 
HMO - HEALTH MAINTANENCE ORGANIZATION The HMO plans come under the managed care plan. Under the managed care plan, you would be provided with a list of practitioners where you need not pay for every visit to your doctor. But you are not provided with the freedom of selecting your own doctor outer the list provided by the HMO.• Under the HMO plan, you have to pay some amount monthly and this is called premium. The co-payments are normally asked to cover the doctors office visits, prescriptions and also hospital admissions. • If you prefer to visit any other doctor who is not listed in the HMO plans, then you would not receive the benefits of HMO. • The traditional HMO Plans do not have any models, but nowadays the health maintenance organization actually has a lot of models. Some of the models are, 1. The staff model• In staff model doctors directly work for the HMO’s. Thus the doctors are allowed to treat only HMO plan patients. The doctor gets paid by the HMO. Thus there is a direct link among the doctors and the Health maintenance organization. • In group model the HMO plan does not pay the doctor directly here, but then it pays to the group or for the team of practitioners and the group head decides how much salary to be given to particular doctor. • The above model we saw only a single group, where as in a network model there would be a combination of groups as the name suggests. • Certain extra services such as preventive care services could be obtained with no additional cost under the HMO. • The HMO provides a kind of review known as the “Utilization review”. And this review is actually analyzed according to the number of times a patient visits the prescribed doctor and the services obtained by patient from the doctor. Thus the utilization reviews largely through checks whether the patient gets the required amount of medical care from the doctor. • There are certain other services in HMO plan called as case management and disease management. In both these services patients with disease could be identified easily. The HMO plans take a lot of interest in patient care and well being. • The health maintenance organization provides coverage even for an infant or for an adopted child. The coverage for an infant starts from the time it’s born. As for an adopted child his/her coverage will begin as soon as the written document is entered. • The HMO avails its services only for any particular zone and if you prefer to be a member of the HMO then it’s necessary that you belong to the service area of the HMO. • According to the HMO, there are some kinds of medications which are termed as prescribed and these come under the drug formularies. HMO uses this service to control costs.
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