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