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Part I: Terminology
 > HMO Models

HMO Organizational Models

There are several common models of HMOs, differing only in the relationships of the providers to the organization that is the HMO.

Staff Model The Health Maintenance Organization employs the physician, and care is usually provided in a facility owned by the HMO. There is a high degree of control over care delivered, and thus premium costs are often lower in this type of structure due to the HMO's ownership of the facility.

Group Model This type of HMO plan is structured around a multi-specialty medical group that may include internists, obstetricians, gynecologists, cardiac and oncology specialists and surgeons contracting exclusively with the HMO to provide services. Care is delivered in facilities owned either by the physician groups, such as clinics, or the HMO, such as a hospital.

Network Model This model is an HMO that contracts with many IPAs and other provider groups to form a "physician network." Care can be provided in a larger geographic service area than would be possible with only one physician group. This network model offers the patient choice of physicians and managed costs.

Mixed Model This term describes certain HMO plans in which the provider network is a combination of delivery systems. In general, a network, or mixed model HMO, offers the widest variety of choices and the broadest geographic coverage to its members. Patients will often have choices of clinics, labs, pharmacies, and hospitals as their providers of care.