The Case Manager's Handbook: Chapter 2

Question 1

Deferentiate between HMO and PPO.

Answer 1

A health maintenance organization (HMO) is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals and other entities in the United States acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.
U.S. health services insurance preferred-provider organization

Question 2

Define managed care organization (MCO)

Answer 2

generic term that encompasses a variety of managed care plan types, such as an HMO, PPO, IPA, IDS, or EPO.

Question 3

Define IPA

Answer 3

a group holding a contract with managed care plan to provide serices in return for a single capitation rate