Which of the following BEST describes a 'staff model' HMO?

a.The HMO contracts with multiple independent physician practices, who continue to see non-HMO patients in private practice
b.Physicians are employees of the HMO itself and typically work in HMO-owned clinics, seeing only HMO members
c.Each member chooses any community physician and the HMO reimburses fee-for-service
d.The HMO is owned by the federal Medicare program

Explanation

HMO organizational models under the federal HMO Act and California Knox-Keene Act include: (1) STAFF model — physicians are W-2 employees of the HMO working in HMO-owned facilities; (2) GROUP model — the HMO contracts with one multi-specialty medical group, which may or may not see outside patients; (3) NETWORK model — the HMO contracts with multiple groups; (4) IPA (Independent Practice Association) model — the HMO contracts with an IPA whose individual physicians remain in private practice and see other patients. Option A describes the IPA model. Option C describes traditional indemnity, not an HMO. Option D is fabricated; HMOs are private (Medicare Advantage HMOs are private plans contracting with CMS, but the HMOs themselves are not federally owned). Staff-model HMOs are the most tightly integrated form.

Law Reference: California Health & Safety Code §1342 et seq. (Knox-Keene Act); HMO models

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