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Phone: (732) 292-1100
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Email: info@themcic.com

Hot Off The Press

Majority of For-Profit HMOs Are Organized Into Network Models

Manasquan, N.J. -- Network model HMOs are more likely to be for-profit than any other type of HMO, according to a new exclusive study by The Managed Care Information Center.

Some 75 percent of network/mixed model HMOs, 67 percent of network model HMOs, 67 percent of network/staff model HMOs and 63 percent of network/group model HMOs are for-profit, found the study, which was based on data collected for The National Directory of Managed and Integrated Care Organizations.

On the other hand, only 39 percent of staff model HMOs and 40 percent of staff/IPA model HMOs are for-profit. Forty-three percent of group model HMOs are for-profit, 57 percent of IPA/network model HMOs are for-profit and 59 percent of IPA/group model HMOs are for-profit.

HMOs are more likely to be organized into an IPA model structure than any other kind of model. Some 49.8 percent of HMOs are IPA. In a distance second, 13.7 percent of HMOs are network model HMOs, 12.4 percent are mixed model HMOs, 11.7 percent are group model HMOs and 5.5 percent are staff model HMOs. The remaining HMOs are some type of combination between the various HMO models.

The trend among newer organizations is to organize as network, IPA and group models.

Eighty-eight percent of network models were founded after 1976, some 55.8 percent of which were founded after 1986. And, 81.5 percent of IPA models were founded after 1976; 50.8 percent of which were founded after 1986. More than 71 percent of group models were founded after 1976.

On the other hand, 63 percent of staff models were founded before 1986.

Network model plans tend to have larger provider networks. The average network model plan has 2,081.5 primary care physicians (PCPs), 3,351.7 specialists and 99.3 hospitals. Staff and group model plans, on the other hand, tend to have less comprehensive networks. The average staff model plan has 461.4 PCPs, 1,371.9 specialists and 27.6 hospitals, while the average group model plan has 854.4 PCPs, 867.6 specialists and 25.3 hospitals. IPA model plans have an average 1,821.3 PCPs, 2,136.4 specialists and 39.3 hospitals.

Staff model plans are more likely to be integrated than any other type of model -- 39 percent of staff model plans reported that they are part of an integrated delivery system (IDS). Thirty-five percent of group model plans reported that they are part of an IDS. And, 25.8 percent and 15 percent of IPA and network model plans, respectively, said they were part of an IDS.

For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail info@themcic.com or online at http://www.themcic.com.


For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail info@themcic.com or online at http://www.themcic.com.

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