• iHMO/Managed Care

    Health Insurance

    WHAT IS AN HMO?

    HMO stands for “Health Maintainence Organization”, two examples being United Healthcare, and Humana.  HMO’s are a big part of the US Healthcare System. Some say the these organizations should not be called “Healthcare Maintainence Organizations“, but rather “Price Maintainence Organizations”. This may be somewhat accurate, because, naturally, any business’s aim is profit. But, in these days of the digitalization of medicine, both Medicine and HMO may find themselves aligned in a certain ways.
    HMO’s provide medical insurance, with certain restrictions.  Some may restrict which doctor the patient sees.  Some may require the patient to go to a primary care physician to get a referral, if that patient needs to see a specialist.  The medical care is managed differnet ways.  PPO’s, or Preferred provider organizations, are becoming more popular nowadays, because although more expensive medical insurance, it provides more flexibility, as as far as other types of  medical insurance.
    First, let us see in the following video, an excellent, easily understood history of medical insurance in the USA, and  what HMO’s are, and how they came about

    Mr McCallister stresses that a fact known to many doctors; that most diseases are caused by patients themselves, leading unhealthy lifestyles; smoking, drinking, eating excessively, and the wrong foods, not exercising, etc, and that these continued behaviors only overloads the healthcare system, and contributes to skyrocketing healthcare costs.

    Furthermore, he says, “…With electronic medical information readily available to provider and patient, more efficient and cost-effective decisions may be made by healthcare providers…”. The patient has to get involved in a long term goal of good health, by changing behaviors, and he hopes that HMOs, like Humana, can give incentives to lead patients to do so. In this fashion, the numbers of the “big five” will decrease, and healthcare costs will also decrease.

    Finally, he says something, that also may apply to the aversion of some doctors to adopt EMR’s:

    “This is hard work because it really, fundamentally, requires a cha

     

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