HOM 5307
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs - ✔️✔️A reduction in HMO membership
New federal and state laws and regulations
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
All the above - ✔️✔️
The HMO Act of 1973 did contributed to the growth of managed care
T or F - ✔️✔️True
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications - ✔️✔️Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in
most environments.
T or F - ✔️✔️False
Which of the following forms of hospital payment contain no elements of risk sharing by
the hospital?
DRGs and MS-DRGs
Per diem
Capitation
Sliding scale FFS - ✔️✔️Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F - ✔️✔️False
,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?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D - ✔️✔️Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other
purchasers of care that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of
care.
A constantly changing array of unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care - ✔️✔️A broad and constantly changing
array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F - ✔️✔️False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care - ✔️✔️Hospitals and Health plans with a
Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care.
T or F - ✔️✔️False
The following term refers to an all-inclusive rate paid by the HMO for both institutional
and professional services:
Bundled payment
Per diem
Case rate
Straight DRGs - ✔️✔️Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
, Insurance companies
Consumers seeking access to health care
A & C Only - ✔️✔️Providers seeking patient revenues and Consumers seeking access
to health care
HMOs are licensed as health insurance companies.
True
False - ✔️✔️false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY - ✔️✔️Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group
practice.
True
False - ✔️✔️False
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a population's health care and/or contract with a payer organization.
True
False - ✔️✔️True
Claims review is an example of
Concurrent review
Discharge planning
Prospective review
Retrospective review - ✔️✔️Retrospective review
UM focuses on telling doctors and hospitals what to do.
True
False - ✔️✔️False
The same methodology used to pay a hospital for inpatient care is usually also use to
pay for outpatient care.
True
False - ✔️✔️False
The Managed care backlash resulted in which of the following?
A reduction in HMO membership
New federal and state laws and regulations
Reduced administrative costs - ✔️✔️A reduction in HMO membership
New federal and state laws and regulations
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
All the above - ✔️✔️
The HMO Act of 1973 did contributed to the growth of managed care
T or F - ✔️✔️True
Behavioral change tools include all but which of the following?
Analytics
Termination from the network
Mission clarity
Communications - ✔️✔️Termination from the network
Fee-for-service physicians are financially rewarded for good disease management in
most environments.
T or F - ✔️✔️False
Which of the following forms of hospital payment contain no elements of risk sharing by
the hospital?
DRGs and MS-DRGs
Per diem
Capitation
Sliding scale FFS - ✔️✔️Sliding scale FFS
PSOs, created by the BBA of 1997, proved to be very popular and successful.
T or F - ✔️✔️False
,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?
The Department of Defense TRICOR program
Public Health Service and Indian Health Service
State Medicaid programs
Medicare Part D - ✔️✔️Medicare Part D
Managed care is best described as:
A broad and constantly changing array of health plans employers, unions, and other
purchasers of care that attempt to manage cost, quality, and access to that care
A broad changing array of health plans employers, unions, and other purchasers of
care.
A constantly changing array of unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
A array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care - ✔️✔️A broad and constantly changing
array of health plans employers, unions, and other purchasers of care that attempt to
manage cost, quality, and access to that care
Consolidation in the payer industry has resulted in most hospitals being unable to obtain
adequate rate increases.
T or F - ✔️✔️False
Which organization(s) need a Corporate Compliance Officer (CCO)?
Hospitals
Health plans with a Medicare Advantage risk contract
Every organization that provides health care - ✔️✔️Hospitals and Health plans with a
Medicare Advantage risk contract
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care.
T or F - ✔️✔️False
The following term refers to an all-inclusive rate paid by the HMO for both institutional
and professional services:
Bundled payment
Per diem
Case rate
Straight DRGs - ✔️✔️Bundled payment
The original impetus of HMOs development came from:
Providers seeking patient revenues
, Insurance companies
Consumers seeking access to health care
A & C Only - ✔️✔️Providers seeking patient revenues and Consumers seeking access
to health care
HMOs are licensed as health insurance companies.
True
False - ✔️✔️false
Common sources of information that trigger DM include:
Claims
Pharmacy data
Laboratory tests
A & b oNLY - ✔️✔️Claims and pharmacy
The GPWW requires the participation of a hospital and the formation of a group
practice.
True
False - ✔️✔️False
An IDS can be described as a legal entity consisting of more than one type of provider
to manage a population's health care and/or contract with a payer organization.
True
False - ✔️✔️True
Claims review is an example of
Concurrent review
Discharge planning
Prospective review
Retrospective review - ✔️✔️Retrospective review
UM focuses on telling doctors and hospitals what to do.
True
False - ✔️✔️False
The same methodology used to pay a hospital for inpatient care is usually also use to
pay for outpatient care.
True
False - ✔️✔️False
