CAREER PLANNING |
Finding the Right Practice
HMO Position
To determine if an HMO position is a good fit, understand the various types of HMOs and the different operational models that exist.
Physicians are employed by the HMO or serve as independent contractors to provide medical services to HMO members and beneficiaries.
What is an HMO?
An HMO, or health maintenance organization, is a type of insurance plan that operates as an organized system to provide managed care services to a set of members. It is usually one of several types of plans offered in employer-sponsored group insurance plans.
Members (or employers) pay premiums to obtain insurance coverage for certain contracted medical services offered within the benefits package and insurance plan.
PROS
regular work schedule, predictable and steady income, less administrative burden, billing and regulatory functions are managed by the HMO, convenient access to various services and specialists for patient care, predictable lifestyle with set hours, benefits
CONS
less practice autonomy, less decision-making authority, less schedule flexibility, less earning potential than private practice, variable compensation based on quality outcomes dictated by HMO clinical standards, HMO driven-decisions or policies
PRACTICE CHALLENGES
following protocol-driven practice standards
not getting reimbursed for off-protocol or non-standard treatments
accepting a lower earning potential compared with private practice physicians
less decision-making authority or control when decisions impact patient care
- Do you prefer to not have to own and manage a practice?
- Do you want a healthy work-life balance?
- Are you comfortable with following clinical standards and defined protocols?
- Do you want a predictable income and work schedule?
What are the different HMO operational models?
HMO operations vary widely and there are several types of compensation or physician reimbursement models to be considered.
STAFF MODEL
The HMO owns its own healthcare facilities and employs its own physicians to provide medical services within those facilities.
GROUP MODEL
Physicians are not employed by the HMO. However, the HMO negotiates a contract with a practice to exclusively provide services to health plan members.
NETWORK MODEL
Like the group model, physicians are not employed by the HMO. Physicians practice independently and the HMO negotiates a contract with group practices or individual physicians.
Physicians do not see the enrolled members of the HMO exclusively and will care and treat members of several different insurances or even self-pay patients.
INDEPENDENT PHYSICIAN ASSOCIATION (IPA)
Physicians practice independently without partners or employment affiliations but join an IPA and are contracted to provide services to a segment of the HMO’s enrolled members.
In this model, the HMO negotiates a contract with the IPA and the physicians, as associates of the IPA, care and treat the enrolled members of the HMO, but not exclusively.
