HOM 5307 - TEST 2 QUESTIONS 100%
CORRECT.
Behavioral change tools include? - ANSWER Analytics
Mission clarity
Communications
Why is data analysis an increasingly important health plan function? - ANSWER 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? - ANSWER Episodes of care
What specific factors other than diseases commonly affect severity of illness? -
ANSWER Culture
Geographic location
Sex
Age
Which of the following is a typical complaint providers have about health plan provider
profiling? - ANSWER 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. - ANSWER true
Managed prescription drug programs must be flexible and customize pharmacy benefit
designs to accommodate diverse financial and benefit richness desires of their
customers. - ANSWER true
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care. - ANSWER false
The majority of prescriptions for behavioral health medications are written by
nonpsychiatrists. - ANSWER true
, Recent legislation ENCOURAGES separate lifetime limits for behavioral care. -
ANSWER false
Extended inpatient treatment for substance abuse is clearly more effective, but too
costly. - ANSWER false
Behavioral health care providers are paid under methodologies similar to those applied
to medical/surgical care providers. - ANSWER true
Pay for performance (P4P) CANNOT be applied to behavioral health care providers. -
ANSWER 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)? - ANSWER 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? - ANSWER
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions 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? - ANSWER Medicare Part D
Two desirable outcomes of tiered prescription member copayments are: - ANSWER
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: -
ANSWER High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group sponsored)
prescription drug benefits? - ANSWER Increasing copayment amounts, especially for
Tier 2 preferred brand drugs and Tier 3 non-preferred brand drugs.
Increasing use of percent coinsurance, especially for Tier 3 and Tier 4 specialty tiers
when available..
Increasing number of consumer-directed health plan designs with higher front-end
deductibles.
CORRECT.
Behavioral change tools include? - ANSWER Analytics
Mission clarity
Communications
Why is data analysis an increasingly important health plan function? - ANSWER 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? - ANSWER Episodes of care
What specific factors other than diseases commonly affect severity of illness? -
ANSWER Culture
Geographic location
Sex
Age
Which of the following is a typical complaint providers have about health plan provider
profiling? - ANSWER 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. - ANSWER true
Managed prescription drug programs must be flexible and customize pharmacy benefit
designs to accommodate diverse financial and benefit richness desires of their
customers. - ANSWER true
Health Plan Employer Data and Information Set is the less widely used set of measures
for reporting on managed behavioral health care. - ANSWER false
The majority of prescriptions for behavioral health medications are written by
nonpsychiatrists. - ANSWER true
, Recent legislation ENCOURAGES separate lifetime limits for behavioral care. -
ANSWER false
Extended inpatient treatment for substance abuse is clearly more effective, but too
costly. - ANSWER false
Behavioral health care providers are paid under methodologies similar to those applied
to medical/surgical care providers. - ANSWER true
Pay for performance (P4P) CANNOT be applied to behavioral health care providers. -
ANSWER 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)? - ANSWER 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? - ANSWER
Improvement in physician drug formulary prescribing conformance
Reduction in drug interactions 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? - ANSWER Medicare Part D
Two desirable outcomes of tiered prescription member copayments are: - ANSWER
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: -
ANSWER High copayments may be a barrier to adherence
What is the common benefit design trend in commercial (employer group sponsored)
prescription drug benefits? - ANSWER Increasing copayment amounts, especially for
Tier 2 preferred brand drugs and Tier 3 non-preferred brand drugs.
Increasing use of percent coinsurance, especially for Tier 3 and Tier 4 specialty tiers
when available..
Increasing number of consumer-directed health plan designs with higher front-end
deductibles.
