Health Care Models

Managed Care

Health care plans that provide coordinated care through a network of providers for preset payments.

Fee for Service (FFS)

Traditional insurance plan where providers are paid for each service performed; patients can generally choose any provider.

Capitation

Providers receive a fixed per-member, per-month payment regardless of the number of visits, encouraging preventive care and cost control.

Health Maintenance Organization (HMO)

Requires a PCP, referrals to specialists, and usually preauthorization; care is provided through a network with lower costs.

Preferred Provider Organization (PPO)

No PCP or referrals required; patients can use in- or out-of-network providers, but in-network care costs less.

Point-of-Service (POS) Plan

PCP and referrals required, but patients can choose in- or out-of-network providers, with lower costs for in-network care.