01.Core Concepts

HMOs place heavy emphasis on controlling costs A common method to pay network physicians is modified fee-for-service, where payments are based on a negotiated fee schedule Providers may receive a capitation fee, which is a fixed annual payment for each plan member regardless of the frequency or type of service provided Some employers have banded together to form purchasing cooperatives to obtain more favorable prices A gatekeeper physician is a primary care physician who determines whether medical care from a specialist is necessary ‹#›