Kaiser Permanente still the no. 1 HMO: and tops among PPOs is Community Care Network.Kaiser Permanente still the No. 1 HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, Health maintenance organizations (HMOs) and preferred provider organizations pre·ferred provider organization n. Abbr. PPO A medical insurance plan in which members receive more coverage if they choose health care providers approved by or affiliated with the plan. (PPOs) continue to expand their grip on the Southland health care market, as this week's List of those two types of organizations shows (see page 26). HMOs and PPOs are "managed care" systems for paying for medical services. In HMOs, employers pay set monthly fees for each employee to the HMO. In turn, the employees go only to HMO doctors and clinics for health care, and have all medical needs taken care of, regardless of cost. Some HMOs have their own staff doctors and hospitals, such as industry giant Kaiser Permanente. Others contract with doctors and hospitals, such as Maxicare Health Plans Inc. In PPOs, employers send sick employees to groups of doctors and hospitals that have agreed to provide health care at agreed-upon rates. Both HMOs and PPOs conduct "utilization review u·til·i·za·tion review n. A process for monitoring the use, delivery, and cost-effectiveness of services, especially those provided by medical professionals. " studies of medical activities to determine whether services are being over-utilized. Both PPOs and HMOs are distinct from old-fashioned "fee-for-service" health insurance, in which patients go to doctors of their own choosing, who bill by their own rates. Because of their cost-saving features, both HMOs and PPOs are growing in the Los Angeles market. The largest HMO on this week's List, Kaiser Permanente, has 2.3 million members and operates 11 hospitals in California List of hospitals in California (U.S. state), grouped by county and sorted by hospital name. Alameda County
The No. 2 HMO is Woodland Hills-based Health Net, a fast-growing non-profit organization that split off from Blue Cross (the insurer) in 1985 and which now has plans before state regulators to convert into a for-profit organization. At the time of the survey, Health Net had 846,289 enrollees in the state, compared with 489,444 in late 1987. The Encino-based for-profit PacifiCare of California is the No. 3 HMO in the Southland. It is also fast-growing, with 709,000 enrollees, compared to 120,000 enrollees in late 1987. PacifiCare is an arm of the PacifiCare Health Systems PacifiCare Health Systems (former NYSE: PHS) was a Fortune 500 healthcare company based in Cypress, California. It was acquired by UnitedHealth Group (NYSE: UNH) in late 2005, which continues to market health plans under the PacifiCare name. Inc., a publicly traded company publicly traded company A company whose shares of common stock are held by the public and are available for purchase by investors. The shares of publicly traded firms are bought and sold on the organized exchanges or in the over-the-counter market. based in Cypress. Among PPOs, the Southland industry leader is the Woodland Hills-based Community Care Network, with 7.32 million members - although that number includes employees covered under a workers compensation program. The No. 2 PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there is the Huntington Beach-based Occupational-Urgent Care Health Services health services Managed care The benefits covered under a health contract Inc., with 1.92 million Southland members, also a for-profit concern. In the No. 3 spot is Physical Therapy Provider Network, a Woodland Hills-based for-profit outfit with 1.5 million Southland members. PHOTO : Terri Vanderschans: Top regional exec at Community Care Network, the No. 1 ranked PPO |
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