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What is HMO

Encyclopedia of Business Analytics and Optimization
HealthCare.Gov defines HOM as a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Published in Chapter:
New Payment Models and Big Data Analytics
Avnish Rastogi (Oracle Corp, USA)
Copyright: © 2014 |Pages: 15
DOI: 10.4018/978-1-4666-5202-6.ch145
Abstract
It has been fascinating to watch how American healthcare delivery system is going through a paradigm shift to meet new government mandates and bend the care delivery cost curve. For years, US health care system has been fragmented and falling short on quality, outcomes, costs, and lacking framework to support care continuum. According to the study conducted by National Research Council and the Institute of Medicine, for many years, US population has been dying at the younger age than population with similar characteristics in other countries such as Canada, Australia and Japan. When compared with the peer countries, US Population did worse in health areas such as drug related deaths, obesity, chronic diseases, disability, etc. (Institute of Medicine of the National Academics. 2013 in, U.S Health in International Perspective Shorter Lives, Poorer Health.)
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Billing and Review Perspectives in Healthcare
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Billing and Review Perspectives in Healthcare
Managed Care (Health Maintenance Organizations).
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