Assessing the impact of open-access HMOs on providers

Abstract

Open-access model HMOs, in which HMO members may seek specialty care without having to be referred by a primary care physician, have been hailed as the next major growth area for the managed care industry. This model is attractive to HMO members because it offers greater freedom in selecting and accessing providers. Payment mechanisms, though, tend to differ from those used by traditional gatekeeper model HMOs. The preferred method of payment in most open-access HMOs is to reimburse primary care physicians on a fee-for-service basis and capitate specialists. Open-access HMOs may lead to more restrictions for providers however, and their continued growth could lead to less desirable payment arrangements and weaker market positions. What types of payment and care delivery systems will ultimately result from open-access HMOs remain to be seen.