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Health Maintenance Organization (HMO) -An organization that provides health coverage with providers under contract.

-A plan for comprehensive health services, prepaid by an individual or by a company for its employees, that provides treatment, preventive care, and hospitalization to each participating member in a central health center. Types of HMOs: 1. Staff Model - Physicians are salaried and have offices in HMO buildings. In this case, physicians are direct employees of the HMOs. 2. Group Model - he HMO does not employ the physicians directly, but contracts with a multi-specialty physician group practice. Individual physicians are employed by the group practice, rather than by the HMO. The group practice may be established by the HMO and only serve HMO members ("captive group model"). 3. Independent Group Model - An HMO may also contract with an existing, independent group practice which will generally continue to treat non-HMO patients. 4. Network Model - an HMO will contract with any combination of groups, IPAs (Independent Practice Associations), and individual physicians. Important things to consider in choosing an HMO a. Financial Stability and Track Record of the HMO - it should be able to meet its obligations to its service providers and suppliers promptly so they will likewise be encourage to render quality service to the HMO's members. b. Network of Service Provider - the HMO should have a vast network of reliable and first rate service providers so it would be very convenient to you to avail your benefits. c. Service Assurance Mechanisms - the HMO must have a dependable support system that will assist you whenever you need it. There should be a 24/7 Customer Service Hotline to handle any emergency concern, a Liaison Officer/Hospital Coordinator to help you while you are confined and also Account Officers that you can turn to whenever you have inquiries or concerns regarding your program d. Quality Assurance Mechanisms - the HMO must ensure that its members are receiving excellent and proper care. HMO Related to Dentistry HMO was intended to provide an acceptable alternative to the fee-for-service payment system and to help restrain the cost of care. Definition: "A legal entity which provides prescribed range of health service to each individual who has enrolled in the organization in return for a prepaid, fixed and uniform payment." HMO has five (5) essential elements: 1. A managing organization 2. A delivery system 3. An enrolled population 4. A benefit package 5. A system of financing and prepayment HMO's use a prepaid capitation system of financing medical services.

Dental Personnel in HMO There are four(4) basic organizational modes under which dental care can be provided in an HMO: 1. Staff Model - dentist, dental hygienist and dental assistants are salaried employees of the HMO. 2. Group Model - HMO contracts directly with a group practice partnership or corporations for the provisions of dental service. 3. Independent Practice Association (IPA) - dentist remain in their own clinic/office and treat their usual fee-for-service or other patients. The IPA's receives it's capitation premium from the HMO in turn reimburses the individual dentist on a capitation basis or a modified fee-for-service basis. 4. Capitated Network Group or Direct Contract Model - it is similar to IPA except that HMO contracts directly with the individual providers for provision of service. Capitation Plan ADA defines it as a dental benefit program in which a dentist/s contract with the program's sponsor administrator to provide all or most of the dental services covered under the program to subscribers in return for a payment on a per capita basis. Capitation Fee - is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment , regardless of whether the participant is he plan receives care or not. Closed Panel - is defined by the ADA as existing when patients eligible to receive benefits can receive them only, if services are provided by dentists who have signed an agreement with the benefits plan. Purest form of closed panel is a practice set up by a union for the treatment of the union's members and staff by salaried dentists who treat only the union group and their dependents. Open Panel is characterized by three(3) features: 1. Any licensed dentist may choose to participate 2. The dentist may accept or refuse the beneficiary of the plan. 3. The beneficiary my receive treatment from among all licensed dentists. Salary Dentists are paid salary in some group practices (especially on closed panel) e.g. Those employed by public agencies or in armed forces. Advantages 1. An immediate reasonably good salary. 2. Fringe benefits such as health disability insurance and liability coverage. 3. Retirement plan. 4. Paid vacation time. 5. Freedom from overhead cost and day to day worries of a private practice. 6. A chance to improve clinical experience and speed.

Disadvantage 1. Salary may not be as high as peak earnings in private practice. References: http://www.investopedia.com/terms/h/hmo.asp http://dictionary.reference.com/browse/health+maintenance+organization http://en.wikipedia.org/wiki/Health_maintenance_organization http://philcare.com.ph/FAQ.php#q2 CM Marya A Textbook of Public Health Dentistry Chapter 18: Finance in Dentistry pp 222-223.

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