• iHMO/Managed Care

    Health Insurance

    WHAT IS AN HMO?

    HMO stands for “Health Maintainence Organization”, two examples being United Healthcare, and Humana.  HMO’s are a big part of the US Healthcare System. Some say the these organizations should not be called “Healthcare Maintainence Organizations“, but rather “Price Maintainence Organizations”. This may be somewhat accurate, because, naturally, any business’s aim is profit. But, in these days of the digitalization of medicine, both Medicine and HMO may find themselves aligned in a certain ways.
    HMO’s provide medical insurance, with certain restrictions.  Some may restrict which doctor the patient sees.  Some may require the patient to go to a primary care physician to get a referral, if that patient needs to see a specialist.  The medical care is managed differnet ways.  PPO’s, or Preferred provider organizations, are becoming more popular nowadays, because although more expensive medical insurance, it provides more flexibility, as as far as other types of  medical insurance.
    First, let us see in the following video, an excellent, easily understood history of medical insurance in the USA, and  what HMO’s are, and how they came about

    Health Maintenance Organizations Aiding the Digitalization of Medicine by Providing “Big Data”, and Promoting Wellness

    HMO’s are co-operating partners, possibly accidentally and coincidentally, with the Healthcare profession..  One way in which HMO’s helps the healthcare community is by sharing health data of their patients, what is called “Big Data”.   (SOURCE)  Analysis of Big Data occurs in gambling, and sports, and it is starting to be widely used in the health care industry, and HMO’s are aiding these efforts.

    What is happening both in Internet Medicine and HMO’s is that they both have a common end; the well-being of the patient.  Internet Medicine strives to do so with effective application of traditional medical practice, and new digital tools, with an increasing emphasis on prevention and wellness.  HMO’s agree, because of the profit motive, on a goal of wellness, and prevention to attain well-being especially for the repeated care of the big five chronic illnesses; diabetes, stroke, heart disease, pulmonary conditions, and hypertension…”  (SOURCE).  And, if those big five can be lessened by focusing on wellness and prevention, everyone wins, especially the patient.  Healthcare gets better, health costs go down.  Win, Win.

    See the following video of the CEO of Humana, Mike McCallister, discussing this approach of his HMO:

    Mr McCallister stresses that a fact known to many doctors; that most diseases are caused by patients themselves, leading unhealthy lifestyles; smoking, drinking, eating excessively, and the wrong foods, not exercising, etc, and that these continued behaviors only overloads the healthcare system, and contributes to skyrocketing healthcare costs.

    Furthermore, he says, “…With electronic medical information readily available to provider and patient, more efficient and cost-effective decisions may be made by healthcare providers…”. The patient has to get involved in a long term goal of good health, by changing behaviors, and he hopes that HMOs, like Humana, can give incentives to lead patients to do so. In this fashion, the numbers of the “big five” will decrease, and healthcare costs will also decrease.

    Finally, he says something, that also may apply to the aversion of some doctors to adopt EMR’s:

    “This is hard work because it really, fundamentally, requires a cha

     

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