What characterizes a Group Model HMO?

What characterizes a Group Model HMO?

• A. It contracts with groups of doctors to provide care.
• B. It is the most common type of HMO.
• C. It operates only as a fee-for-service indemnity plan.
• D. It uses a government-defined network of providers.

Answer: (A)

Group Model HMOs are defined by their arrangement with a physician group to deliver care for members. In this setup, a medical group—physicians who practice together under one organizational umbrella—contracts with the HMO to provide a wide range of services to enrolled members. The HMO pays the group (often on a capitation basis or by salary), and the group is responsible for coordinating all care within the network. Because care is delivered through the contracted group rather than doctors employed directly by the HMO, the group handles referrals and care management within the defined network. This differs from models where physicians are directly employed by the HMO (staff model), and it is not a fee-for-service indemnity plan or a government-defined network. The essential feature is the contract with an independent physician group that provides the core medical services for the plan.

Group Model HMOs are defined by their arrangement with a physician group to deliver care for members. In this setup, a medical group—physicians who practice together under one organizational umbrella—contracts with the HMO to provide a wide range of services to enrolled members. The HMO pays the group (often on a capitation basis or by salary), and the group is responsible for coordinating all care within the network. Because care is delivered through the contracted group rather than doctors employed directly by the HMO, the group handles referrals and care management within the defined network. This differs from models where physicians are directly employed by the HMO (staff model), and it is not a fee-for-service indemnity plan or a government-defined network. The essential feature is the contract with an independent physician group that provides the core medical services for the plan.