Final Paper Submission, How HMO's Threaten Quality of Care

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Module 02 – Outline and Annotated Bibliography 9

Module 2 – Outline and Annotated Bibliography

Jamie Raines

Rasmussen College

H310/HSA3109 Section 01 Foundation of Managed Care

Sandi Moore-Foggey

May 29th, 2020

Thesis Statement

The most comprehensive analysis of comparisons on quality “found that HMOs provide care that is generally better than or equal to fee-for-service care. However, HMOs are leading long-overdue efforts to measure quality of care, so that it can be brought up to standard” (Major Myths of Healthcare, n.d.). Introduction of HMO accountability for the quality of services, the investor-controlled market was not really free. Good companies were not rewarded for delivering high-quality services, and bad companies were not punished for withholding it.

Outline

I. What is an HMO

a. How it related to Health plan

b. How it relates to consumers

II. Key Facts with HMO

a. PCP Physicians

b. Copays

c. In Network vs Out of network

III. HMO vs PPO

a. How are they different

b. Why choose one over the other

c. Which one is right for you

IV. Benefits of HMO Plans

a. Costs

b. Claims

c. Convenience

Annotated Bibliography

What's the difference between HMO and PPO plans? (n.d.). Retrieved May 30, 2020, from https://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/difference-hmo-ppo.html

When you’re shopping for health insurance, you have a lot of options to choose from.

Knowing the differences between plans can help you choose the one that’s right for your health care needs and budget. As you look at plans, you may notice that some plans are HMOs and some are PPOs, but what does that mean?

As a reliable source from blue cross blue shield, they give us factors in how we can choose which plan make work best for a certain individual. This is an up to date source as a health insurance carrier however it can be influential because it is an actual health plan organization. This is a great source to determine differences between an HMO and a PPO.

GetInsured. (2019, April 11). Health Maintenance Organization (HMO) Plans Explained. Retrieved May 31, 2020, from https://company.getinsured.com/health-maintenance-organization-hmo-plans-explained/

With an HMO, you’ll probably need to select a primary care physician (PCP). Most HMO plans only cover your care if you see a doctor within the HMO’s network of providers. If you go outside the network, your services might not be covered at all. If you want to see a specialist, you’ll most likely have to get a referral from your PCP.

This information is up to date based on the research that I have done. It is less than a year old. I do believe this information is objective because it relates to health insurance. Most information that is out there is all the same when it comes to why and what an HMO is, and how it can affect your choices.

This source is helpful to me, and should be when deciding on what plan you may want for you and your family. This is a credible source as it has won many web awards.

· 2019 Health Care Standard of Excellence

· 2019 Insurance Standard of Excellence

· 2018 Outstanding Website

· 2017 Health Care Standard of Excellence

· 2016 Outstanding Website

· 2015 Health Care Standard of Excellence

· 2014 Health Care Standard of Excellence

Advantages and Disadvantages: HMO vs. PPO: Kaiser Permanente. (n.d.). Retrieved May 31, 2020, from https://thrive.kaiserpermanente.org/thrive-together/health-care-101/hmo-vs-ppo-advantages

When you’re searching for jobs or considering a job offer, employer-provided health insurance is an important factor. You want to make sure there’s a plan available that meets your family’s health needs, allows you to see your preferred doctors or specialists, and works with your budget. The most common choice you’ll have is between a health maintenance organization (HMO) plan and a preferred provider organization (PPO) plan.

Kaiser Permanente is one of the nation's largest not-for-profit health plans, serving 12.4 million members. At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible, so in my theory yes this is most definite a credible source when it comes to figuring out HMO for your family. After reading numerous articles in my opinion no it has not changed how I feel about HMO’s and PPO’s.