Health Insurance Articles
Group Practice HMOs And How They Affect Healthcare Coverage
2010-05-05
Healthcare coverage options for Americans are already many and varied, and may become even more diverse in the next few years. Despite many of the new options which have surfaced in the last decade, one of the most common types of health coverage plans used by Americans are health management organizations, or HMOs. These come in a variety of shapes, sizes, and coverage levels, and offer a wide range of services. Group practice HMOs, which employ an affiliated amalgam of physicians, have become more common recently, as they typically offer more freedom and accountability than traditional staff model HMOs.
A staff model HMO is one in which all physicians are directly employed by the HMO itself and work out of HMO leased buildings and offices. This model is closed by nature, meaning that the providers will only see patients who are in their HMO. Group practice HMOs, meanwhile, operate slightly differently. There are two distinct types of group HMOs, the captive group model, and the independent group model. The captive group model is one in which the physician group is recruited and solidified by the HMO itself. This group is usually diverse, containing not only GPs, but specialists of every stripe. A captive group HMO will also be closed and serve only those who are members of the HMO.
An independent group HMO, meanwhile, is one in which a pre-existing group of doctors have been approached by the HMO company and asked to act as contractors. Again, this type of group will include a broad range of specialists and doctors, but will often treat patients who are outside the HMO, as the doctors are not directly in the employ of the HMO itself. Both types of group coverage tend to offer a better patient experience, as the doctor group retains some of its independence and has more control over patient care and treatment. It is important to note that all types of group HMOs are still considered to be "closed panel" as no physician from outside the group can participate in it or in any of their discussions. The closed nature of HMOs at any level has always been one of their largest drawbacks.
For those interested in finding HMO healthcare coverage that offers more flexibility, as well as more independent physicians, a group HMO plan may be the way to go. With several options available, patients can choose the one that best suits their health needs, as well as balancing cost, time and physician availability. While it can be difficult to tell initially what type of HMO structure is being used, a few well-placed calls to a company representative should be able to clear up any concerns.
