Certified Nurse Manager and Leader (CNML) Practice Test

What is the primary function of Health Maintenance Organizations (HMOs)?

1. Provide specialized care for chronic illnesses

2. Offer comprehensive healthcare under a fixed fee

3. Facilitate access to out-of-network providers

4. Negotiate prices with pharmaceutical companies

The correct answer is: Offer comprehensive healthcare under a fixed fee

Health Maintenance Organizations (HMOs) primarily offer comprehensive healthcare services under a fixed fee. This model emphasizes preventive care and the management of overall health rather than just responding to illnesses as they arise. Members typically pay a monthly premium that covers a wide range of services, which may include doctor visits, hospital care, and preventive services, often with low or no copayments for in-network services. This structure encourages members to use services that promote health and well-being, as the costs are spread across a larger group, reducing the overall financial burden on individuals. The emphasis on coordination of care within a network of providers helps streamline treatment and can lead to improved health outcomes, as patients are more likely to receive regular preventive care and follow-up treatment. Options highlighting specialized care for chronic illnesses or facilitating access to out-of-network providers do not align with the primary function of HMOs, as these organizations focus on comprehensive care within a defined network. Similarly, while negotiating prices with pharmaceutical companies is beneficial, it is not the primary purpose of HMOs; their main aim is to manage healthcare costs and services effectively for their members.