What does the nurse understand is the focus of healthcare when a client receives services from a health maintenance organization (HMO)?
A) Avoiding coverage for needed services
B) Health promotion and maintenance
C) To offer discounted services to all patients
D) High-quality service and contain cost
B
Feedback:
If the HMO does not require much high-cost care, providers make money; if members use many high-cost resources, providers lose money. This method of financing provides the strongest incentives for limiting use of expensive services and focusing healthcare on health maintenance and promotion. If services such as diagnostic testing are required, the HMO will cover this and not avoid payment. Services are not discounted for patient's that are nonmembers or members. The goals of a physician hospital organization (PHO) are to maintain high-quality service and contain costs while fostering group contracts, collaboration, and capitation.
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