Also known as Participating Medical Group, Primary Medical Group IPA PMG A partnership, association, corporation, or other legal entity which delivers or arranges for the delivery of health services and which has entered into a written services arrangement with health professionals, the majority of whom are licensed to practice medicine.
Under this structure, physicians practicing in their own offices participate in a prepaid, capitated healthcare plan. The physicians charge agreed upon rates to enrolled patients and bill the IPA on a fee-for-service basis.
A physician organization which typically contracts with an HMO to provide services to the HMO's enrollees. The HMO usually makes capitated payments to the IPA; however, the IPA may reimburse its physicians on a fee-for-service basis. Physicians are in solo practice and can contract with other HMOs and see other fee-for-service patients.
Organization of physicians who have joined together for purposes of contracting with HMO PPO s, or other payers. IPA physicians continue to practice in solo settings or in groups, maintain their offices and regular practices, and usually are reimbursed on a fee-for-service basis.
An HMO where doctors care for patients in their own offices, rather than a central location. See Group Model HMO, Network Model HMO, Staff Model HMO.
A type of HMO that contracts with sole practitioners in medicine, dentistry, and other health-care fields. From the patients' perspective, they receive network care when selecting among the affiliate providers. However, these practitioners may also serve fee-for-service patients. IPAs may pay their physicians fee for service or may capitate their physicians, but the physicians bear some degree of risk for medical expenses.
An organization comprised of individual physicians or physicians in small group practices that contracts with Managed Care Organizations on behalf of its member physicians to provide health care services.
An organization comprised of individual physicians or physicians in group practices that contracts with the insurer on behalf of its member physicians to provide healthcare services.
An "HMO without walls," in which patients choose doctors from a select list and are treated at the physicians' private offices. IPA physicians are free to contract with more than one HMO at a time and they can treat fee-for-service patients.
A partnership, association, or corporation that delivers or arranges for the delivery of health services and which has entered into a contract with health professionals, a majority of whom are licensed to practice medicine or osteopathy.
An HMO that contracts with individual doctors to serve its members. Payment is typically through capitation or a modified fee-for-service arrangement. IPA doctors may also treat patients with other types of insurance, and thus may not be financially dependent on the HMO.
A type of HMO that contracts with physicians who are in private practice (instead of groups) to provide services to patients in the physician's private office.
A legal entity or other group of providers that contract with managed care plans while maintaining their separate practice. A member who selects an IPA-affiliated primary care office generally will be referred to specialists and hospitals affiliated with the IPA, unless the member's medical needs extend beyond the capability of these providers. Network Physicians, hospitals and other health care providers who contract with the companies to participate in health benefits plans. For certain HMO and PPO plans, a member must access care through the network to receive the maximum level of benefits.
a group of physicians with separate offices who form an organization to contract, manage and share financial responsibilities for providing healthcare services to health plan members.
A health maintenance organization delivery model in which the HMO contracts with a physician organization, which, in turn, contracts with individual physicians. The IPA physicians practice in their own offices and continue to see fee-for-service patients. The HMO reimburses the IPA on a capitated basis; however, the IPA usually reimburses the physicians on a fee-for-service basis. This type of system combines prepayment with the traditional means of delivering health care.