HOM 5307 - Exam 2 - Sum 2025 – Q’s and
A’s
Behavioral change tools include which of the following? - -Analytics
Mission clarity
Communications
- Why is data analysis an increasingly important health plan function? - -
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? - -Episodes of care
- What specific factors other than diseases commonly affect severity of
illness? - -Culture
Geographic location
Sex
Age
- Which of the following is a typical complaint providers have about health
plan provider profiling? - -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. - -true
- Managed prescription drug programs must be flexible and customize
pharmacy benefit designs to accommodate diverse financial and benefit
richness desires of their customers. - -true
- Health Plan Employer Data and Information Set is the less widely used set
of measures for reporting on managed behavioral health care. - -false
- The majority of prescriptions for behavioral health medications are written
by nonpsychiatrists. - -true
, - Recent legislation ENCOURAGES separate lifetime limits for behavioral
care. - -false
- Extended inpatient treatment for substance abuse is clearly more
effective, but too costly. - -false
- Behavioral health care providers are paid under methodologies similar to
those applied to medical/surgical care providers. - -true
- Pay for performance (P4P) CANNOT be applied to behavioral health care
providers. - -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)? - -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? - -
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? - -Medicare Part D
- Two desirable outcomes of tiered prescription member copayments are: - -
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: - -High copayments may be a barrier to adherence
- What is the common benefit design trend in commercial (employer group
sponsored) prescription drug benefits? - -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..
A’s
Behavioral change tools include which of the following? - -Analytics
Mission clarity
Communications
- Why is data analysis an increasingly important health plan function? - -
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? - -Episodes of care
- What specific factors other than diseases commonly affect severity of
illness? - -Culture
Geographic location
Sex
Age
- Which of the following is a typical complaint providers have about health
plan provider profiling? - -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. - -true
- Managed prescription drug programs must be flexible and customize
pharmacy benefit designs to accommodate diverse financial and benefit
richness desires of their customers. - -true
- Health Plan Employer Data and Information Set is the less widely used set
of measures for reporting on managed behavioral health care. - -false
- The majority of prescriptions for behavioral health medications are written
by nonpsychiatrists. - -true
, - Recent legislation ENCOURAGES separate lifetime limits for behavioral
care. - -false
- Extended inpatient treatment for substance abuse is clearly more
effective, but too costly. - -false
- Behavioral health care providers are paid under methodologies similar to
those applied to medical/surgical care providers. - -true
- Pay for performance (P4P) CANNOT be applied to behavioral health care
providers. - -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)? - -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? - -
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? - -Medicare Part D
- Two desirable outcomes of tiered prescription member copayments are: - -
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: - -High copayments may be a barrier to adherence
- What is the common benefit design trend in commercial (employer group
sponsored) prescription drug benefits? - -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..
