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Topic: HMOs

	HMOs
		Houses that are in multiple occupation (HMOs) are defined as houses that are not occupied by a single household.
		HMOs are not occupied in the same manner as a house occupied by a single family and there is often a need for the provision of additional bathroom and kitchen facilities.
		In addition, HMOs have proved to be at greater risk from damage by fire and for this reason additional fire precautions such as fire doors and smoke alarms are normally fitted tp protect people living there.
	www.eastleigh.gov.uk /ebc-2060 (446 words)

	Financial Guide: HMOs: How To Choose—And Deal With Them
		On the positive side, HMOs can be very convenient, since you can go a long time without filling out a claim form; and you will probably pay a lot less for your health care than you would under a traditional fee-for-service plan.
		HMO guidelines do not usually allow for approval of payment for procedures that are not approved by the Food and Drug Administration (FDA).
		One problem encountered by HMO patients is that primary care doctors, who may be under pressure to keep referrals low, perform procedures that would be better done by specialists.
	www.gofso.com /Premium/LE/07_le_cp/fg/fg-HMO.html (1463 words)

	HMOs and Rural California
		As the data reported by HMOs and shown in Figure 1 indicate, as of May 2002, about 37 percent of California's rural counties (11) no longer have any HMO that provides services to the county on a countywide basis.
		The HMOs indicate that they have withdrawn from participation in Medicare+Choice because of what they consider to be low federal payment rates that inadequately compensate them for increases in the cost of prescription drugs that are often a key component of the coverage they provide.
		The state may inadvertently be undercutting efforts to encourage HMO coverage in rural communities by operating its own major health assistance programs in rural areas on a fee-for-service basis instead of as managed-care programs.
	www.lao.ca.gov /2002/hmos_rural_ca/8-02_hmos_rural_ca.html (7836 words)

	NurseWeek: Squeeze play: HMOs faced with profit losses, tight finances
		HMOs, heralded as saviors of health care and a means of providing quality preventive care to millions at rock-bottom prices when they first took off in the mid-’80s, are now seen by many industry watchers as a victim of their own success.
		The total stock value of HMOs grew from $3.3 billion in January 1987 to $38.9 billion at the end of 1997, a nearly 12-fold increase, according to the foundation.
		Bianco said HMOs seem to be running out of places to trim fat from the system and said consumers and healthcare professionals need to remain vigilant to ensure the quality of patient care.
	www.nurseweek.com /features/99-4/HMO.html (1710 words)

	HMOs Skip a Beat
		HMOs were supposed to be the answer to runaway increases in health care costs of the 1980s, and they’ve been delivering on that promise.
		HMOs are expected to continue to gain size and economies of scale through mergers and acquisitions.
		Rossiter says some HMOs are turning to a "demand management" approach, which builds on consumers’ increasing interest in taking charge of their own health care.
	www.gatewayva.com /biz/virginiabusiness/magazine/yr2000/mar00/hmos.html (1920 words)

	About HMOs, Benefits, Human Resources, Northwestern University
		HMOs take an active interest in helping their members stay healthy, not simply treating them once they become ill, as conventional health plans do.
		Because HMOs direct a high volume of business to providers within a network, providers are able to offer HMOs lower prices for their services.
		In addition, HMOs' emphasis on preventive care means members are covered for a broader range of health services than are persons with ordinary insurance.
	www.northwestern.edu /hr/benefits/plans/health/faq/hmos.html (709 words)

	HMOS - Wikipedia, the free encyclopedia
		HMOS, high-performance n-channel MOS, uses n-type metal-oxide-semiconductor field effect transistors (MOSFETs) to implement logic gates and other digital circuits.
		It is based on NMOS technology, achieving higher speed at the cost of greater power consumption.
		HMOS was obsoleted by CMOS in the 1980s.
	en.wikipedia.org /wiki/HMOS (75 words)

	Inter-Generations: HMOs ~ Health Maintenance Organizations
		HMOs take an interest in helping their members stay healthy, not simply paying for treatment once they become ill, as conventional health plans do.
		HMOs pay for treatment in a hospital emergency room in the case of emergencies such as a serious injury or the onset of life-threatening medical conditions.
		This practice allows HMO patients to be treated in the most appropriate setting by doctors who are familiar with their medical histories.
	www.intergens.com /hmo_faq.html (1089 words)

	Medicare and Droppage by HMOs
		HMOs dropped 407,000 Medicare beneficiaries in 1999; 327,000 in 2000; 933,000 in 2001; 536,000 in 2002 and 198,000 in 2003.
		HMO executives claim that the reason for the discontinuance is because of inadequate payments made to them under the Medicare program.
		As an inducement to the HMO to sign up members, the HMO would be granted the option of increasing the group's premium by a percentage tied into to the medical rate of increased cost plus a slight premium.
	www.therubins.com /medicare/droppage2.htm (3626 words)

	HMOs - Illinois Division of Insurance
		An HMO may operate only in certain counties and zip codes called a "service area." It is important that you live within your HMO's service area since you must travel there for all medical treatment.
		If you travel a lot, are outside the HMO service area for long periods of time, or have a child attending college outside the service area, an HMO may not be the best choice for you.
		Your HMO may require you to notify it of the birth and pay a premium to have coverage for your newborn.
	www.idfpr.com /DOI/HealthInsurance/HMOs.asp (1642 words)

	Health maintenance organization - Wikipedia, the free encyclopedia
		A health maintenance organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States and Switzerland that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.
		HMOs often provide preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition that would require a great deal of medical services.
		When HMOs were coming into existence, indemnity plans often did not cover preventive services, such as immunizations, well-baby checkups, mammograms, or physicals.
	en.wikipedia.org /wiki/Health_maintenance_organization (736 words)

	NurseWeek: Tough Times: HMOs struggle to make ends meet
		HMOs are going to have to make changes in order to regain the public trust.” That means everything from emphasizing preventive care and improving customer service to getting on board with some reform legislation, Bianco said.
		HMOs that are forced to close their doors have a responsibility to ensure that continuity of care is not entirely disrupted and that patients are informed about how their care will change, Bianco added.
		“HMOs have cut back more than fat, but bone and muscle, to the point where California’s premiums are 25 percent less than the rest of the country, she said.
	www.nurseweek.com /features/99-9/redca.html (919 words)

	CCHC: Blame Congress for HMOs
		I believe that the HMO is the best idea put forth so far for containing costs and improving the organization and the delivery of health-care services."8 In a roll call vote, only Senator Herman Talmadge voted against the bill.
		The planners' long-range goal was to place Medicare and Medicaid recipients into managed care where HMO managers, instead of Congress, could ration care and the government's financial liability could be limited through capitation (a fixed payment per enrollee per month regardless of the expense incurred by the HMO).
		For example, Minnesota's HMOs, MCOs, and nonprofit insurers are required by law to fund public-health initiatives approved by the Minnesota Department of Health, the state regulator for managed care plans.
	www.cchconline.org /privacy/hmoart.php3 (1996 words)

	HMOs' fate rests in Atlanta
		The HMOs counter that there are mechanisms in place that allow doctors to resolve their payment disputes, and they contend it is the doctors who have improperly jacked up the claims they charge for office visits and medical treatments.
		These disputes involve the HMOs' denial of payments for medical procedures doctors believe to be necessary as well as the denial or downgrading of reimbursements after claims are filed, Cook said.
		The HMOs are asking the 11th Circuit to reverse a ruling issued in September by U.S. District Judge Federico Moreno of Miami, who certified the class action case on behalf of the doctors.
	www.freerepublic.com /focus/f-news/786406/posts (1413 words)

	Higher costs have soured Medicare HMOs
		But the costs of caring for a Medicare HMO member were thought to be considerably lower than the government's average because Medicare HMOs tended to attract younger, healthier seniors.
		Of the three Medicare HMO operators in Allegheny County, the largest, Highmark Inc., said it would triple monthly premiums for the lowest cost version of its Security Blue plan to $36 and raise rates for the other versions anywhere from 41 percent to 49 percent.
		Medicare HMO plans are generally more costly in outlying counties, where federal payments to Medicare HMOs are lower than in Allegheny County.
	www.post-gazette.com /businessnews/20021217medicare1222bnp3.asp (1536 words)

	HMOs, PPOs, and POS Plans
		HMOs, and their close cousins, preferred provider organizations (PPOs), share the goal of reducing healthcare costs by focusing on preventative care and implementing utilization management controls.
		HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a given month.
		Except for emergencies occurring outside the HMO's treatment area, HMO members are required to obtain all treatment from HMO physicians.
	www.agencyinfo.net /iv/medical/types/hmo-ppo-pos.htm (1479 words)

	Families USA: Monitoring Medicare HMOs
		Claims Processing: This section indicates whether HMOs are paying for emergency and urgently needed services that its Medicare members obtain outside the plan, whether they process claims in an appropriate and timely manner, and whether they handle denial of claims appropriately, including informing members of their rights to appeal.
		If a beneficiary is not satisfied by the outcome of an appeal handled by the HMO, he or she is entitled to have that decision reviewed by an independent party if the case involves a denial of a Medicare-covered benefit.
		HMOs are required to inform beneficiaries about both their own grievance process and the Medicare appeals process.
	www.familiesusa.org /site/PageServer?pagename=media_reports_monitor (14229 words)

	USATODAY.com - HMOs win, patients lose and Congress stays in coma (Site not responding. Last check: 2007-10-12)
		In the latest tug of war between patients and their HMOs, a unanimous U.S. Supreme Court sided Monday with insurers.
		At least nine states copied it, and early experience disputed HMO claims that such laws would trigger an explosion of lawsuits and further drive up insurance costs.
		HMOs also have responded constructively to public outcries through improved appeals processes, quicker access to specialists and a greater willingness to respect the medical decisions of attending physicians.
	www.usatoday.com /news/opinion/editorials/2004-06-21-edit_x.htm (626 words)

	DLEG - Health Maintenance Organization (HMOs) Basics (Site not responding. Last check: 2007-10-12)
		An HMO may not provide coverage if you receive health care services from a doctor, hospital or other health care provider outside its network or service area, and you may need a referral to see a specialist.
		HMOs might not be your best choice if you travel regularly, want to cover dependents that live in another community, or have a specific physician you want to see that is not part of the HMO’s provider network.
		Each HMO is required by law to have an internal complaint/grievance process available to it members to address problems regarding a health care service.
	www.michigan.gov /cis/0,1607,7-154-10555_12902_35510_36780---,00.html (3412 words)

	Medicare HMOs — What if your plan leaves Medicare?
		In 1998, at the peak of HMO popularity, 6.5 million people were enrolled in Medicare HMOs and other managed care plans.
		Medicare HMOs are attractive because they cover many of the gaps in the Original Medicare benefits plan.
		While HMOs may charge small copayments for doctor visits and prescription drugs, their enrollees don't have to purchase a Medicare Supplemental (Medigap) insurance policy.
	www.todaysseniors.com /pages/Medicare_FAQsHMO.html (1607 words)

	DLEG - Michigan HMOs Third Quarter Financial Analysis (Site not responding. Last check: 2007-10-12)
		As of September 30, 2001, the HMO industry, in total, reported a year to date loss of $28.2 million compared to a year to date profit of $44.4 million as of September 30, 2000.
		Fifteen HMOs reported a decline in profitability in the first nine months of 2001 for a total of $89.7 million with Omnicare representing $46.1 million or 51% of the decline.
		As of September 30, 2000 PMPM medical was $143.97 and as of September 30, 2001 it is $163.52, an increase of 13.58%.
	www.michigan.gov /cis/0,1607,7-154-10555_13222_13250-39099--,00.html (1090 words)

	2000_01 \| STATE INITIATIVES: Massachusetts Battle Goes To Heart of Tax-Exempt Question
		Galvin found the HMOs' transitional assistance programs for elderly members who now faced benefit caps were difficult to join, and in some cases were not representative of the announced programs.
		In September, Galvin released a five-page report, "Nonprofit HMOs and the Health Care Crisis." Based on filings from the Division of Insurance and the attorney general's Division of Public Charities, as well as information from the HMOs themselves, Galvin concluded that "all three HMOs may have engaged in activities in conflict with their non-profit status."
		The size and timing of the HEFA bond issue on behalf of the state's largest HMO, which lost $98 million in 1998 and was expected to lose $100 million last year, triggered controversy.
	www.managedcaremag.com /archives/0001/0001.states.html (1199 words)

	VOTE.COM \| Should patients be able to sue HMOs?
		HMOs are financial entities which focus on cutting medical costs and maximizing their profits.
		Without the right to sue, there is no effective counterweight to this profit motive, nothing to balance concern for the dollar with concern for the patient.
		HMOs were developed to stop rising medical care costs; Litigation is what drove these costs up
	www.vote.com /vote/1175/argument1293.phtml?cat=6834357 (360 words)

	HMOs (Site not responding. Last check: 2007-10-12)
		HMOs that were Part of an Integrated Health Care System
		HMO Requirements for Choosing Branded Over Generic Drugs
		HMO Participation in Rebate and Charge-back Programs
	www.managedcaredigest.com /edigests/hm2000/hm2000c01.html (79 words)

	Medicare HMOs \| ElderWeb
		Medicare HMO - (or Medicare Managed Care) An alternative to traditional Medicare which offers additional benefits and less paperwork in exchange for restrictions on hospitals and other providers which can be used.
		Medicare HMOs receive county-specific rates, with the lowest rates in rural counties and the highest rates in urban areas.
		Seniors who use up their prescription drug benefits are far more likely to drop their HMO coverage, according to research by Express Scripts Inc., one of the nation's largest pharmacy benefit managers (PBMs).
	www.elderweb.com /home/node/6357 (581 words)

	USATODAY.com - Medicare payments increase for HMOs (Site not responding. Last check: 2007-10-12)
		The higher rates that took effect Thursday reflect a roughly 5% increase, depending on complex formulas that take into account where an HMO is and how many and what type of patients they serve, according to the Health Care Financing Administration, which runs Medicare.
		When an HMO leaves, Medicare beneficiaries who were enrolled do not lose health insurance coverage.
		But they must find another HMO, which may mean having to switch doctors or else return to submitting medical bills directly to Medicare, losing the extra benefits many HMOs offer.
	www.usatoday.com /news/health/2001-03-02-medicare.htm (474 words)

	Political Action Needed to Keep Medicare HMOs Viable
		The Medicare HMO program is good for PAMF as well, explained PAMF President and CEO David Druker, M.D., since it produces a modest profit for the Clinic at a time when several other types of health coverage including traditional Medicare are unprofitable arrangements that don't cover the Clinic's costs for treating those patients.
		Those who like their Medicare HMO coverage should contact their federal government representatives and urge them to push for legislation boosting Medicare HMO funding, he said.
		It's important to keep the Medicare HMO program alive, he said, since it produces a modest profit for PAMF at a time when the Clinic is losing money on other types of insurance.
	www.pamf.org /news/2002/0402_hmos.html (568 words)

	HMOs and Health Insurer Products (Site not responding. Last check: 2007-10-12)
		The consequences of dealing with a financially strapped HMO or health insurance company often go far beyond the potential loss of premium dollars.
		That's why it is critically important to periodically monitor the financial condition of each HMO and health insurer with whom you have a relationship.
		So, whether you are an HMO member, an employer, or a healthcare professional, the Weiss Safety Ratings can help you.
	www.weissratings.com /products_hmo.asp (349 words)

	Investor-Owned vs Not-for-Profit HMOs...[Abstract, July 14 JAMA. 1999;282:159-163] (c) AMA 1999
		These data reflect 1996 plan characteristics and performance for 329 HMO plans (248 investor-owned and 81 not-for-profit) in 45 states, representing 56 percent of the total HMO enrollment in the United States.
		The cost per HMO member, per month averaged $128.00 in investor-based owned plans versus $127.50 in not-for-profit plans, according to the authors.
		Between 1985 and 1998 the proportion of HMO members enrolled in investor-owned plans increased from 26 percent to 62 percent; between 1980 and 1998 the market share of group- and staff-model plans decreased from 81 percent to 12 percent.
	www.harp.org /himmel.htm (927 words)

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