HCS Chapter 9 Latest Exam Questions
And Answers Rated A+.
The oldest form of managed care is the - Answer Health Maintenance Organization (HMO)
According to Fortune magazine's analysis of industries managed care had - Answer the highest growth
rate of the five major healthcare sectors
ACA mandates that health insurance companies - Answer must spend 80-85% of their premium
revenues on quality of healthcare
MCOs do what - Answer manage cost of healthcare services by controlling who the consumer sees and
how much the service costs
MCOs became well established in the healthcare system when - Answer Health Maintenance
Organization Act of 1973 was signed into law by Nixon
Health Maintenance Organization Act of 1973 - Answer Controlled reimbursement rate of services-
control over health insurance
-Physician's resisted: threatened by loss of income
-Soon realized that participation in MC plans: guaranteed income
-Medicare Part C and many employers: offer managed care plans
HMO Act, 1973 (President Nixon) - Answer Amended in 1976, 1978, and 1988
Rewarded HMOs for cost control
Any business with 25 or more employees should offer an HMO option if available
Why was managed care created? - Answer healthcare costs were spiraling out of control with the fee-
for-service system
, Kaiser Permanente Plan - Answer 1933: Developed for Kaiser industries workers
1945: Post war- opened to public (300,000 members)
1990: *Kaiser Permanente was the country's largest nonprofit HMO*
2023: 12.7 million member & 25 billion total operating revenue
Balanced Budget Act - Answer Medicare part C which developed different structures of managed care
plans
Medicare part D was passed by whom - Answer George W Bush
All MCOs have what five common characteristics - Answer 1. Establish relationships with organizations
and providers to offer a designated set of services to their members
2.Establish criteria for their members to utilize the MCO
3. Establish measures to estimate cost control
4.Provide incentives to encourage health service resources
5. Provide and encourage utilization of programs to improve the health status of their enrollees
Types of managed care models - Answer Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Exclusive Provider Organizations (EPOS)
Physician Hospital Organizations (PHOs)
Point-of-Service (POS) Plans
Provider-Sponsored Organizations (PSOs)
Types of HMOs - Answer staff model, group model, network model, independent practice associations
Health Maintenance Organization (HMO) - Answer Oldest type of manages care
Members must see their primary care provider first to get a referral for a specialist
And Answers Rated A+.
The oldest form of managed care is the - Answer Health Maintenance Organization (HMO)
According to Fortune magazine's analysis of industries managed care had - Answer the highest growth
rate of the five major healthcare sectors
ACA mandates that health insurance companies - Answer must spend 80-85% of their premium
revenues on quality of healthcare
MCOs do what - Answer manage cost of healthcare services by controlling who the consumer sees and
how much the service costs
MCOs became well established in the healthcare system when - Answer Health Maintenance
Organization Act of 1973 was signed into law by Nixon
Health Maintenance Organization Act of 1973 - Answer Controlled reimbursement rate of services-
control over health insurance
-Physician's resisted: threatened by loss of income
-Soon realized that participation in MC plans: guaranteed income
-Medicare Part C and many employers: offer managed care plans
HMO Act, 1973 (President Nixon) - Answer Amended in 1976, 1978, and 1988
Rewarded HMOs for cost control
Any business with 25 or more employees should offer an HMO option if available
Why was managed care created? - Answer healthcare costs were spiraling out of control with the fee-
for-service system
, Kaiser Permanente Plan - Answer 1933: Developed for Kaiser industries workers
1945: Post war- opened to public (300,000 members)
1990: *Kaiser Permanente was the country's largest nonprofit HMO*
2023: 12.7 million member & 25 billion total operating revenue
Balanced Budget Act - Answer Medicare part C which developed different structures of managed care
plans
Medicare part D was passed by whom - Answer George W Bush
All MCOs have what five common characteristics - Answer 1. Establish relationships with organizations
and providers to offer a designated set of services to their members
2.Establish criteria for their members to utilize the MCO
3. Establish measures to estimate cost control
4.Provide incentives to encourage health service resources
5. Provide and encourage utilization of programs to improve the health status of their enrollees
Types of managed care models - Answer Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Exclusive Provider Organizations (EPOS)
Physician Hospital Organizations (PHOs)
Point-of-Service (POS) Plans
Provider-Sponsored Organizations (PSOs)
Types of HMOs - Answer staff model, group model, network model, independent practice associations
Health Maintenance Organization (HMO) - Answer Oldest type of manages care
Members must see their primary care provider first to get a referral for a specialist
