What is an Open Panel HMO?

An open panel HMO is a health maintenance organization that allows individual physicians to participate in the program through the auspices of an independent practice association. A physician who participates in an HMO is this manner is free to see patients who are not connected with the organization and is not committed to taking on a patient simply because he or she is with the HMO. This is in contrast to a closed panel HMO, in which the physician is directly linked to the HMO and is under contract to any and all HMO members who are assigned to the doctor by the organization.

An open panel HMO was not part of the original design for a health maintenance approach to healthcare coverage. The concept of the health maintenance organization dates to the early 1970’s in the United States. Initially, HMOs functioned as a means of providing in network health care. That is, persons covered under the terms of the HMO were assigned to specific doctors and were free to use any medical facilities that that had contracted with the HMO provider. In later years, the coverage was broadened to allow members to see any physician who had contracted with the HMO directly.

Open panel HMO structures began to appear in the 1980’s and 1990’s. There were several advantages to this arrangement for both patients and physicians. The patient was able to pay a fixed fee in exchange for quality medical care, and has the ability to choose from a wide range of physicians to be the primary care provider. This was in contrast to the earlier provision that in order for medical costs to be covered, the patient had to use only HMO contracted physicians and medical facilities.

For the physician, the open panel HMO meant it was no longer necessary to contract directly with the HMO in order to see patients with this type of coverage. He or she could simply contract with an intermediary group practice HMO association that had contracted with the HMO and be able to see HMO patients and be paid for services rendered. At the same time, the physician is still able to refuse any patient associated with the HMO if he or she feels the action is warranted, without incurring any censure. Doctors who wish to continue treating a patients outside the confines of a health maintenance organization often prefer to go with an open panel HMO arrangement.