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Module 1 Part 3

Pharmacology

QuestionAnswer
contract with a medical center or group of physicians to provide preventative and acute care for insured HMO
what always requires a referral to a specialist HMO
what are some common HMO models IPA, staff model, group model
general or family practice that practices independently IPA
Physicians hired by HMO staff
multispecialty people with or without a gatekeeper group
what preserves the fee-for-service concept PPO
has a predetermined list of charges and is contracted with providers PPO
no capitations or prepaid care PPO
usually has deductibles and/or copays PPO
has capitaiton plans HMO
providers are paid per member, per month capitation plans
patients may not even see the provider but they are paid a fee for that month capitation plans
combines features of HMO and PPO exclusive provider organization
employers agree not to contract with any other plan exclusive provider organization
members much choose from a list of network providers exclusive provider organization
america's oldest and largest system of independent health insurers blue cross/blue shield
offers incentive contracts to healthcare providers blue cross/blue shield
federal government assists states in providing healthcare services medicaid
physicians may decide if they want to treat patients with this kind of coverage medicaid
Created by: emileekp
 

 



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