HOM 5307 Exam 2 Set 2 Exam Questions and
Answers
/Behavioral change tools include which of the following? - 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 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? - 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..
Answers
/Behavioral change tools include which of the following? - 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 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? - 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..
