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A Health Maintenance Organization

2. According to an essay published online by the United States Department of Health and Human Services, one of the goals of managed care HMOs contracting with IPAs is to prevent the potential overuse of health care specialists. Traditional HMOs permit access to specialists only with authorization from a primary care provider acting as a gatekeeper. According to a recent study, individuals who have direct access to specialists in their HMOs do not make more visits to specialists than individuals enrolled in gatekeeper HMOs. According to this essay, the rules governing the gatekeeper's role in an HMO may actually encourage additional visits to the primary care physician and to specialists. The rationale is simple: the more visits one has to a primary care physician, the more opportunities one has to get a referral to a specialist. Thus, the Managed Care IPA model may actually strain rather than reduce the strain on both primary care services and the visits made to specialists (Health Care Costs and Financing, 2000).

3. According to an essay published online by the National Cancer Institute, transitional care can be defined as that which is required to facilitate a shift from one stage of care to another. For example, as a disease progresses, a patient may require vastly different levels of treatment within increasingly specialized, costly and comprehensive forms of treatment. For an increasing numbers of patients enrolled in HMOs with a goal of showing a profit, managed care results in challenges in transitioning from routine to specialized health care services (Transitional Care Planning, 2005).

Managed Care IPAs tend to try to emphasize disease prevention and health education, eliminate the paperwork, and lower the cost of medical services. Members of managed care plans usually do not have claims forms, and they have few out-of-poc


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A Health Maintenance Organization. (1969, December 31). In Retrieved 20:38, November 28, 2015, from
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