Who acts as the gatekeeper in a health maintenance organization HMO?

Asked by: Rudolph Koch  |  Last update: February 11, 2022
Score: 5/5 (19 votes)

People with Medicare can choose to get their Medicare benefits through an HMO. HMO members must choose a primary care physician (PCP) who coordinates their care and acts as a gatekeeper to their care.

What is the role of the gatekeeper in an HMO plan?

Anyone who receives health insurance coverage in the form of a managed care plan, specifically a health maintenance organization (HMO) plan, is assigned a gatekeeper or allowed to choose one. ... This means that the gatekeeper is in charge of authorizing the patient's referrals, hospitalizations, and lab studies.

What is a gatekeeper in healthcare?

Gatekeeping is the term used to describe the role of primary care physicians or general practitioners (GPs) in authorising access to specialty care, hospital care, and diagnostic tests. 1 Gatekeeping has crucial influences on service utilisation, health outcomes, healthcare costs, and patient satisfaction.

Is HMO gatekeeper or open access?

HMO (Health Maintenance Organization): The primary care physician is the gatekeeper. He alone refers patients to specialists. There is not usually out-of-network coverage available. POS (Point of Service): The primary care physician as the gatekeeper.

Is HMO a gatekeeper open access or combination of both?

Open-access and point-of-service (POS) products are a combination of an HMO and traditional indemnity plan. The member(s) are not required to use a gatekeeper or obtain a referral before seeing a specialist. In that case, the traditional benefits are applicable.


28 related questions found

Who started HMO?

The Health Maintenance Organization Act, also known as the HMO Act, is a U.S. federal law enacted under President Richard Nixon on December 29th, 1973. The act is stated in bill S. 14 of Public Law 93-222 and defines qualifications for HMOs.

What is a gatekeeper and why are they important?

A gatekeeper is a person who controls access, either to someone in authority or to information. Gatekeepers can also decide whether a message will be spread to a wider audience. Assistants, receptionists and secretaries can act as gatekeepers.

What is an example of a gatekeeper?

The definition of a gatekeeper is a person who controls access to something or someone. A secretary who controls who gets an appointment with a president of the company is an example of a gatekeeper.

What is the gatekeeper concept?

The Concept of Gatekeeping:

The gatekeeper decides what information should move past them (through the information “gate”) to the group or individuals beyond, and what information should not. Gatekeepers are the at a high level, data decision makers who control information flow to an entire social system.

Who is the gatekeeper in terms of some managed care organizations to aid in cost control quizlet?

A primary care physician ("gatekeeper") authorizes all the services provided. Provide two distinct tiers of coverage. When subscribers use the PPO's preferred provider network, the required cost sharing with deductibles or coinsurance is lower than that of out-of-network providers.

What is the purpose of the gatekeeper in an HMO quizlet?

Most HMOs rely on the primary-care physician, or "gatekeeper," to screen patients seeking medical care and effectively eliminate costly and sometimes needless referral to specialists for diagnosis and management.

Is there a gatekeeper in US healthcare?

During the past 20 years, formal gatekeeping (physicians authorising referrals to specialists) proliferated in tandem with the growth of health maintenance organisations. Currently 38% of the US population has a primary care physician who acts as a formal gatekeeper.

Should the primary care provider act as a gatekeeper in care coordination?

We need PCPs because they refer patients to specialists and help coordinate care. They are the gatekeepers." ... In healthcare, primary care physicians, who are on the front line of medical care, serve in the gatekeeper role, providing access to specialists and coordinating patient care.

What is the gatekeeper of the cell?

Membrane proteins, the gatekeepers of cells, have been implicated in neurotransmission, sensing, and transport of nutrients and drugs into and out of cells.

Who can be a gatekeeper quizlet?

Terms in this set (9)

gatekeepers are people in positions of authority in the mass media, editors, producers, talent scouts etc. they're in charged for example of what song gets played on a radio station, what stories are on the front pg of the newspaper etc.

What is the gatekeeper model used by managed care plans quizlet?

What is the gatekeeper model used by managed care plans? An HMO enrollee chooses a primary care physician, who then controls the enrollee's diagnostic and specialist referrals.

Who propounded gatekeeping?

Currently, the gatekeeping theory also addresses face-to-face communication and the many-to-many dynamic inherent on the Internet. Social psychologist Kurt Lewin first instituted Gatekeeping theory in 1943.

What is another word for gatekeeper?

In this page you can discover 14 synonyms, antonyms, idiomatic expressions, and related words for gatekeeper, like: , sentinel, guard, porter, sentry, watchman, hall-porter, ostiary, CSDs, go-between and doorkeeper.

What are the factors influencing gatekeeping?

The factors that influence gatekeeping are:
  • Individual: Journalist who creates the report is the person who is the most influential to make the news article. ...
  • Routine: The themes shown in the news and other media is always in a pattern. ...
  • Organization: ...
  • Extra-Media: ...
  • Ideology:

Who are the gatekeepers in corporate governance?

Coffee (2006) lays out three criteria that define a gatekeeper as an independent professional who: (1) acts as reputational intermediary between the corporation and investors, (2) is positioned to prevent wrongdoing, and (3) is susceptible to significant reputational capital to depreciation or depletion if he or she ...

What is a gatekeeper in public relations?

Gatekeeping is “the process by which selections are made in media work, especially decisions whether or not to admit a particular news story to pass through the “gates” of a news medium into the news channels” (McQuail, 1994, p.

Who is a gatekeeper audience?

Gatekeeper Audience

A gatekeeper is a person within an organization that can prevent your message from reaching the intended recipient. In some cases, a gatekeeper may exist outside of the organization, for example, an editor with a trade journal who controls what press releases will be printed.

How do you deal with gatekeepers?

Here are a few ways to make a good impression with the gatekeeper.
  1. Treat the gatekeeper with respect. Most gatekeepers are highly respected within the firm. ...
  2. Keep your cool. ...
  3. Speak with confidence. ...
  4. Be friendly. ...
  5. Use the executive's first name. ...
  6. Be honest. ...
  7. Don't sell to the gatekeeper. ...
  8. Ask to leave a voicemail.

What is the significance of gatekeeping in regard to primary care and keeping health care costs down?

Explain the significance of gatekeeping in regards to primary care and keeping health care costs down. Gatekeeping lowers costs by eliminating unnecessary trips to specialists and incurring higher prescription costs and health assessment expenses.

What is a gatekeeper in leadership?

The construct of gatekeeper, from which the term “gatekeeping leadership” has evolved, is defined as an individual's ability to frequently engage in both internal and external communication (Allen, 1977) and perform both kinds of communication effectively.