HSM 310 questions with accurate answers
1115 waivers in Arkansas Ans✓✓✓ -people losing medicaid coverage
-seems difficult to get the coverage/access it online
-barriers to reporting 80 hours: physically demanding job, fluctuating
work hours, chronic condition, lack of transportation, homeless,
unreliable internet access, needs 1:1 help with computers
2017 GOP tax reform bill Ans✓✓✓ changed individual mandate
penalty to $0
2019 Scorecard on State Health System Performance Ans✓✓✓ -where
you live matters to your health in the US
-sharp health care disparities between states
-up to sixfold disparities on key health indicators
-a countrywide rise in deaths of despair, but states are affected
differently
-a decrease in uninsured rates, but uninsured rates vary dramatically
across states
-per capita spend is growing faster in employer plans than in medicare,
but again varies widely
3 domains of global health challenges Ans✓✓✓ - Unfinished agenda:
high rates of preventable infectious diseases, childhood deaths, and
maternal deaths
- Emerging agenda: demographic changes shifting disease burden
towards NCDs and injuries
,- Cost agenda
4 types of payments Ans✓✓✓ -fee for service
-capitation payments
-bundled payment
-P4P/P4V
ACA addresses population health in 4 ways Ans✓✓✓ 1. expanding
insurance coverage
2. provisions aimed at improving the quality of care delivered
3. prevention and health promotion measures
4. promoting community and population-based activities
ACA addresses population health in 4 ways Ans✓✓✓ 1. Expanding
insurance coverage
2. Provisions aimed at improving the quality of care delivered
3. Prevention and health promotion measures
4. Promoting community and population-based activities
ACA and non-profit hospitals Ans✓✓✓ -community health needs
assessment
-periodic federal reports on hospital investments and tax penalties for
non-compliance
,ACA has 4 requirements for hospitals to maintain non-profit status
Ans✓✓✓ - Community Health Needs Assessments
- Bans unreasonable billing and collection practices
- Financial assistance obligations
- Adherence to EMTALA (must treat and stabilize any patient that
comes into the ED)
ACA increases insurance coverage through the "three legged stool"
Ans✓✓✓ 1. Guaranteed issue & renewal: Insurers must issue coverage
regardless of preexisting conditions - can only adjust rates based on age,
location, family size, and smoking status
2. Individual mandate (now effectively revoked): Must pay additional
tax if don't have qualified health insurance coverage - meant to fight
adverse selection issues and freeriding
3. Subsidies to expand insurance: Medicaid expansions (not all states
adopted), subsidies to help afford coverage, and dependent-coverage
until 26
Accountable Care Organizations (ACOs) Ans✓✓✓ -ACA provides
funding, since proliferated
-network of doctors, hospitals and other providers that coordinate patient
care and agree to take financial responsibility for quality and efficiency
of care
-payments tied to quality metrics and cost of care
-responsible for total healthcare costs of patients under care
, Accountable Health Communities Ans✓✓✓ -model of care to address
upstream health determinants for medicare and medicaid beneficiaries
-focus on health-related social needs, more than clinical care
-use bridge organizations to link patients to social services
ACO payment model Ans✓✓✓ -private insurers note that it is
important to properly incentivize providers
-payers and policy makers remain enthusiastic
ACO results Ans✓✓✓ -financial: all ACOs saved money relative to
benchmarks but many did not save $ after bonus payments and dropped
out
-quality: ACOs improved in quality over time
ACOs Ans✓✓✓ -ACA provided funding for Medicare ACOS
-have been increasing over time and have been adopted by private
payers as well
-different forms in medicare and across private payers (most include
non-traditional payment such as capitation or modified capitation)
Adverse selection Ans✓✓✓ riskier people are more likely to buy
insurance than less-risky
AHCs Ans✓✓✓ -a new model of care being tested by CMS in a 5-year
program
1115 waivers in Arkansas Ans✓✓✓ -people losing medicaid coverage
-seems difficult to get the coverage/access it online
-barriers to reporting 80 hours: physically demanding job, fluctuating
work hours, chronic condition, lack of transportation, homeless,
unreliable internet access, needs 1:1 help with computers
2017 GOP tax reform bill Ans✓✓✓ changed individual mandate
penalty to $0
2019 Scorecard on State Health System Performance Ans✓✓✓ -where
you live matters to your health in the US
-sharp health care disparities between states
-up to sixfold disparities on key health indicators
-a countrywide rise in deaths of despair, but states are affected
differently
-a decrease in uninsured rates, but uninsured rates vary dramatically
across states
-per capita spend is growing faster in employer plans than in medicare,
but again varies widely
3 domains of global health challenges Ans✓✓✓ - Unfinished agenda:
high rates of preventable infectious diseases, childhood deaths, and
maternal deaths
- Emerging agenda: demographic changes shifting disease burden
towards NCDs and injuries
,- Cost agenda
4 types of payments Ans✓✓✓ -fee for service
-capitation payments
-bundled payment
-P4P/P4V
ACA addresses population health in 4 ways Ans✓✓✓ 1. expanding
insurance coverage
2. provisions aimed at improving the quality of care delivered
3. prevention and health promotion measures
4. promoting community and population-based activities
ACA addresses population health in 4 ways Ans✓✓✓ 1. Expanding
insurance coverage
2. Provisions aimed at improving the quality of care delivered
3. Prevention and health promotion measures
4. Promoting community and population-based activities
ACA and non-profit hospitals Ans✓✓✓ -community health needs
assessment
-periodic federal reports on hospital investments and tax penalties for
non-compliance
,ACA has 4 requirements for hospitals to maintain non-profit status
Ans✓✓✓ - Community Health Needs Assessments
- Bans unreasonable billing and collection practices
- Financial assistance obligations
- Adherence to EMTALA (must treat and stabilize any patient that
comes into the ED)
ACA increases insurance coverage through the "three legged stool"
Ans✓✓✓ 1. Guaranteed issue & renewal: Insurers must issue coverage
regardless of preexisting conditions - can only adjust rates based on age,
location, family size, and smoking status
2. Individual mandate (now effectively revoked): Must pay additional
tax if don't have qualified health insurance coverage - meant to fight
adverse selection issues and freeriding
3. Subsidies to expand insurance: Medicaid expansions (not all states
adopted), subsidies to help afford coverage, and dependent-coverage
until 26
Accountable Care Organizations (ACOs) Ans✓✓✓ -ACA provides
funding, since proliferated
-network of doctors, hospitals and other providers that coordinate patient
care and agree to take financial responsibility for quality and efficiency
of care
-payments tied to quality metrics and cost of care
-responsible for total healthcare costs of patients under care
, Accountable Health Communities Ans✓✓✓ -model of care to address
upstream health determinants for medicare and medicaid beneficiaries
-focus on health-related social needs, more than clinical care
-use bridge organizations to link patients to social services
ACO payment model Ans✓✓✓ -private insurers note that it is
important to properly incentivize providers
-payers and policy makers remain enthusiastic
ACO results Ans✓✓✓ -financial: all ACOs saved money relative to
benchmarks but many did not save $ after bonus payments and dropped
out
-quality: ACOs improved in quality over time
ACOs Ans✓✓✓ -ACA provided funding for Medicare ACOS
-have been increasing over time and have been adopted by private
payers as well
-different forms in medicare and across private payers (most include
non-traditional payment such as capitation or modified capitation)
Adverse selection Ans✓✓✓ riskier people are more likely to buy
insurance than less-risky
AHCs Ans✓✓✓ -a new model of care being tested by CMS in a 5-year
program
