Why Consider an HMO or a Managed Care Organization?
Health maintenance organizations (HMOs) and other managed care organizations (MCOs) have demonstrated an ability to deliver quality health care services while at the same time managing the cost to employers. In concept, they are able to do this by: • Providing a full range of preventive benefits with lower out-of-pocket expenses to members. Preventive care reduces hospitalizations and saves money. • Incorporating internal quality review and management standards to ensure access to appropriate quality services. • Coordinating and controlling access to specialty and hospital care. Referrals to specialty and most hospital care must be approved by the primary care physician, often referred to as a gatekeeper. • Negotiating with physician and hospital providers to deliver care to a group of patients for a predetermined rate.
