Health Maintenance Organizations (HMOs) Internal Operations

HMO’s Internal Operations
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HMO’s Internal Operations
Health Maintenance Organizations (HMOs) are responsible for enhancing public health by making health care services affordable to many deserving clients. More importantly, HMOs must operate as efficient and skilled health insurers. They must perform various internal operations to achieve this fate, as illustrated below. First, HMOs must endeavor to provide and coordinate health care for all enrollees (Obikeze & Onwujekwe, 2020). To this end, they must manage their clients’ primary, preventative, acute, and chronic health care needs. They must also make specialist referrals for deserving patients and obtain pre-authorization for patients, thus making it easier for them to access high-quality and timely health care services when a need arises. Secondly, HMOs should hold a harmless clause in a contract. In this regard, HMO health care service providers must leverage contracts prohibiting them from billing patients&r...