How are PPOs different from HMOs?
Medicare Advantage
As with all HMOs—no matter whether a person is on Medicare or not—persons who enroll in a Medicare Advantage or other Part C HMO cannot use certain specialist physicians or out-of-network providers without prior authorization from the HMO, except in emergencies. In almost all Medicare Advantage plans—HMO or otherwise—the beneficiary must choose a primary care physician (PCP) to provide referrals and the beneficiary must confirm that the plan authorizes the visit to which the beneficiary was referred by the PCP. As with all HMOs, this can be a problem for people who want to use out-of -network specialists or who are hospitalized and are forced to use out-of-network doctors while hospitalized. Many Medicare Advantage PPO plans permit a subscriber to use any physician or hospital without prior authorization, but at a somewhat higher expense.
Paul M. Ellwood Jr.
Paul M. Ellwood Jr. (born 16 July 1926) is a prominent figure in American health care. Often referred to as the "father of the health maintenance organization," he not only coined the term, he also played a role in bringing about structural changes to the American health care system to simultaneously control cost and promote health by replacing fee-for-service with prepaid, comprehensive care. The term "HMO" was coined by Dr. Paul M. Ellwood Jr. in a January 1970 Fortune Magazine article. More recently, he has advanced an agenda for monitoring health outcomes, so that patients, providers, and payers can make health care decisions based on real information about what treatments and providers are actually effective.
List of small modular reactor designs
A commercial version of a Los Alamos National Laboratory project, the HPM is a LMR that uses a Pb-Bi coolant. It has an output of 25 MWe, and less than 20% enrichment. The reactor is a sealed vessel, which is brought to the site intact and removed intact for refueling at the factory, reducing proliferation dangers. Each module weighs less than 50 tons. It has both active and passive safety features.
Aureusidin synthase
Aureusidin synthase is homologous to plant polyphenol oxidase (PPO), but contains certain significant modifications. While PPO has a highly conserved N-terminal amino acid sequence in order to facilitate transport to the plastid lumen, aureusidin synthase lacks this sequence and thus is not localized to the plasmid. Much like PPOs, aureusidin synthase is likely first synthesized as a larger ~60 kDa protein and then undergoes proteolytic cleavage to remove transport groups.
Metropolitan planning organization
A metropolitan planning organization (MPO) is a federally mandated and federally funded transportation policy-making organization in the United States that is made up of representatives from local government and governmental transportation authorities. They were created to ensure regional cooperation in transportation planning. MPOs were introduced by the Federal-Aid Highway Act of 1962, which required the formation of an MPO for any urbanized area (UZA) with a population greater than 50,000. Federal funding for transportation projects and programs are channeled through this planning process. Congress created MPOs in order to ensure that existing and future expenditures of governmental funds for transportation projects and programs are based on a continuing, cooperative, and comprehensive (“3‑C”) planning process. Statewide and metropolitan transportation planning processes are governed by federal law (). Transparency through public access to participation in the planning process and electronic publication of plans now is required by federal law. As of 2015, there are 408 MPOs in the United States.
Patient-reported outcome
PROs should not be confused with PCOs, or "patient-centered outcomes". The latter implies the use of a questionnaire covering issues and concerns that are specific to a patient. Instead, "patient-reported" outcomes refers to reporting situations in which only the patient provides information related to a specific treatment or condition; this information may or may not be of concern to the patient.
Charter management organization
The National Alliance for Public Charter Schools makes a clear distinction. CMOs are non-profit; EMOs are for-profit.
, companies that develop and deploy online curricula for schools. An organization may play in both spaces, but the roles are different.
Point-to-Point Protocol over Ethernet
PPPoE is used to connect a PC or a router to a modem via an Ethernet link and it can also be used in Internet access over DSL on a telephone line in the "PPPoE over ATM" (PPPoEoA) over ADSL protocol stack.
PPPoE over ATM has the highest overhead of the popular DSL delivery methods, when compared with for example PPPoA (RFC 2364).
Partners in Population and Development
Partners in Population and Development (PPD) is an intergovernmental initiative created specifically for the purpose of expanding and improving South-to-South collaboration in the fields of reproductive health, population, and development. PPD was launched at the 1994 International Conference on Population and Development (ICPD), when ten developing countries from Asia, Africa and Latin America formed an intergovernmental alliance to help implement the Cairo Program of Action (POA). This POA, endorsed by 179 nations, stresses the need to establish mechanisms to promote development through the sharing of experiences in reproductive health (RH) and family planning (FP) within and among countries and to promote effective partnerships among the governments, Non- Governmental-Organizations (NGOs), research institutions and the private sector.
Health maintenance organization
HMOs in the USA are regulated at both the state and federal levels. They are licensed by the states, under a license that is known as a certificate of authority (COA) rather than under an insurance license. State and federal regulators also issue "mandates", requirements for health maintenance organizations to provide particular products. In 1972 the National Association of Insurance Commissioners adopted the HMO Model Act, which was intended to provide a model regulatory structure for states to use in authorizing the establishment of HMOs and in monitoring their operation.
Managed care
They are licensed at the state level, under a license that is known as a certificate of authority (COA), rather than under an insurance license. In 1972, the National Association of Insurance Commissioners adopted the HMO Model Act, which was intended to provide a model regulatory structure for states to use in authorizing the establishment of HMOs and in monitoring their operations. In practice, an HMO is a coordinated delivery system that combines both the financing and the delivery of health care for enrollees. In the design of the plan, each member is assigned a "gatekeeper", a primary care physician (PCP) responsible for the overall care of members assigned. Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.
Health maintenance organization
The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. This is considered by some to be the first example of an HMO. However, Ross-Loos Medical Group, established in 1929, is considered to be the first HMO in the United States; it was headquartered in Los Angeles and initially provided services for Los Angeles Department of Water and Power (DWP) and Los Angeles County employees.200 DWP employees enrolled at a cost of $1.50 each per month. Within a year, the Los Angeles Fire Department signed up, then the Los Angeles Police Department, then the Southern California Telephone Company (now AT&T Inc.), and more. By 1951, enrollment stood at 35,000 and included teachers, county and city employees. In 1982 through the merger of the Insurance Company of North America (INA) founded in 1792 and Connecticut General (CG) founded in 1865 came together to become CIGNA. Also in 1929 Dr. Michael Shadid created a health plan in Elk City, Oklahoma in which farmers bought shares for $50 to raise the money to build a hospital. The medical community did not like this arrangement and threatened to suspend Shadid's licence. The Farmer's Union took control of the hospital and the health plan in 1934. Also in 1929, Baylor Hospital provided approximately 1,500 teachers with prepaid care. This was the origin of Blue Cross. Around 1939, state medical societies created Blue Shield plans to cover physician services, as Blue Cross covered only hospital services. 
These prepaid plans burgeoned during the Great Depression as a method for providers to ensure constant and steady revenue.
Positive pressure personnel suit
The PPPS is a sophisticated variety of personal protective equipment (PPE), a type of hazmat suit, which is air-tight and designed for positive pressure to prevent contamination to the wearer even if the suit becomes damaged. BSL-4 cabinets and "Suit Laboratories" have special engineering and design features to prevent hazardous microorganisms from being disseminated into the outside environment. These biosafety suites, where PPPSs are used, are suites of laboratory rooms which are essentially equivalent to large Class III biosafety cabinets in which the interiors of the PPPSs serve as the "outside" environment for workers. Examples include the biocontainment suites at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland and the Maximum Containment Facility (MCF) of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
HMO (disambiguation)
An HMO is a health maintenance organization, an organization that provides or arranges managed care.
Alternative public offering
What differentiates an APO from a reverse merger is the simultaneous PIPE raise. A PIPE is when a publicly traded company sells its stock to investors in a privately negotiated transaction. The stock is normally sold at a discount to current market value and investors are normally acquiring unregistered “restricted” stock. The typical PIPE investor is an institutional investor such as a hedge fund or mutual fund. PIPEs are usually completed by investment banks who act as “Placement Agent” in the transaction.
Project management office
There are a range of PMO types, including: The Project Management Institute (PMI) Program Management Office Community of Practice (CoP), describes the PMO as a strategic driver for organizational excellence, which seeks to enhance the practices of execution management, organizational governance, and strategic change leadership.
Center for Organizational Performance
The research into the characteristics of high performing managers (HPMs) is based on a sample of 808 Dutch managers and a sample in the UK consisted of employees of the ATLAS Consortium , a consortium of five ICT companies that were charged with improving the information and communication technology infrastructure of the British Ministry of Defence. Most of these employees were based in England, and using the cross-cultural framework of Excellent Leadership by Selvarajah et al., the profile of an excellent Dutch and British High Performance Manager was derived.
This profile can be described by a five-dimensional factor structure consisting of: (1) Excellent Leadership; (2) Managerial Behaviors; (3) Environmental Influences; (4) Personal Qualities; and (5) Organizational Demands. The results of the research have significant practical implications in that organizations can use the profile to tailor their management development programs, evaluation and coaching programs, and recruiting processes.
The above research showed that the framework for HPM is valid for both the Dutch and British context. The research results indicate that the five-factor structure is a sound representation of data, portraying reliable factors that are important to characterize Dutch and British HPMs.
The importance of partnerships to organizational success has increased considerably the past decennia and many organizations strive at creating high performance partnerships (HPPs). For this to happen, organizations in the partnerships have to be of high quality and their collaborations should be world-class. Whereas the factors that make up high performance organizations (HPO) are well established, the HPP factors are still unclear. This research develops a scale for measuring HPP factors. Based on empirical research at a cable company and its suppliers (a total of 239 filled-in questionnaires were received back, 46 from the cable company and on average 48 per supplier.), a HPP Framework was developed consisting of nine HPP characteristic: Control, Trust, Commitment, Coordination, Interdependence, Communication, Conflict, Valuing and Diversity. 
This framework is then tested at the ATLAS Consortium. The results of the application of the HPP framework in such a complicated environment are evaluated and the HPP framework is finalized.
The research results show a strong relationship between HPP factors, HPO factors and the success factors of a partnership. This research adds to the literature by extending the concept of HPOs to the value chain these HPOs operate in. The practical benefit is that managers can use the HPP factors to increase their partnership quality.Do Bonuses Matter? They Do If Part of a Fair and Equitable Rewards System
Health maintenance organization
This last provision, called the dual choice provision, was the most important, as it gave HMOs access to the critical employer-based market that had often been blocked in the past. The federal government was slow to issue regulations and certify plans until 1977, when HMOs began to grow rapidly. The dual choice provision expired in 1995.
Partners in Population and Development
According to their website, the PPD is the "only organization in the world fully dedicated to South-South partnerships."
Capitation (healthcare)
Physicians and other health care providers lack the necessary actuarial, underwriting, accounting and finance skills for insurance risk management, but their most severe problem is the greater variation in their estimates of the average patient cost, which leaves them at a financial disadvantage as compared to insurers whose estimates are far more accurate. Because their risks are a function of portfolio size, providers can reduce their risks only by increasing the numbers of patients they carry on their rosters, but their inefficiency relative to that of the insurers' is far greater than can be mitigated by these increases. To manage risk as efficiently as an insurer, a provider would have to assume 100% of the insurer's portfolio. HMOs and insurers manage their costs better than risk-assuming healthcare providers and cannot make risk-adjusted capitation payments without sacrificing profitability. Risk-transferring entities will enter into such agreements only if they can maintain the levels of profits they achieve by retaining risks.
Proton-pumping pyrophosphatase
Two types of inorganic diphosphatase, very different in terms of both amino acid sequence and structure, have been characterised to date: soluble and transmembrane proton-pumping pyrophosphatases (sPPases and H()-PPases, respectively). sPPases are ubiquitous proteins that hydrolyse pyrophosphate to release heat, whereas H-PPases, so far unidentified in animal and fungal cells, couple the energy of PPi hydrolysis to proton movement across biological membranes. The latter type is represented by this group of proteins. H-PPases are also called vacuolar-type inorganic pyrophosphatases (V-PPase) or pyrophosphate-energised vacuolar membrane proton pumps. In plants, vacuoles contain two enzymes for acidifying the interior of the vacuole, the V-ATPase and the V-PPase (V is for vacuolar).
Wendell Potter
Wendell Potter (born July 16, 1951) is an American consumer advocate, "New York Times" bestselling author, consultant, and former health insurance industry executive. A critic of HMOs and of the tactics used by insurers, Potter is also an advocate for major reforms of the industry, including universal health care. Prior to his resignation in 2008, Potter was vice president of corporate communications for the health insurance company CIGNA. In June 2009, he testified against the HMO industry in the U.S. Senate to expose health insurance industry practices. He has served as senior analyst at the Center for Public Integrity, a fellow at the Center for Media and Democracy, and a consumer liaison representative to the National Association of Insurance Commissioners. Potter is a regular contributor to "The Huffington Post" and Healthinsurance.org.
High performance organization
The success of HPOs are due to their ability to have structures in place that allow them to quickly adjust to the environment that they operate within. HPOs have the ability to reconfigure themselves to meet the demands of the marketplace and avoid its threats. HPOs constantly survey and monitor the environment to understand the context of their business, identify trends, and seek out any competitors. A HPO's growth is facilitated by creating partnerships and creating networks with other organizations after careful examination of the value added by entering into these relationships. They have high external orientation and strive to meet customer demands. They meet and exceed customer demands by fostering close relationships with customers, understanding their customers' values, and being responsive to their customers' needs. HPOs maintain relationships with their stakeholders by creating mutual relationships.
Political positions of Mike Huckabee
Huckabee thinks HMOs should not be required to cover people with preexisting conditions.
Group purchasing organization
Medicare and Medicaid stimulated growth in the number of GPOs to 40 in 1974. That number tripled between 1974 and 1977. The institution of the Medicare Prospective Payment System (PPS) in 1983 focused greater scrutiny on costs and fostered further rapid GPO expansion. In 1986, Congress granted GPOs in healthcare "Safe Harbor" from federal anti-kickback statutes after successful lobbying efforts.
By 2007, there were hundreds of healthcare GPOs, "affiliates" and cooperatives in the United States that were availing themselves of substantial revenues obtained from vendors in the form of administrative fees, or "remuneration." 96 percent of all acute-care hospitals and 98 percent of all community hospitals held at least one GPO membership. Importantly, 97 percent of all not-for-profit, non-governmental hospitals participated in some form of group purchasing.
Health maintenance organization
In 1970, the number of HMOs declined to fewer than 40. Paul M. Ellwood, Jr., often called the "father" of the HMO, began having discussions with what is today the U.S. Department of Health and Human Services that led to the enactment of the Health Maintenance Organization Act of 1973. This act had three main provisions:
Medicare Advantage
Evidence is mixed on how quality and access compare between Medicare Advantage and "traditional" Medicare. ("traditional" in quotes because it is not the same as Original Medicare; everyone in Medicare must begin by joining Original Medicare; the term "traditional" typically refers to FFS and almost always means the beneficiary has a private group or individually purchased supplement to Original Medicare). Most research suggests that enrollees in Medicare HMOs tend to receive more preventative services than beneficiaries in traditional Medicare; however, beneficiaries, especially those in poorer health, tend to rate the quality and access to care in traditional Medicare more favorably than in Medicare Advantage. It is difficult to generalize the results of studies across all plans participating in the program because performance on quality and access metrics varies widely across the types of Medicare Advantage plans and among the dozens of providers of Medicare Advantage plans.
The Adventures of Peter Pan
Differences from the book or other PP versions
Point-to-Point Protocol over Ethernet
On the customer-premises equipment, PPPoE may be implemented either in a unified residential gateway device that handles both DSL modem and IP routing functions or in the case of a simple DSL modem (without routing support), PPPoE may be handled behind it on a separate Ethernet-only router or even directly on a user's computer. (Support for PPPoE is present in most operating systems, ranging from Windows XP, Linux to Mac OS X.) More recently, some GPON-based (instead of DSL-based) residential gateways also use PPPoE, although the status of PPPoE in the GPON standards is marginal.
Massively multiplayer online game
To further explore the effects of social capital and social relationships on MMOs, Steinkuehler and Williams combined conclusions from two different MMO research projects: sociocultural perspective on culture and cognition, and the other on media effects of MMOs. The conclusions of the two studies explained how MMOs function as a new form of a "third place" for informal social interactions much like coffee shops, pubs, and other typical hangouts. Many scholars, however, such as Oldenburg (1999), refute the idea of a MMOs serving as a "third place" due to inadequate bridging social capital. His argument is challenged by Putnam (2000) who concluded that MMOs are well suited for the formation of bridging social capital, tentative relationships that lack in depth, because it is inclusive and serves as a sociological lubricant that is shown across the data collected in both of the research studies.
Cell-penetrating peptide
Antisense oligonucleotides (asONs) have been used in basic research and are being developed as possible medical treatments. CPP strategies have been developed to deliver antisense oligomers such as PNA and PMO into cells. Overcoming the repulsion by the cell membrane of negative-charged ONs and the degradation of asONs by enzymes, CPPs increase asONs bioavailability. Two types of neutral ON analogues, peptide nucleic acid (PNA) and phosphorodiamidate morpholino oligomers (PMO or Morpholino) are becoming dominant in this area. PNA has been conjugated with various CPPs either through disulfide linkages or through stable amide bonds. For example, antisense activity within cells that blocked expression of the galanin receptor was observed when a 21-mer PNA was coupled to the penetratin. Results on antiviral activity with PNA targeting HIV-1 have also been reported through disulfide linkage with TAT. CPP-PMO conjugates have also been successfully used to inhibit the replication of several viruses such as SARS and influenza and attachment of CPPs has improved the efficacy of splice-modifying Morpholinos in development for treatment of Duchenne muscular dystrophy
University of Oxford
The colleges are:
The Permanent Private Halls were founded by different Christian denominations. One difference between a college and a PPH is that whereas colleges are governed by the fellows of the college, the governance of a PPH resides, at least in part, with the corresponding Christian denomination. The six current PPHs are:
The PPHs and colleges join together as the Conference of Colleges, which represents the common concerns of the several colleges of the university, to discuss matters of shared interest and to act collectively when necessary, such as in dealings with the central university. The Conference of Colleges was established as a recommendation of the Franks Commission in 1965.
Professional employer organization
A professional employer organization (PEO) is an outsourcing firm which provides services to small and medium sized businesses (SMBs). Typically, the PEO offering may include human resource consulting, safety and risk mitigation services, payroll processing, employer payroll tax filing, workers' compensation insurance, health benefits, employers' practice and liability insurance (EPLI), retirement vehicles (401(k)), regulatory compliance assistance, workforce management technology, and training and development. The PEO enters into a contractual co-employment agreement with its clientele. Through co-employment, the PEO becomes the employer of record for tax purposes through filing payroll taxes under its own tax identification numbers.
Paleothermometer
Ocean water is mostly HO, with small amounts of HDO and HO. In Standard Mean Ocean Water (SMOW) the ratio of D to H is and O/O is . Fractionation occurs during changes between condensed and vapour phases: the vapour pressure of heavier isotopes is lower, so vapour contains relatively more of the lighter isotopes and when the vapour condenses the precipitation preferentially contains heavier isotopes. The difference from SMOW is expressed as 
and a similar formula for δD. values for precipitation are always negative. The major influence on is the difference between ocean temperatures where the moisture evaporated and the place where the final precipitation occurred; since ocean temperatures are relatively stable the value mostly reflects the temperature where precipitation occurs. Taking into account that the precipitation forms above the inversion layer, we are left with a linear relation:
Fee-for-service
A goal of accountable care organizations (ACOs), part of the 2010 Patient Protection and Affordable Care Act (PPACA), is to move from FFS to integrated care. ACOs, however, fit largely into a FFS framework and do not abandon the model entirely. That approach suggests policymakers are attempting to avoid provoking public outcry, as happened with managed care in the 1990s by giving providers incentives to give less care. The PPACA aims to first move Medicare away from FFS and then other payers. A Swiss study showed physicians wanted significant pay raises to leave FFS for an integrated care model, and patients wanted lower premiums before they would choose one, results that hint at difficulties for PPACA aims
Pharmaceutical policy
Pharmaceutical policy may also encompass how drugs are provided to beneficiaries. This includes the mechanics of drug distribution and dispensing as well as the funding of such services. For example, some HMOs in the US use a ‘central fill’ approach where all prescriptions are packaged and shipped from a central location instead of at a community pharmacy. In other jurisdictions, retail pharmacies are compensated for dispensing drugs to eligible beneficiaries. A state-operated approach may also be taken, as with Sweden’s Apoteket, which had the monopoly on retail pharmacy until 2009, and was not-for-profit. Pharmaceutical policy may also subsidize smaller, more marginal pharmacies, using the rationale that they are needed health care providers. The UK’s Essential Small Pharmacies Scheme works this way.
Exclusive provider organization
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to an HMO. Also, the payment scheme is usually fee for service, in contrast to HMOs in which the healthcare provider is paid by capitation and receives a monthly fee, regardless of whether the patient is seen.
Hidden Markov model
"Poisson hidden Markov models (PHMM)" are special cases of hidden Markov models where a Poisson process has a rate which varies in association with changes between the different states of a Markov model. PHMMs are not necessarily Markovian processes themselves because the underlying Markov chain or Markov process cannot be observed and only the Poisson signal is observed.
Fine chemical
Contract research organizations (CROs) provide services to the life science industries along product development. There are more than 2000 CROs operating worldwide, representing revenues of more than $20 billion. One distinguishes between "Product" and "Patient" CROs. Whereas the production sites of CMOs are multipurpose plants, allowing for the production of tens to hundreds of tons of fine chemicals, the work places of patient CROs are the test persons (volunteers) for the clinical trials and those of the product CROs are the laboratory benches. Major customers for CRO services are the large global pharmaceutical companies. Half a dozen companies (Pfizer, GlaxoSmithKline, Sanofi-Aventis, AstraZeneca, Johnson & Johnson, and Merck & Co.) alone absorb about one third of all CRO spending. As for CMOs also for CROs, biotech start-up companies with their dichotomy between ambitious drug development programs and limited resources are the second most promising prospects. Product CROs (chemical CROs) are providing primarily sample preparation, process research and development services. An overlap between the latter and CMOs exists with regard to pilot plants (100 kg quantities), which are part of the arsenal of both types of enterprise.
There are more 100 product CROs. Most of them are privately held and have revenues of $10–$20 million per year or less, adding up to a total business in the range of $1.5-$2 billion. Their tasks are described in Chapter 5,
Examples of are:
Center for Organizational Performance
Definition of an HPO
According to dr. De Waal the definition of an HPO is: “A High Performance Organization is an organization that achieves financial and non-financial results that are exceedingly better than those of its peer group over a period of time of five years or more, by focusing in a disciplined way on that which really matters to the organization.”
Administrative services organization
An administrative services organization (ASO) is an organization that provides outsourced solutions to meet the administrative and HR needs of the client, with the client retaining all employment-related risks and liabilities. The term ASO was established by the PEO industry in the late 1990s in order to distinguish between selective administrative support and full-scale PEO services. The principal difference between the two types of service is that, in an ASO arrangement, the employer remains the "employer of record" for tax purposes. Ultimately, with this structure, tax and insurance filings are done through the administrative firm, but under the client company’s employer identification number. All W-2 and workers' compensation policies remain the responsibility of the employer and not the administrative firm.
Direct public offering
A DPO is similar to an initial public offering (IPO) in that securities, such as stock or debt, are sold to investors, but unlike an IPO, a company uses a DPO to raise capital directly and without a "firm underwriting" from an investment banking firm or broker-dealer. A DPO may have a sponsoring FINRA broker, but the broker does not guarantee full subscription of the offering. In a DPO, the broker merely assures compliance with all applicable securities laws and assists with organizing the offering. Following compliance with federal and state securities laws, a company can sell its shares directly to anyone, even non-accredited investors, including customers, employees, suppliers, distributors, family, friends and others.
Michelle Paige Paterson
Paige Paterson is director of the integrated-wellness program at the Health Insurance Plan of New York HMO, a program that assists individuals with chronic health problems to better manage their conditions by helping them to improve their life skills. She previously worked as a lobbyist for North General Hospital in Manhattan.
Medicare Advantage
Plans are required to limit out-of-pocket (OOP) spending by a beneficiary for Parts A and B to no more than $6,700 (as of 2018) per year for in-network providers. The OOP limit may be higher for out of network providers in a PPO; out of network providers are typically not permitted in an HMO. The average OOP limit in 2018 was around $5000. Note that an OOP limit is not a deductible as is often reported; it is instead a financial-protection benefit.
PPPO
PPPO is an abbreviation and can mean:
Paramedics in Australia
Patient transport officers (PTOs), or ambulance transport officers, provide non-emergency patient transport. PTOs provide a pre-booked, non-urgent service that includes home to hospital and hospital to hospital transfers. In some states, PTOs may occasionally be required to act as first responders to emergencies. This is usually limited to situations where it would take significantly longer for paramedics to arrive at the scene than a nearby patient transport crew, or where patients that are assessed to be low-risk and require a low level of care in transit. Also, as many patient transport ambulances carry a second stretcher, non-emergency ambulance officers can be utilised to assist emergency crews in incidents involving numerous casualties. In Victoria, PTOs & AAs will respond to Medium Acuity 000 calls that are dispatched through the ESTA Referral Service.
Paul M. Ellwood Jr.
In 1970 Ellwood was invited to consult with President Nixon's staff to reshape national health policy, where he advanced the idea of giving consumers a choice among health plans that would compete on price and quality. He coined the term Health Maintenance Organization, or HMO, to describe groups of physicians who were pre-paid on a per-patient basis (capitation) instead of a fee-for-service arrangement. While the term "HMO" was Ellwood’s, this institutional model already existed in the form of the non-profit Kaiser health plan in California. Ellwood argued that creating a system of many competing HMOs would give health providers an incentive to keep patients well while driving down health care costs. Doctors would promote preventive medicine and would be less inclined to order costly procedures that had not been proven to improve health outcomes. Ellwood’s work with the Nixon administration culminated in the passage of the Health Maintenance Organization Act of 1973. The result was a dramatic change to the landscape of health care in the United States: the proliferation of HMOs, Preferred Provider Organizations (PPOs), and Independent Provider Associations (IPAs) alongside traditional fee-for-service arrangements.
Human milk oligosaccharide
HMOs are used as supplements in baby food to ensure a provision of babies that are not being breastfed with this important component of the human milk.
Eosinophil peroxidase
The protein contains only a single modular domain. In this respect it is primarily a metabolic enzyme or terminal effector; it has little role in cellular signalling pathways. The overall structure of the four mammalian heme peroxidases (MPO, LPO, EPO and TPO) is almost identical. However, MPO is unique in existing as a catalytic dimer bridged by a disulphide bond. One of the first aspects known of eosinophil peroxidase was that it was highly cationic, as indicated by its high isoelectric point (see Protein). Eosinophil peroxidase has not been characterized by X-ray crystallography. However, a direct correspondence between the absorption spectra of EPO, TPO and LPO as well as high sequence similarity allows us to compare the properties of the three. Myeloperoxidase's characteristics are somewhat different, owing to its multimerization state as well as its alternative heme linkage. Further, a homology model has been created for EPO based on the X-ray diffraction structure.
David Cutler
In summary, movement from adverse selection and adverse retention is minimal, but it is highly correlated and concentrated in the older and less healthy population, favoring HMO plans by their lower premiums and economic stability. Overall, adverse selection and retention are not critical factors in adjusting risk for health care plans, but demographics such as sex and age seem to be significant in spending patterns and differences in plan choices.
Dental insurance
In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.
Group purchasing organization
Non-profit GPOs are similar to regular GPOs, but they are typically made of up a board of non-profit, community-based organizations working together to help lower their costs.
Privy Council Office (Canada)
The Privy Council Office's role is different from that of the Prime Minister's Office, which is a personal and partisan office. It is understood that the Prime Minister should not receive advice from only one institutionalized source. To that end, the PCO serves as the policy-oriented but politically-sensitive advisory unit to the Prime Minister, while the PMO is politically-oriented but policy-sensitive.
House in multiple occupation
All HMOs must be registered and must comply with certain standards and obligations.
Linda Peeno
Following employment as a medical reviewer for Humana and medical director at Blue Cross/Blue Shield Health Plans, she became a critic of how U.S. HMOs drive profits through denial of care.
Hippo signaling pathway
The Hippo pathway consists of a core kinase cascade in which Hpo phosphorylates the protein kinase Warts (Wts). Hpo (MST1/2 in mammals) is a member of the Ste-20 family of protein kinases. This highly conserved group of serine/threonine kinases regulates several cellular processes, including cell proliferation, apoptosis, and various stress responses. Once phosphorylated, Wts (LATS1/2 in mammals) becomes active. Misshapen (Msn, MAP4K4/6/7 in mammals) and Happyhour (Hppy, MAP4K1/2/3/5 in mammals) act in parallel to Hpo to activate Wts. Wts is a nuclear DBF-2-related kinase. These kinases are known regulators of cell cycle progression, growth, and development. Two proteins are known to facilitate the activation of Wts: Salvador (Sav) and Mob as tumor suppressor (Mats). Sav (WW45 in mammals) is a WW domain-containing protein, meaning that this protein contains a sequence of amino acids in which a tryptophan and an invariant proline are highly conserved. Hpo can bind to and phosphorylate Sav, which may function as a scaffold protein because this Hpo-Sav interaction promotes phosphorylation of Wts. Hpo can also phosphorylate and activate Mats (MOBKL1A/B in mammals), which allows Mats to associate with and strengthen the kinase activity of Wts.
Perceived psychological contract violation
Both PPCV and perceived organizational support (POS) are based on the norm of reciprocity. Both POS and PPCV are types of social exchanges and therefore involve implicit obligations, rather than economic exchanges, which involve explicit obligations (Blau, 1964; Emerson, 1972). Perceived organizational support is focused on favorable treatment and the degree to which employees engage in positive reciprocity with the organization, whereas PPCV is focused on unfavorable treatment and the degree to which employees engage in negative reciprocity with the organization.
Genetically modified organism
The definitions focus on the process more than the product, which means there could be GMOS and non-GMOs with very similar genotypes and phenotypes. This has led scientists to label it as a scientifically meaningless category, saying that it is impossible to group all the different types of GMOs under one common definition. It has also caused issues for organic institutions and groups looking to ban GMOs. It also poses problems as new processes are developed. The current definitions came in before genome editing became popular and there is some confusion as to whether they are GMOs. The EU has adjudged that they are changing their GMO definition to include "organisms obtained by mutagenesis". In contrast the USDA has ruled that gene edited organisms are not considered GMOs.
Accountable care organization
ACOs are composed mostly of hospitals, physicians and other healthcare professionals. Depending on the ACO's level of integration and size, providers may include health departments, social security departments, safety net clinics and home care services. The various providers within an ACO work to provide coordinated care, align incentives and lower costs. ACOs are different from HMOs in that they allow providers much freedom in developing infrastructure. Any provider or provider organization may assume the leadership role.
House in multiple occupation
Apart from the statutory definition of HMOs requiring a mandatory licence, Local Authorities have the power to introduce approved licensing schemes which include smaller HMOs as licensable. Typically these are for 3 or more tenants forming more than 1 household.
The Council Tax (Liability for Owners) Regulations 1992 provide a different definition of HMO that is used solely for determining Council Tax liability.
Methane monooxygenase
There are two well-studied forms of MMO: the soluble form (sMMO) and the particulate form (pMMO). The active site in sMMO contains a di-iron center bridged by an oxygen atom (Fe-O-Fe), whereas the active site in pMMO utilizes copper, although some propose that pMMO also uses iron. Structures of both proteins have been determined by X-ray crystallography; however, the location and mechanism of the active site in pMMO is still poorly understood and is an area of active research.
Interest-only loan
Interest-only securities are sometimes generated artificially from structured securities, particularly CMOs. A pool of securities (typically mortgages) is created, and divided into tranches; the cash received from the underlying debts are spread through the tranches according to predefined rules. An Interest-only (IO) security is one type of tranche that can be created, it is generally created in tandem with a principal-only (PO) tranche. These tranches will cater to two particular types of investors, depending on whether the investors are trying to increase their current yield (which they can get from an IO), or trying to reduce their exposure to prepayments of the loans (which they can get from a PO). The investment returns on IOs and POs depend heavily on mortgage prepayment rates and permit investors to benefit from different prepayment expectations.
For-profit hospital
Detractors, however, claim that the relative success of for-profit medical providers arises from their positioning themselves in the medical marketplace in such a manner as to offer mainly profitable care services for a largely affluent and insured clientele whilst avoiding unprofitable care areas. Critics thus claim, for example, that for-profit hospitals specialize in such highly lucrative fields as medical rehabilitation, elective/plastic surgery, and cardiology while avoiding provision of loss-making services such as emergency medicine which in turn caters mainly to the indigent. Analogously, critics of for-profit HMOs argue that such firms disproportionately insure healthy people, while simultaneously eschewing chronically ill patients, who must then by default be cared for disproportionately by public insurance schemes and non-profit providers—thus a so-called "dumping" of undesirable patients.
Preferred provider organization
A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as be billed at a reduced rate when its insureds utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all insureds in the organization will use only providers who are members. PPOs have gained popularity because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.
High performance organization
The most apparent difference in the organizational design of HPOs is their reliance on teamwork. Teams operate semi-autonomously to set schedules, manage quality, and solve problems. These self-directed work teams thrive off of information sharing from all levels of the organization and are multi-skilled with the flexibility to solve problems without the need of direct supervision. Members of self-directed work teams have been shown to have greater job satisfaction, more autonomy and idea input, and improved work variety. These teams are often small in number, typically ranging from 7–15 members. Members of these teams share complementary skills and membership is often cross-functional. In order for these teams to truly operate at high performance, they must buy into the teamwork framework. Team members who are part of high performance teams tend to have strong personal commitment to one another's growth and success, and to the organizations growth and success. The high sense of commitment exhibited by teams in a high performance organization allow these teams to have a better sense of purpose, more accountability, and more actionable goals which allows them greater productivity. High performance teams move through the same stage development framework, which was popularized by Tuckman, as other teams. They must be guided by a competent leader through the stages until they are ready to truly operate at high performance.
Papaye Peasant Movement
MPP focuses on re-establishing food sovereignty in Haiti through a number or programs and methods which include educating people on sustainable farming methods and organizing skills. While these are the primary foci of MPP, the organization has expanded to provide a plethora of other services to its members, including legal aid, health care services, and university scholarships. The movement seeks to empower peasants to control their own livelihood, thus decreasing dependency on multinational organizations which have flooded the Haitian agricultural market in recent decades.
Point-to-Point Protocol over Ethernet
PPPoE hoped to merge the widespread Ethernet infrastructure with the ubiquitous PPP, allowing vendors to reuse their existing software and deliver products in the very near term. Essentially all operating systems at the time had a PPP stack, and the design of PPPoE allowed for a simple shim at the line-encoding stage to convert from PPP to PPPoE.
Cartagena Protocol on Biosafety
LMOs intended for direct use as food or feed, or processing (LMOs-FFP) represent a large category of agricultural commodities. The Protocol, instead of using the AIA procedure, establishes a more simplified procedure for the transboundary movement of LMOs-FFP. Under this procedure, A Party must inform other Parties through the Biosafety Clearing-House, within 15 days, of its decision regarding domestic use of LMOs that may be subject to transboundary movement.
Vial of Life
Another important directive is a legal document called the Health Care Power of Attorney (HCPOA) which designates a person to make medical decisions in the event the patient is no longer able to express their own preferences - due to illness or unconsciousness. This legal document generally requires notarized signatures of the patient and one of more witnesses to the patient's signature. Unlike the physician orders (DNR, MOST, POLST) the HCPOA will generally include a listing of various patient preferences for receiving or declining medical treatment. In some jurisdictions - the HCPOA may not carry the same weight with emergency responders (EMTs) because EMTs may not know what form is required for the HCPOA document to be legally binding and the HCPOA may be a multipage document using legal language not understood by the EMT.
Point-to-Point Protocol over Ethernet
In this alternative technology, PPPoE is merely a means of connecting DSL-modems to an Ethernet-only router (again, or to a single host PC). Here it is not concerned with the mechanism employed by an ISP to offer broadband services.
High performance organization
The high performance organization (HPO) is a conceptual framework for organizations that leads to improved, sustainable organizational performance. It is an alternative model to the bureaucratic model known as Taylorism. There is not a clear definition of the high performance organization, but research shows that organizations that fit this model all hold a common set of characteristics. Chief among these is the ability to recognize the need to adapt to the surroundings that the organization operates in. High performance organizations can quickly and efficiently change their operating structure and practices to meet needs. These organizations focus on long term success while delivering on actionable short term goals. These organizations are flexible, customer focused, and able to work highly effectively in teams. The culture and management of these organizations support flatter hierarchies, teamwork, diversity, and adaptability to the environment which are all of paramount success to this type of organization. Compared to other organizations, high performance organizations spend much more time on continuously improving their core capabilities and invest in their workforce, leading to increased growth and performance. High performance organizations are sometimes labeled as high commitment organizations.
Point-to-Point Protocol over Ethernet
PPPoE over GPON is reportedly used by retail service providers such as Internode of Australia's National Broadband Network, Romania's RCS & RDS (for their "Fiberlink" customers — GPON is sold as Ethernet ports in MDUs)., Orange France and Philippines' Globe Telecom. Verizon's FIOS product uses DHCP in some states and PPPoE in others.
HPO formalism
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HMO (disambiguation)
HMO or hmo may also refer to:
Direct public offering
Direct public offerings are often viewed as a type of investment crowdfunding; but unlike the offerings made under crowdfunding exemptions (Title III of the federal JOBS Act or similar state laws), DPOs are typically registered at the state level and undergo some degree of regulatory scrutiny. DPOs also generally offer more flexibility in marketing and soliciting investors for the offering than exempt crowdfunding offerings.
House in multiple occupation
HMOs are somewhat cheaper than a one bedroom flat with a room for tenants. When comparing the average tenant from an HMO and the average tenant from a one bed flat, the HMO tenant could save £1608 more over the year. HMO agreements often include most utility bills with the rent. This is because it is difficult for landlords to apportion the cost of bills to each tenant fairly and it is also more appealing to potential tenants.
West Midlands Police
Officers from the OMU manage their assigned PPOs under two strands. One consists of rehabilitation and resettlement under which partner agencies are involved in an effort to halt re-offending whilst the other consists of catching and convicting offenders who have been identified as not participating in rehabilitation programmes or are wanted for outstanding crimes.
Patient Protection and Affordable Care Act
Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO. Also, unlike HMOs, ACOs must achieve quality of care goals.
HPO
HPO may refer to:
Exclusive provider organization
The beneficial relationship between medical care providers and the insurer often transfers to the insured subscriber because lower rates of medical services means lower rates of increase in monthly premiums. Although a good deal, the downside of EPOs is that they can be quite restrictive. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside of the network for covered care. For example, going to a hospital outside of the network in an emergency, one may have to pay the medical bills partially or completely out-of-pocket.
Private cable operator
A private cable operator (also known as PCO) is a private small independent cable company competing directly with Multi system operators (MSO). PCOs typically offer services to multi-family dwellings, gated communities, hotels and other small businesses. In some small municipalities in the city may be a PCO.
House in multiple occupation
HMOs do not need to be licensed if they are managed or owned by a housing association or co-operative, a council, a further education institute or student housing provider, a health service or a police or fire authority.
Preferred provider organization
In health insurance in the United States, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
Managed care
An Independent Practice Association is a legal entity that contracts with a group of physicians to provide service to the HMO's members. Most often, the physicians are paid on a basis of capitation, which in this context means a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care. The contract is not usually exclusive so individual doctors or the group may sign contracts with multiple HMOs. Physicians who participate in IPAs usually also serve fee-for-service patients not associated with managed care.
Human milk oligosaccharide
This protective function of the HMOs is activated when in contact with specific pathogens, such as certain bacteria or viruses. These have the ability to bind themselves to the glycan receptors (receptors for long chains of connected sugar molecules on the surface of human cells) located on the surface of the intestinal cells and can thereby infect the cells of the intestinal mucosa. Researchers have discovered that HMOs mimic these glycan receptors so the pathogens bind themselves to the HMOs rather than the intestinal cells. This reduces the risk of an infection with a pathogen.
In addition to this, HMOs seem to influence the reaction of specific cells of the immune system in a way that reduces inflammatory responses. It is also suspected that HMOs reduce the risk of premature infants becoming infected with the potentially life-threatening disease necrotizing enterocolitis (NEC).
Houston Police Department
After completing the Field Training Program, PPOs are partnered with mentor officers for approximately 4 months.Their first assignment after completing Field Training is a Patrol Officer. The Mentor Program is not a graded or pass/fail program. Instead, it is designed to give PPOs additional guidance before they are allowed to patrol on their own after their probationary period.
Health maintenance organization
In the network model, an HMO will contract with any combination of groups, IPAs (Independent Practice Associations), and individual physicians. Since 1990, most HMOs run by managed care organizations with other lines of business (such as PPO, POS and indemnity) use the network model.
Political positions of Rand Paul
Paul, a medical doctor who practiced ophthalmology prior to seeking political office, opposes federal government involvement in healthcare. He has stated that he would repeal the HMO Act of 1973 that "drives a wedge between the patient and his doctor". He believes that government has driven up the cost of healthcare and causes the quality and coverage to decrease. Paul would support a free-market approach to health care, including tax deductions for medical expenses. He opposes federal regulations discouraging businesses from providing coverage. He supports Health Savings Accounts (HSAs). On Medicare, Paul has suggested higher deductibles as well as changes to premiums or eligibility rules as ways to address what he sees as the program's looming financial problems, saying "You want to have more participation by the person who's receiving the entitlement... by that I mean that they need to be more involved with some sort of economic transaction every time they use their entitlement, and that means they have to bear more of the burden." Paul also stated that he does not support such changes for current retirees or people nearing retirement.
Point-to-Point Protocol over ATM
The use of PPPoA over PPPoE is not geographically significant; rather, it varies by the provider's preference.
HPO formalism
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Health insurance in the United States
Network-based plans may be either closed or open. With a closed network, enrollees' expenses are generally only covered when they go to network providers. Only limited services are covered outside the network—typically only emergency and out-of-area care. Most traditional HMOs were closed network plans. Open network plans provide some coverage when an enrollee uses non-network provider, generally at a lower benefit level to encourage the use of network providers. Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans.
High performance organization
The roles of managers in an HPO are also reinvented. Traditional models for organizations would have leaders closely monitor or supervise their teams. Team leaders in HPOs are more concerned with long term strategic planning and direction. They take a more hands off approach and their titles reflect this change in responsibility. Leaders in HPOs trust in their employees to make the right decisions. They act as a coach to their team members by giving them support and keeping them focused on the project at hand. These leaders are able to lead depending on the situation and have the capability to adjust their leadership style based upon the needs of their team members. They know when to inspire people with direct communication and also have the ability to read when a more hands off approach is necessary. Although these leaders act with a hands-off approach, they hold non-performers accountable for not reaching their goals.
HPO formalism
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Breast milk
Breast milk contains a unique type of sugars, human milk oligosaccharides (HMOs), which are not present in infant formula. HMOs are not digested by the infant but help to make up the intestinal flora. They act as decoy receptors that block the attachment of disease causing pathogens, which may help to prevent infectious diseases. They also alter immune cell responses, which may benefit the infant. To date (2015) more than a hundred different HMOs have been identified; both the number and composition vary between women and each HMO may have a distinct functionality.
Communist Party of the Soviet Union
The primary party organization (PPO) was the lowest level in the CPSU hierarchy. PPOs were organized cells consisting of three or more members. A PPO could exist anywhere; for example, in a factory or a student dormitory. They functioned as the party's "eyes and ears" at the lowest level and were used to mobilize support for party policies. All CPSU members had to be a member of a local PPO. The size of a PPO varied from three people to several hundreds, depending upon its setting. In a large enterprise, a PPO usually had several hundred members. In such cases, the PPO was divided into bureaus based upon production-units. Each PPO was led by an executive committee and an executive committee secretary. Each executive committee is responsible for the PPO executive committee and its secretary. In small PPOs, members met periodically to mainly discuss party policies, ideology or practical matters. In such a case, the PPO secretary was responsible for collecting party dues, reporting to higher organs and maintaining the party records. A secretary could be elected democratically through a secret ballot, but that was not often the case; in 1979, only 88 out of the over 400,000 PPOs were elected in this fashion. The remainder were chosen by a higher party organ and ratified by the general meetings of the PPO. The PPO general meeting was responsible for electing delegates to the party conference at either the district- or town-level, depending on where the PPO was located.
UnitedHealth Group
UnitedHealthcare Choice functions as a HMO plan with access to specialists, whereas UnitedHealthcare Choice Plus is an HMO which allows for out-of-network coverage.
Primary health organisation
The Government introduced PHOs, which were similar to the IPAs, in 2001, with the first PHOs being formed in July 2002. There were 81 PHOs by 2010 but some have since merged.
Health insurance in the United States
Over time, the operations of many Blue Cross and Blue Shield operations have become more similar to those of commercial health insurance companies. However, some Blue Cross and Blue Shield plans continue to serve as insurers of last resort. Similarly, the benefits offered by Blues plans, commercial insurers, and HMOs are converging in many respects because of market pressures. One example is the convergence of preferred provider organization (PPO) plans offered by Blues and commercial insurers and the point of service plans offered by HMOs. Historically, commercial insurers, Blue Cross and Blue Shield plans, and HMOs might be subject to different regulatory oversight in a state (e.g., the Department of Insurance for insurance companies, versus the Department of Health for HMOs). Today, it is common for commercial insurance companies to have HMOs as subsidiaries, and for HMOs to have insurers as subsidiaries (the state license for an HMO is typically different from that for an insurance company). At one time the distinctions between traditional indemnity insurance, HMOs and PPOs were very clear; today, it can be difficult to distinguish between the products offered by the various types of organization operating in the market.
Council of governments
CoGs may either be distinct from—or encompass—regional Metropolitan Planning Organizations (MPOs) and Rural Transportation Planning Organizations (RTPOs). MPOs are multi-governmental urban transportation planning entities that arose out of the requirements of the Federal-Aid Highway Act of 1962, which made federal financing for urban transportation projects contingent upon the existence of a "continuing, comprehensive, urban transportation planning process undertaken cooperatively by the states and local governments". RTPOs are bodies similar to, and inspired by the model of MPOs, but organized for rural areas. Though RTPOs existed for decades, they were only formally recognized by on a federal level by the Moving Ahead for Progress in the 21st Century Act (MAP-21) of 2012. Of the 556 CoGs in the US, 165 operate an associated MPO, and 265 operate an associated RTPO.
Health insurance in the United States
A "health maintenance organization" ("HMO") is a type of managed care organization (MCO) that provides a form of health care coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options. Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. Benefits are provided through a network of providers. Providers may be employees of the HMO ("staff model"), employees of a provider group that has contracted with the HMO ("group model"), or members of an independent practice association ("IPA model"). HMOs may also use a combination of these approaches ("network model").
David Cutler
Although there is little difference in terms of selection effects between HMOs and FFS since the enrollee pays a small portion of marginal costs, Cutler contends that adverse selection (less-healthy individuals moving from more restrictive HMO to less-restrictive and more-costly FFS plans) has a greater impact than adverse retention on enrollees' choice of health plans.