Create a 1 page page paper that discusses health maintenance organizations. HMO and PPO Affiliation: HMO and list the four main models of organization.Health Maintenance Organizations are a form of managed care organizations which utilize several doctors, health care providers as well as hospitals for the employees within this HMO. This organization has four models: Staff model where the physicians are employees of the HMO and group model where doctors are not directly hired but their private practice is paid by HMO. Open-panel model with independently contracted physician treating non-HMO patients and network model which is a combination of open-panel and group model (Rosdahl & Kowalski, 2008).
Define a PPO and the major models of organization.
A Preferred Provider Organization combines managed care with the traditional insurance. This plan unlike HMO allows for the patients to go outside their health care plan. It also utilizes a network of health care specialists who are paid on a fee-for-service basis rather than prepaid. The insurer pays a small amount on doctor’s visit while the insurance pays the rest of the fee.
How do HMO and PPOs differ from each other?
HMOs only cover their patients if they visit HMO designated doctors while PPO patients have freedom of movement with partial payment covered by insurance while they pay the rest. PPOs also have a wider network of physicians and specialists than HMO as most of these physicians prefer it due to the prompt fee for service pay. On the other hand, HMOs are much cheaper than PPOs and their plans are rated more favorably by their subscribers even though nowadays PPO has more people (Rosdahl & Kowalski, 2008).
List three HMO and PPO organizations. Summarize their mission, vision
BlueCross Blue shield Michigan’s mission is to improve the healthcare of residents of Michigan and the vision is to make significant contributions to the health care in that state (Blue Cross Blue Shield, 2015).
The mission of Zinn Insurance Agency is to meet the health needs of individuals and seniors. Its vision is to continue growing the needs of the family (Zinn Insurance Agency, 2015).
Williams Insurance Agency Inc. has the vision of meeting the needs of the customers through quality care while its mission is to make a difference in the community (Williams Insurance Agency Inc., 2015).
Blue Cross Blue Shield. (2015). Blue Cross Blue Shield Blue Care Network. Retrieved from http://www.bcbsm.com/foundation/about/vision-and-mission.html
Rosdahl, C. & Kowalski, M. (2008). Textbook of Basic Nursing. New York: Lippincott Williams & Wilkins.
Williams Insurance Agency Inc. (2015). Williams Insurance Agency Inc. Retrieved from http://www.traversdownes.com/mission-statement/
Zinn Insurance Agency. (2015). Zinn Insurance Agency. Retrieved from http://www.zinninsurance.com/about-zinn-insurance.