Health Maintenance Organization

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Related to Health Maintenance Organizations: Preferred provider organizations

Health Maintenance Organization

Commonly called an HMO. A nonprofit organization that offers health insurance to a group of persons and charges members of the group the same monthly premium. Most HMOs require policyholders to have a primary physician who provides referrals for specialists and other medical services. Without these referrals, medical care generally will not be covered. This fact has made HMOs somewhat controversial. However, they generally operate at a lower out-of-pocket cost to consumers. They trace their origins to the early 20th century, but became more popular after the Health Maintenance Organization Act of 1973.
References in periodicals archive ?
The National Committee on Quality Assurance's Quality Compass shows a wide disparity among health maintenance organizations and other managed care plans on a variety of quality measures.
But the governors point out that the programs are intertwined, so that when the federal government cuts Medicare payments to hospitals and health maintenance organizations or increases premiums for Medicare beneficiaries, states incur new costs.
But some health maintenance organizations have adopted guidelines encouraging doctors to discharge mastectomy patients without overnight stays, and some experts estimate 7 percent or 8 percent of such procedures are now done on an outpatient basis.
Health maintenance organizations and insurance company representatives deny prohibiting doctors from discussing clinical information.
Humana's problems may be more severe than those of other managed-care companies: Analysts note, for example, that other health maintenance organizations have not reported the same increases in patients' use of hospitals as Humana.
The American Association of Retired Persons announced recently that it plans to endorse health maintenance organizations (HMOs) that meet its standards for quality health care, cost and member satisfaction.
Over the last 18 months, at least 34 states have outlawed or curtailed methods that many health maintenance organizations have used to shorten some types of hospital stays, discipline physicians or keep patients in the dark about the incentives and ground rules of managed care.
based in Las Vegas, is a diversified healthcare services company that operates health maintenance organizations, indemnity insurers, preferred provider organizations and a multi-specialty medical group.
In a move that could prompt millions of older Americans to join managed health plans, the American Association of Retired Persons will begin licensing its name to health maintenance organizations across the country later this year.

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