Abundant Home Healthcare Patients: A Case Study

HMO- Is the most popular of the plans and is a group of providers that provides services to subscribers with a very small or even co copay when services are rendered. There actually are various types of HMO's that link providers to create a healthcare delivery system, they are Group Model HMO, Individual Practice Association HMO, Network Model HMO, Staff Model HMO, and Open Access HMO.

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

EPO vs HMO-- EPO contracts solely with specific specialists, clinics, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses. HMO’s requires a co-payment on each visit while EPO’s have no co-pays. Both EPO’s and HMO’s keep costs low. EPO’s do not require a referral while HMO’s must confirm that specialized care is required before they will issue a referral

New England Health Maintenance Organization (HMO) is a regional not for profit managed care company that has its headquarters in Boston, MA, with over 500,000 enrollees within 25 different plans including Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. A consortium of employers has shown interest in bidding on a managed care contract to be offered to the consortium’s 75,000 employees whom are locate in and around Nashua, New Hampshire. The consortium of employers includes companies such as IBM, Ford, and Prudential Insurance.

Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs have been licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their area.

Today, there are several types of managed care plans including Preferred Provider Organizations (PPOs), HMOs, and Point-of-Service (POS) plans. There are many types of HMOs that offer members a variety of health benefits. An HMO plan requires the member to use health care providers and facilities within the HMO network in order receive coverage, unless it is an emergency (Andrews, 2014, p. 1). A PPO is a form of managed care that most resembles a fee-for-service type situation. The plan members can generally refer themselves to doctors, including doctors outside the plan, although they typically will pay a higher percentage of the cost if the doctor is out of the network (Andrews, 2014, p. 1). A POS plan allows members to refer themselves outside the HMO network and still get some coverage (Andrews, 2014, p. 1). While these

The Health Maintenance Organizations, well-known as HMO, has made healthcare a reasonably priced for numerous people here in America. What is an HMO? An HMO is an organization where the patient or subscriber is able to choose a medical provider from a list of doctors in a certain medical group. Every medical doctor has signed an agreement to see patients at a reduced rate. This kind of

Medicare is a federal health insurance program for people sixty- five or older, also there can be younger people with disabilities, and people with End-Stage Renal Disease. Medicare splits into two segments. Segment A concerns inpatient hospital, skilled nursing facility care and home health care. Once officially registered in Medicare, you will be given these benefits instantly and won’t have to pay premiums for them, because you’ve already paid for them through your taxes. Segment B concerns majority of your medically necessary doctors’ services, preventive care, durable medical equipment, etc. You will pay a monthly inducement for this coverage. Segment C concerns of Medicare policy that permits private health insurance companies to equip. HMO’s and PPO’s (Medicare private health plans) are acknowledged as Medicare Advantage Plans. You have the choice to choose Medicare Advantage Plan in place of going through Original Medicare. Segment D concerns Medicare that

HMO is an organization that provides or arranges managed care for health insurance, individual and other entities in the United States. It existed prior to the 1970s, which required employer who has 25 or more employee to offer HMO healthcare. In most of HMO plans, it required the insurers to select a primary care physician (PCP) who is responsible for all their healthcare services. If they need care from a physician specialist in the network, their primary care physician will have to provide them with a referral. If they don’t get the referral or they select to go to see a doctor outside of your HMO’s network, they will most likely have to pay all or most of the cost.

The relationship of an HMO and its physician member is to help provide a wider range health care for its patients and a wide area of services available for its physician members. A patient must choose a primary care physician from a list of providers. The relationship with the physician provided from the HMO is in a contract that is to deliver services to their patients for a fee. There can also be a group plan which is a HMOs contract with a group of physicians to deliver services. The HMO organization compared to PPOs, a PPO is a variation of an HMO, and it features traditional insurance and managed care.

A health plan is a contractual arrangement between the MCO and the members; it includes a list of covered health services to which members are entitled

Interventions provided during this service: Intensive home-based services were provided. WYP assisted the client to decrease some energies (client was physically aggressive and cannot function by following directives) by engaging in football. Client was able to relax to engage in other activitites. WYP assisted the client with pro-social behaviors while engaging in a positive activity (tag) in the community. Client was rewarded by playing tag for not kicking, playing fair, and following the rules. Client was also rewarded with a Pokemon card with no physical aggression (kicking). WYP monitored the client for any inappropriate languages. Client was not rewarded with a Pokemon card, due to use of inappropriate languages. Client was prompted

The United States being referred for specialties depends on the insurance plan (Mossialos, Wenzel, Osborn, Sarnak, 2016, pp. 171-177). Health Maintenance Organization (HMO) plans give access to certain healthcare organizations and physician within their network that have agreed to lower rates for their services. The individual must agree to these services to have services covered. All services will be coordinated by the primary care physician PCP. Medicaid coverage is also based on these principles. Preferred Provider Organization (PPO) plan have higher premiums but give more flexibility. PPO allows the individual to see any physician they choose but cost is less if the individual stays within the network. PPO does not require that the individual have a PCP. No referrals for specialist are needed.

There are currently have two main insurance options available for consumers, Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Both health insurance plans are great, but we will be focusing on the plan with lower costs in general which is Health Maintenance Insurance, or HMO. HMO is an organized system of health care that offers medical services to its members on a prepaid foundation. It combines health insurance and delivery functions in an effort to keep low costs and maximize the quality care provided. There are several types of HMOs that are available: staff model, group model, network model and individual practice association, or IPA. For the staff model, physicians are salaried and have offices in HMO