Health Maintenance Organizations are supposed to facilitate access to quality healthcare delivery to patients, but oftentimes managing them can be quite frustrating. From our experience, these are the top 10 HMOs in Nigeria and how hospitals can best reconcile them to improve patient satisfaction.

As a healthcare provider, it is probably expected that your healthcare facility collaborates with health maintenance organizations, popularly referred to as HMOs. 

I mean, it could even be a deal breaker for some patients, because of this collaboration, healthcare institutions have a better possibility of growing their patient inflow, and it also helps to affirm a hospital’s reliability. 

Let’s take a step back and get things straight first. 

What exactly is an HMO in Nigeria?

A health maintenance organization (HMO) is a private or public incorporated organization that has been registered by the National Health Insurance Plan to only oversee the provision of healthcare services through the program’s approved healthcare facilities. Currently, there are over 77 accredited HMOs functioning in Nigeria. 

HMOs are designed to provide access to healthcare by allocating funds to plan participants, notably healthcare providers. So, what exactly is the problem? How did these partnerships become burdensome rather than useful over time? 

In this blog post, we would be addressing the top ten HMOs in Nigeria, the challenges encountered when adopting them, and why investing in an HMIS to curb these challenges may be worth your while.

Top 10 HMOs in Nigeria

Without further ado, in no particular order, here are the top HMO providers in Nigeria today;

• AIICO Multishield Limited.
• Redcare Health Services Limited.
• Metro Health
• Hygeia HMO
• Reliance HMO
• Avon HMO
• Integrated healthcare Limited
• IHMS
• Total Health Trust Limited
• Greenbay

These look familiar, right? Some of us right now are probably thinking, “Hey, I recognize that one” or “Hmm, my hospital works with 6 out of 10 of these.” The above-mentioned HMOs are likely to conjure up memories of either a positive or a not-so-positive one. Okay, let’s talk numbers now. 

In 2020, the International Journal for Equity in Health recorded the results of a study conducted on the roles of HMOs in implementing the national social health insurance scheme in Enugu, Southeast Nigeria. 

The results were as follows: One-third (31.5%) of respondents said that the roles of HMOs were very important, while 23% said that their roles were not important. More than half (57.70%) ranked HMOs very low in their roles, while 24.10% ranked them the highest.

The respondents of this study had a thorough understanding of the functions of HMOs, notwithstanding, their general belief was that HMOs were not meeting the scheme’s expectations. 

In fact, at the beginning of 2022, it was predicted that hospitals were to drop HMOs over poor tariffs and debt. 

Common Problems with HMO Providers in Nigeria

Since the inception of HMOs, a constant debate has plagued healthcare institutions as to whether partnerships with them will improve or weaken the institution. To give a little more insight, here are some challenges healthcare institutions might be facing;

Lack of reconciliation of accounts with HMOs

This has to be the most common problem that every healthcare provider has encountered at least once.  Hospitals lose millions of naira in unclaimed cash to HMOs on a regular basis due to inconsistencies in budgets and records. 

Due to the lack of simultaneous real-time operations in healthcare facilities, hospitals are still doing things almost manually, which means that medical facilities are unable to prepare claim forms and make correct claims for their actual money, leaving them at the mercy of HMOs.

Delay of codes from HMOs for patients to receive services

Consider this scenario: a patient walks up to the front desk of a hospital and requests a consultation with a doctor. 

They feel down and generally irritated. Have you ever been in a hospital waiting room and observed patients shouting or speaking harshly to medical employees because they couldn’t wait to see the doctor? 

Now, this patient isn’t even upset about waiting in line to see the doctor; rather, they are still stuck at the front desk trying to book a consultation since her HMO provider is obstructing her treatment process owing to a code delay. 

How heartbreaking is that? Your patients are not only subjected to long wait times but they are also subjected to delayed processes because a code must be provided before services can be rendered.

Rejection of bills in terms of diagnosis

From the perspective of an accountant at your healthcare facility. He/She goes through the tedious process of putting things together and finally generates your claims form and forwards it to the HMOs involved, and eventually, it bounces back. 

Agitated, you follow up only to find out that the reason is that the diagnosis put forward doesn’t match and, therefore, the payment can’t be made/acknowledged. What would you do? Who covers the costs of the services already rendered? How would any healthcare provider address such loopholes in the system?  The answer is simply put in one word, HYELLA.

Why use Hyella HMIS for HMO Reconciliation?

Hyella, the future of hospital management systems, offers solutions that facilitate the ease of daily operations, and business functions of healthcare providers and help to curb imbalances and or discrepancies. 

By giving you accurate real-time data for your healthcare facility, it makes the workflow seamless, easier, and more efficient. With Hyella, manual reconciliation and backlogs in the process will be a thing of the past.

Conclusion

Regardless of having a good quality HMIS, EHR or EMR at your healthcare facility, there is still a clear need for the Federal Government to establish more effective recommendations for HMOs, supervise and monitor the application of such rules for HMOs to improve on their duties through the National Health Insurance Scheme.

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