HOM 5307 Exam 2025 Latest Questions Answered 100%
Behavioral change tools include which of the following?
Analytics
Mission clarity
Communications
Why is data analysis an increasingly important health plan function?
Cost increases 2-3 times the consumer price index
Potential for improvements in medical management
Third-party consultants that specialize in data analysis and aggregate data across health plans
Which of the following is a method for providing a complete picture of care delivered in all
health care settings?
Episodes of care
What specific factors other than diseases commonly affect severity of illness?
Culture
Geographic location
Sex
Age
Which of the following is a typical complaint providers have about health plan provider
profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
,More than 90% of members of employer-sponsored health plans have access to prescription
drug coverage, and over 90% of all prescriptions in the U.S. are reimbursed by insured
prescription drug benefit programs.
true
Managed prescription drug programs must be flexible and customize pharmacy benefit
designs to accommodate diverse financial and benefit richness desires of their customers.
true
Health Plan Employer Data and Information Set is the less widely used set of measures for
reporting on managed behavioral health care.
false
The majority of prescriptions for behavioral health medications are written by
nonpsychiatrists.
true
Recent legislation ENCOURAGES separate lifetime limits for behavioral care.
false
Extended inpatient treatment for substance abuse is clearly more effective, but too costly.
false
Behavioral health care providers are paid under methodologies similar to those applied to
medical/surgical care providers.
true
Pay for performance (P4P) CANNOT be applied to behavioral health care providers.
false
, What statement is true regarding the trends of traditional, non-specialty drugs (mostly oral
and topical drugs dispensed in community pharmacy) and specialty drugs (biotech,
injectables, high-cost orals)?
Many expensive and popular traditional drugs are losing patent protection, and generics are
driving a declining cost trend. A growing number of the drugs in the pipeline for FDA approval
are injectable products and the specialty drug trend, already at 20%, is expected to increase.
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions and resulting serious adverse effects
Reduction in prescribing and dispensing errors
In January 2006, what large federal prescription drug program was implemented that offered
pharmacy benefits to more than 40 million people at that time and is expected to increase by
30% throughout the next decade?
Medicare Part D
Two desirable outcomes of tiered prescription member copayments are:
The use of less expensive generic drugs increases and members save money by paying lower
Tier 1 generic copayments
One potential negative consequence of drug formularies with high copayments is:
High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group sponsored)
prescription drug benefits?
Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-
preferred brand drugs.
Behavioral change tools include which of the following?
Analytics
Mission clarity
Communications
Why is data analysis an increasingly important health plan function?
Cost increases 2-3 times the consumer price index
Potential for improvements in medical management
Third-party consultants that specialize in data analysis and aggregate data across health plans
Which of the following is a method for providing a complete picture of care delivered in all
health care settings?
Episodes of care
What specific factors other than diseases commonly affect severity of illness?
Culture
Geographic location
Sex
Age
Which of the following is a typical complaint providers have about health plan provider
profiling?
I get different results using my own data
My patients are sicker than other providers' patients
The quality and cost measures used are not accurate enough
,More than 90% of members of employer-sponsored health plans have access to prescription
drug coverage, and over 90% of all prescriptions in the U.S. are reimbursed by insured
prescription drug benefit programs.
true
Managed prescription drug programs must be flexible and customize pharmacy benefit
designs to accommodate diverse financial and benefit richness desires of their customers.
true
Health Plan Employer Data and Information Set is the less widely used set of measures for
reporting on managed behavioral health care.
false
The majority of prescriptions for behavioral health medications are written by
nonpsychiatrists.
true
Recent legislation ENCOURAGES separate lifetime limits for behavioral care.
false
Extended inpatient treatment for substance abuse is clearly more effective, but too costly.
false
Behavioral health care providers are paid under methodologies similar to those applied to
medical/surgical care providers.
true
Pay for performance (P4P) CANNOT be applied to behavioral health care providers.
false
, What statement is true regarding the trends of traditional, non-specialty drugs (mostly oral
and topical drugs dispensed in community pharmacy) and specialty drugs (biotech,
injectables, high-cost orals)?
Many expensive and popular traditional drugs are losing patent protection, and generics are
driving a declining cost trend. A growing number of the drugs in the pipeline for FDA approval
are injectable products and the specialty drug trend, already at 20%, is expected to increase.
Electronic prescribing offers which of the following potential outcomes?
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions and resulting serious adverse effects
Reduction in prescribing and dispensing errors
In January 2006, what large federal prescription drug program was implemented that offered
pharmacy benefits to more than 40 million people at that time and is expected to increase by
30% throughout the next decade?
Medicare Part D
Two desirable outcomes of tiered prescription member copayments are:
The use of less expensive generic drugs increases and members save money by paying lower
Tier 1 generic copayments
One potential negative consequence of drug formularies with high copayments is:
High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group sponsored)
prescription drug benefits?
Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-
preferred brand drugs.
