These organizations may also be involved in the management and oversight of the facilities. A risk-bearing organization with management responsibility for providing comprehensive health services, with an emphasis on preventive care, on a prepayment or capitated basis to voluntarily enrolled people in a designated population. Services are provided at an HMO-owned facility. HMOs operate as staff model programs. An HMO model in which medical services are provided through an organization that contracts with practitioners in medicine, dentistry, and other health care fields.
Patients receive primary care and access to specialists is managed.
Services are provided in private offices. Care providers are paid at a contracted rate or at a capitated rate. A term applied to a variety of direct contractual relationships between hospitals, physicians, insurers, employers, or third-party administrators for a network in which providers negotiate with group purchasers to provide health services for a defined population at a negotiated rate. The preferred providers are often subject to other stipulations regarding the monitoring of utilization and quality of care. Utilization management review Utilization review and intervention actions are a series of control techniques or processes used to identify and reduce inappropriate and unnecessary care services.