Health Medical Organizations’ Identifying and Comparison

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Topic: Health & Medicine
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Introduction

Improving the working conditions of medical professionals is essential for quality health care delivery. Health Medical Organizations (HMOs) operate in the health care environment to offer members services similar to those offered by insurance companies to cater for their unique needs (Taylor et al., 2010). The beneficiaries of the HMO services include health care professional and health care facilities that receive coverage pertaining health issues. HMOs act as health care financing and delivery structures that offer comprehensive health care services to member situated in a particular geographical area. For the successful implementation of HMO programs, plan providers get integrated to reach the individual enrollees under different panels (Kaplan, Provost, Froehle, & Margolis, 2012). As such, discerning the various types of HMO including the open and close panels is crucial to understand the manner in which the system operates in states like Florida. Therefore, this paper would describe the HMO panels, their similarities, and differences, and identify the advantages and disadvantages of each before explaining the HMO classification applied in the state of Florida.

Open and Close HMO Panels

Open panel HMOs operate with a web of medical practitioners who apply for the HMO’s programs on a part-time basis in their private office settings. As such, open panel HMOs permit individual physicians to take part in the program through the sponsorships of an independent practice association. Open panel HMOs include the network model and the independent group model. On the other hand, close panel HMOs comprise of a collection of physicians operating out of the HMO facility and considered as HMO employees. The existence of several physicians under the same HMO roof led to the dubbing of the close panel as ‘Doc-in-a-box” since it encloses them in the HMO’s coverage. Close panel HMOs include the staff model and the group model (Cowen & Moorhead, 2011).

Similarities and differences between the network model and the independent group model

The similarity that exists between the network model and the independent group model is that physicians in both cases could use their private offices to see and treat patients including non-members. However, the two types of open panel HMOs differ since the network model could have their offices located in the HMO-owned offices or elsewhere unlike the independent model that operates on their private premises only. Therefore, they network model allows the physicians to offer their services to both the subscribers and non-subscribers of the HMO that have contracted them (Rosenthal, Landon, Normand, Frank, & Epstein, 2006).

Similarities and differences between the staff model and the group model

As a close panel, the staff model resembles the group model since the contracted physicians operate on the premises of the HMO, serving patients subscribed to the HMO (Kaplan et al., 2012).In both models, the physicians receive payments directly or indirectly as employees contracted by the HMOs. Conversely, the staff model differs with the group model since, in the latter’s situation, the contracting HMO considers the physicians as its direct employees thereby enumerates them through their individual accounts unlike in former’s case where the doctors determine the distribution of the salaries (Cowen & Moorhead, 2011).

Advantages and Disadvantages of the Open and Close HMO panels

The open panel has various edges that benefit the subscribers and contracted physicians. Notably, the independent group model and the independent group model allow the contracted physicians to operate in premises of their choice besides offering their services to both subscribers and non-subscribers of the HMO (Berenson & Rich, 2010). Further, the open panel allows physicians from different specialties to work under the same HMO roof thereby offering equal opportunities. However, for the independent group model to get contracted by a given HMO, it has to go through an independent practice association (IPA) (Rosenthal et al., 2006).

The close panel, on the other hand, has its fair share of merits and demerits. Through the contact, the physicians are assured of regular salaries from the HMO, who regards them as their employees after seeing and treating subscribed patients. However, the open panels are disadvantaged especially in the case of the group model since conflicts could arise from the distribution of the payment to each physician (Berenson & Rich, 2010).

HMO Panel Mostly Used in the State of Florida

In the state of Florida, almost the entire HMOs provide services focused on both the open and close panels. However, the HMOs in the state have received an increase the subscriptions and coverage for the open panel owing to the increased number of physicians operating in private settings. The preference relates to the increasing need for autonomy among doctors who serve a wide array of patients including subscribers and non-subscribers to the HMO of their affiliation (Cowen & Moorhead, 2011).

Conclusion

The open panel and close panel HMOs provide important coverage services to the various physicians in the state of Florida. Therefore, physicians and patients ought to understand their unique needs to identify the HMO panel that suits them best. The advantages and disadvantages that exist in each of the HMO panels require close consideration for the physician to benefit maximally.

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