(+.) Physicians in a network model HMO might be members of one group or two or more groups that contract to provide services for a monthly fee.
The first two features are typical of staff or group model MCOs but rare in other MCO models (e.g., network model HMOs) that dominate the MCO market (5).
* Network Model HMO
- An HMO contracts with several physician groups and physicians that may share in savings but also may provide care to other patients who are non-HMO members.
The Association of University Physicians, the medical practice plan affiliated with the University of Washington, is a participating medical group in a capitation-based network model HMO
. Enrollees in this HMO are assigned to a primary care provider who acts as a "case manager" overseeing the health care of those patients.
Similarly, IPA (Independent Practice Association) and network model HMOs
are likely to have higher demand prices than group or staff model HMOs.
That pattern does not hold as well for group and network model HMOs
, where 11 to 32 percent of the rural classification counties are included in service areas.
IPAs, network model HMOs
, mixed-model HMOs, and point-of-service (POS) plans were combined into one category (mixed HMO/IPA/POS plans).
In addition, GHAA, AMCRA, and InterStudy also include a category for Network Model HMOs, which are defined as those that contract with two or more fee-for-service group practices to provide medical services.
Conversely, fee-for-service medical groups that contract with the Group Model and Network Model HMOs have fee-for-service patients as well as prepaid patients and, therefore, may have a different practice style that is less likely to be consistent with the HMO's approach.