How does a health maintenance organization (HMO) typically operate?

Health maintenance organizations (HMOs) typically operate by requiring members to select a primary care physician (PCP) who serves as their main point of contact for healthcare needs. This structure is integral to the HMO model because it promotes coordinated care, encourages preventive services, and helps manage patient health more effectively. The primary care physician not only provides routine check-ups and treatment for common illnesses but also acts as a gatekeeper for access to specialized services. If a member requires further care from a specialist, they usually must obtain a referral from their PCP. This system helps control costs for the organization while ensuring that care is managed in a cohesive manner.

This focus on a primary care physician differentiates HMOs from other types of health plans that might allow members more direct access to specialists or cover out-of-network services with different rules. In contrast to an HMO's approach, some plans might provide broader access to various healthcare providers without the need for a referral or a designated primary care provider, thus demonstrating the unique functioning of HMOs within the healthcare landscape.