HEALTH MAINTANCE ORGANIZATION (HMO)

AVENA, MMA. CDH 412 - DGC

DEFENITION
"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."

Types of HMO
Staff Model Group Model Independent Group Model Network Model

Important things to consider in choosing an HMO

Financial Stability and Track Record of the HMO Network of Service Provider Service Assurance Mechanisms Quality Assurance Mechanisms

HMO Related to Dentistry

Dental Personnel in HMO

Four(4) basic organizational modes under which dental care can be provided in an HMO:

Staff Model - dentist, dental hygienist and dental assistants are salaried employees of the HMO. Group Model - HMO contracts directly with a group practice partnership or corporations for the provisions of dental service. Independent Practice Association (IPA) - dentist remain in their own clinic/office and treat their usual fee-for-service or other patients. Capitated Network Group or Direct Contract Model - 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 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: Any licensed dentist may choose to participate The dentist may accept or refuse the beneficiary of the plan. 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 Salary may not be as high as peak earnings in private practice.

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