Although many HMOs operate in a diverse array of styles across a large range of facets within the medical business community, three distinct types of HMOs are commonly responsible for providing group health insurance to patients of contracted companies.
In certain cases, physicians may be on a HMO's payroll, acting as salaried employees of a specific health maintenance organization. With offices located in the same buildings as their respective HMO, group health insurance providers of this type fall into what is referred to as the "staff model," meaning that the doctors responsible for providing care for referred patients are contracted under the direct orders and specifications of the health maintenance organization that they are working for (or, in this case, with). Representative of what is called a "closed-panel" HMO, physicians contracted by this staff model type of company are only allowed to see patients receiving care from their specific HMO and are prevented from acting as practitioners to the general public.
When operating under what is known as the "group model," a HMO is not responsible for the direct employment of participating physicians, but rather, contracted with a group practice of multi-specialty physicians who are employed by a group practice. This group is contractually obligated to be the sole provider of physicians to the HMO in question, and group health insurance plans under this model will direct patients toward the specific group practice that is contracted with their respective HMO.
A sub-section of the group model known as the "captive group model" is seen when a group practice is established by a HMO itself with the sole purpose of providing only those patients who are members of the HMO with group health insurance. Alternatively, another sub-section of the group model known as the "independent group model" is used to classify those HMOs who maintain a contract with an already established, independently existing group practice. Like the "staff model", group models are also considered to be "closed panel" in nature due to the fact that the physicians operating under such models must be members of the group to participate in the HMO, which provides group health insurance using exclusively doctors within their contracted community.
In the "network model" HMO, group health insurance providers contract with multiple groups, individual doctors and independent practice associations (IPAs) who contract with HMOs but see non-HMO patients as well. This is the most commonly active model of HMO as seen throughout the last thirty years, specifically by those HMOs who run under the direction of managed care organizations, most of whom are involved in other areas of the medical business (i.e. PPOs, or Preferred Provider Organizations).
The above classifications are loose, and when contemplating group health insurance options, businesses should also consider that few HMOs fit neatly into one of the above categories. Partial attribution to the negative public opinion toward HMOs, and the intricacies behind the legal and business aspects of group health insurance plans in general, is due to the somewhat restrictive and exclusive nature of their appearance. Contractual obligations, archetypal deviance and structural variations are all prevalent factors to be considered in the realm of group health insurance. As the same logic applies to their own business as well, employers and employees should recognize that group health insurance providers, specifically HMOs, operate under the same general circumstances as any other professional outlet.
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