Match the term with the appropriate definition or description:
-An organization that provides a wide range of comprehensive health care services for a specified group of subscribers for a fixed, prenegotiated, periodic rate, normally a PMPM capitation rate

Question

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HMO stands for Health Maintenance Organization, which is described as an organization that provides a wide range of comprehensive health care services for a specified group of subscribers for a fixed, prenegotiated, periodic rate, normally a PMPM capitation rate.

Answer: L
 PMPM stands for Per Member Per Month, which is the periodic rate that subscribers pay to a health maintenance organization (HMO) for a fixed set of comprehensive health care services.

Answer: O
 Capitation is a method of payment used by HMOs and other managed care organizations, in which providers receive a fixed amount of compensation per patient, regardless of the amount of services provided to that patient.

Answer: H
 Managed care refers to a system of healthcare delivery that seeks to control costs and improve quality by managing access to, and utilization of, healthcare services. Managed care organizations (MCOs), such as HMOs, use a variety of tools and techniques to achieve this goal, including capitation, utilization review, and disease management programs.

Answer: G
 Kaiser Permanente is one of the largest and best-known HMOs in the United States. It was founded in 1945 and currently serves more than 12 million members in eight states and the District of Columbia. Kaiser Permanente operates a unique integrated delivery system (IDS), which includes its own hospitals, medical centers, and physicians.

Answer: D
 The HMO Act of 1973 was a federal law that encouraged the growth of health maintenance organizations (HMOs) by providing grants and loans to help establish new HMOs, and by requiring employers with more than 25 employees to offer a federally qualified HMO as an option in their health benefit packages.

Answer: A
 Closed panel refers to a type of HMO in which the provider network is limited to a specific group of physicians and hospitals. Members are required to choose a primary care physician (PCP) from within the network, and are only allowed to see specialists or receive services outside of the network with prior approval from their PCP or the HMO.

Answer: B
 Gatekeeper refers to the role of the primary care physician (PCP) in an HMO or other managed care organization. The PCP serves as the "gatekeeper" to specialty care and other services, and is responsible for coordinating and managing the member's care within the network.

Answer: C
 Group model HMO is a type of HMO in which the HMO contracts with a single medical group to provide all of the healthcare services for its members. The medical group in turn contracts with individual physicians to provide care to the members. This model allows for greater coordination and integration of care, but also raises concerns about potential conflicts of interest and lack of competition among providers.

Answer: E
 Independent practice association (IPA) is a type of HMO in which the HMO contracts with a network of independent physician practices rather than a single medical group. This allows for greater flexibility and competition among providers, but can also make coordination of care more challenging.

Answer: F
 Integrated delivery system (IDS) is a healthcare delivery model that seeks to provide comprehensive and coordinated care to patients across the continuum of care. An IDS typically includes its own hospitals, medical centers, and physicians, and may also include post-acute care providers, home health agencies, and other healthcare providers. The goal of an IDS is to improve quality of care, reduce costs, and enhance patient satisfaction.

Answer: N
 Staff model HMO is a type of HMO in which the HMO employs its own physicians and other healthcare providers, who work exclusively for the HMO and provide care to its members. This model allows for greater control and integration of care, but can also be more expensive to operate than other models.

Answer: J
 Network model HMO is a type of HMO in which the HMO contracts with a network of individual physicians and hospitals rather than a single medical group. Members are required to choose a primary care physician (PCP) from within the network, and can see specialists or receive services outside of the network with prior approval from their PCP or the HMO.

Answer: K
 Open panel refers to a type of HMO in which members are allowed to see any provider they choose, regardless of whether or not the provider is within the HMO's network. This model is less common than closed or network models, and may be more expensive for both the HMO and the member.

Answer: I
 Managed indemnity plans are a type of managed care plan that combines elements of both traditional fee-for-service insurance and managed care. Under a managed indemnity plan, members are typically allowed to see any provider they choose, but may be subject to utilization review and other managed care techniques to control costs and improve quality of care.

Answer: P
 Physician hospital organization (PHO) is a type of integrated delivery system (IDS) that combines the resources of a hospital or group of hospitals with a network of physician practices. The goal of a PHO is to provide coordinated and comprehensive care to patients across the continuum of care, while also improving the financial performance of both physicians and hospitals.

Match the Term with the Appropriate Definition or Description