Which type of HMO delivers health care services through members of an independent multispecialty group practice?

Prepare for your Health Insurance Billing Exam. Utilize flashcards and multiple choice questions, each with explanations. Boost your readiness!

The group model HMO is defined by its structure in which health care services are delivered through a contract with an independent multispecialty group practice. This arrangement allows the HMO to provide a wide range of services while utilizing the specialists and facilities of the group practice. Because the independent group is made up of various providers across multiple specialties, members can receive comprehensive care easily coordinated within one organization.

This model is particularly advantageous as it can increase the efficiency of patient care and improve communication between different specialists who may be involved in a patient's treatment, thereby enhancing overall outcomes. The payment structure for this model often includes capitation, where the HMO pays the group a set fee per member regardless of the number of services provided, which incentivizes cost efficiency and preventive care.

In contrast, other options present different organizational structures. The staff model HMO employs physicians directly on their staff, while the individual practice association HMO contracts with solo practitioners or small group practices rather than a single multispecialty group. The direct contract model HMO generally works with healthcare providers directly rather than through an organized group practice, which also sets it apart from the group model HMO. Understanding these distinctions clarifies why the group model HMO is the correct choice for this scenario.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy