Models Of Managed Healthcare Organizations

Managed healthcare organizations have different models that guide their goals, performance, and day-to-day functions, among others. While there are many types of such models, some of the most commonly used are (1) Health Maintenance Organizations, (2) Preferred Provider Organizations, and (3) Exclusive Provider Organizations. First, Health Maintenance Organizations (HMOs) are organizations or corporations that provides insurance coverage for its clients, for an annual or monthly fee depending on the kind of subscription that the patient would avail. One of the main strengths of an HMO is that it directs their client to specific healthcare providers, whom are contracted by the organization to provide healthcare services. Accordingly, this allows more patients to be directed to only a specific number of physicians or providers, which also lowers the ‘premiums’ that the clients would have to pay. However, this also means that the patients would have to pay the full amount, if not higher, of any treatment conducted “out-of-network” CITATION Hay19 \l 1033 (Hayes, 2019). Nonetheless, in order to strengthen these weaknesses, other ‘sub-contrac...