurance because it has a very low premium cost‚ but the truth be known that sometimes cheaper is
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Network Development in the Managed Care Organization To guarantee that its members receive appropriate‚ high level quality care in a cost-effective manner‚ each managed care organization (MCO) tailors its networks according to the characteristics of the providers‚ consumers‚ and competitors in a specific market. Other considerations for creating the network are the managed care organization’s own goals for quality‚ accessibility‚ cost savings‚ and member satisfaction. Strategic planning for networks
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arrangements that integrate the financing and delivery of health care. It encompasses many different arrangements with particular doctors‚ hospitals and other providers to deliver services that make up networks of health care plans. Most managed care organizations offer a wide array of benefit designs that include HMO products‚ preferred provider organizations‚ and direct access products that allow patients to self-refer to specialists. (Sekhri‚ 1997) In practice‚ there are three different big categories;
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August 27‚ 2012 Russell Arezz III Evolution of Health Care Congress adopted the Health Maintenance Organization Act in 1973 that financed start-up costs for managed care companies and mandated firms with 25 employees or more to offer traditional health insurance. These provisions were terminate in 1995‚ but by this point health maintenance organizations and other managed care organizations were established in companies around the United States. Identify the Subject Managed Care
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place managed organizations started forming to accompany the increase of the healthcare’s systems role inn society. With this need for increase individuals were forced to search for lower cost providers for preventive care needs such as routine physicals‚ mammograms‚ emergency care‚ x-rays‚ and laboratory procedures. Managed care is defined as a system that manages and controls how much healthcare services are‚ how these services are utilized and examines the performance of providers such as physicians
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(POS)‚ Preferred Provider Organization (PPO)‚ and Consumer Driven Health Plans (CDHP) (Valerius‚ Bayes‚ Newby‚ & Seggern‚ 2008). A short description and comparison is as follows: 1. Indemnity Plans-protection against loss; under this plan‚ the payer indemnifies the policy holder against medical service and procedure costs. Patients choose their own providers. The physician bills the insurance company as services are given (Valerius et al.‚ 2008). 2. Health Maintenance Organizations (HMO’s)
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insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide
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to patients. It has been introduced with an intention to avoid paying for unessential facilities and services directly to physicians. It helps in forming an intermediate between patients and physicians in such a way that health insurance organizations pay the physicians from the premiums paid by patients to insurers for the services provided. This helps in monitoring how cost effectively the services are utilized. It is not to be mistaken as health care delivery at discounted prices. It’s
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PPO Versus CDHP October‚ 20‚ 2013 PPO Versus CDHP Preferred provider organizations (PPOs) are a private plan which is the most popular‚ followed by health maintenance organizations (HMOs). PPOs sometimes pay participating providers based on a discount from their physician fee schedules which is called a discounted fee-for-service. With a PPO the patient pays annual premiums and often a deductible. The patient has two choices with the first being offered a low deductible with a higher premium
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