NMNC 4520 FINAL UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

NMNC 4520 FINAL UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS

Question:
1. Vertical Integration model
Answer:
Consolidates all levels of care, staff and facilities under one organizational ownership consolidates health
services under one roof

Question:
2. virtual integration model
Answer:
contacting services with HMOs, physicians maintain ownership but can still practice in HMO involves
contractual links between HMOs and physician groups, hospitals, and other provider units.

Question:
3. Dawson's model
Answer:
high value placed on primary care, Regionalized/Coordinated Care/Regulated, british NHS

Question:
4. free flowing model
Answer:
What model of healthcare organization allows for a more fluid role for caregivers, and more free-flowing
movement of pts, across all levels of care, that tends to pace higher value on services at the tertiary care
apex than the primary care base?

Question:
5. First Generation HMOs
Answer:
full time salary model, vertical integration (Kaiser Permanente) -> health plan, hospitals and medical group
-> consolidated model, salaried physicians, global budget hospitals -> helps control costs, ensure
continuity of care -> less choice for patient, less physician autonomy

Question:
6. Second Generation HMOs
Answer:
virtual integration -> doesn't own but has contracts with hospitals, physicians, pharmacies, IPAs and home
health agencies. result of provider resistance of moving into group practice or being limited to one HMO

Question:
7. Four habits of high value HCOs

, Answer:
uSpecification and planning: This includes both operational decisions and clinical decisions. These
decisions are based on specific criteria. u2. Infrastructure design: This element includes microsystems such
as technology, physical design, and policies and procedures. u3. Measurement and oversight:
High-performing organizations seem to collect more data—and use it—than other organizations. u4. Self
study: This habit involves introspection about any deviations from expected results, both positive and
negative. The goal is to increase the positive deviations and intervene when the deviations are negative.
Outcomes are viewed as critical to the organization, not just to an individual or unit.

Question:
8. Primary Care Nursing Exs
Answer:
uIndependent Nursing Visit uinjections and procedures, newborn weight and color assessments, lactation
support, first prenatal visits, complex medication reconciliations, wound care, and follow-up with patients
after a visit to the emergency department. umedication titration protocols to collaborate with PCPs in the
management of patients with common chronic illnesses, patient-specific "order sets" to be implemented by
the RN care manager over a series of visits for chronic illness management prior to a return visit with the
PCP uTransition of Care uCoumadin Panel Management uCollaborative PCP and RN visit for complex
patients uHome Visiting

Question:
9. Levels of Care
Answer:
Primary - common health probs, preventive care secondary- specialized clinical expertise, hospital/acute
care, urgent care tertiary - management of rare complex disorders, combination of highly specialized care
and hospital care

Question:
10. Painless cost control
Answer:
Controlling fees and provider incomes Cutting the price of pharmaceuticals and other supplies Reducing
administrative waste Eliminating medical interventions of no benefit Substituting less costly technologies
that are equally effective Increasing the provision of those preventive services that cost less than the
illnesses they prevent

Question:
11. Cost-Benefit Curve
Answer:
steeper - small investment for high value flatter - larger investment for not as much outcome

Question:
12. Mechanisms of cost control