HOM 5307 Exam 1 questions and correct answers

HOM 5307 Exam 1 questions and correct answers T/F An IPA is an HMO that contracts directly with physicians and hospitals. - ANSWERS False An IPA is an HMO that contracts with physicians, then health plan. An HMO contracts directly with hospital (A direct contract Open Panel HMO contracts directly with physicians and hospitals) T/F The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members - ANSWERS false the defining feature of a direct contract model is between the HMO and physicians. Almost all models of HMOs contract directly with hospitals T/F HMOs are licensed as health insurance companies - ANSWERS false HMOs are licensed by states under certificate of authority (COA) rather than under an insurance license T/F A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospital's admitting physicians - ANSWERS true PHO = physician hospital organization T/F hospitals purchased physician practices and employed physicians in the 1990s but will no longer do so - ANSWERS false T/F an IDS can be described as a legal entity consisting of more than one type of provider to manage a populations' healthcare and/or contract with a payer organization - ANSWERS true IDS = integrated delivery system (Not all types of providers will be found in all IDS - it is highly variable) T/F the GPWW requires the participation of a hospital and the formation of a group practice - ANSWERS false GPWW requires the practice of physicians that are actual members/employees of a medical group GPWW = group practice without walls EPOs share similarities with: A- PPOs B- HMOs C - Point of Service D - A & B - ANSWERS D - PPOs and HMOs EPO = exclusive physician organization commonly recognized HMOs include: A- IPAs B- Network C - Staff and group D- All the above - ANSWERS D- All of the above T/F PSOs, created by the BBA of 1997, proved to be very popular and successful - ANSWERS false they failed spectacularly PSO = physician service organization BBA = balanced budget act key common characteristics of PPOs include: A- Selected provider panels B- Negotiated payment rates C- Consumer choice & Utilization management D- All the above - ANSWERS D- all of the above advantages of an IPA include: A- Broader physician choice for members B- More convenient geographic access C- Requires less start-up capital D- All the above - ANSWERS D- all of the above (HMOs are extremely costly) capitation is usually described as: A- Fee-for-service including withhold provisions B- Stop-loss reinsurance provisions C- Prepayment for services on a fixed, per member per month basis D- Performance based compensation system - ANSWERS C- prepayment for services on a fixed, per member per month basis in what model does an HMO contract with more than one group practice to provide medical services to its members? A- Group model B- Staff model C- Independent Physician Association model D- Network model - ANSWERS D- network model the integral components of managed care are: A- Wellness and prevention B- Primary care orientation C- Utilization management D- All of the above - ANSWERS D- all of the above