Which term refers to the system that coordinates care and payment under a prepaid plan, often associated with HMOs?

Which term refers to the system that coordinates care and payment under a prepaid plan, often associated with HMOs?

• A. Health Care Delivery
• B. Health Maintenance Organization (HMO)
• C. Health Exchange
• D. Group Practice

Answer: (B)

This term refers to a prepaid, integrated system that coordinates both care and payment, and is commonly linked with HMOs. An HMO contracts with a network of providers to deliver comprehensive services for a fixed prepaid premium. Care is coordinated through a primary care physician who acts as a gatekeeper, guiding referrals and ensuring preventive services are emphasized. Payments to providers are often on a capitation basis, which helps control costs by funding a set amount per patient rather than paying for each service. Because of this structure, the focus is on coordinating care within the network to improve outcomes and efficiency, rather than on fee-for-service delivery. Health Care Delivery is too broad to capture the prepaid coordination and financing aspect. Health Exchange refers to a marketplace for purchasing health insurance, not the delivery-and-payment system itself. Group Practice describes a shared physician practice arrangement and doesn’t inherently imply the prepaid, coordinated financing model of an HMO.

This term refers to a prepaid, integrated system that coordinates both care and payment, and is commonly linked with HMOs. An HMO contracts with a network of providers to deliver comprehensive services for a fixed prepaid premium. Care is coordinated through a primary care physician who acts as a gatekeeper, guiding referrals and ensuring preventive services are emphasized. Payments to providers are often on a capitation basis, which helps control costs by funding a set amount per patient rather than paying for each service. Because of this structure, the focus is on coordinating care within the network to improve outcomes and efficiency, rather than on fee-for-service delivery.

Health Care Delivery is too broad to capture the prepaid coordination and financing aspect. Health Exchange refers to a marketplace for purchasing health insurance, not the delivery-and-payment system itself. Group Practice describes a shared physician practice arrangement and doesn’t inherently imply the prepaid, coordinated financing model of an HMO.