HOM 5307 Exam 1 |29 Questions
and Answers
2. The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members (T,F) - -
False
- 3. Hospitals purchased physician practices and employed physicians in the
1990s, but will no longer do so (T,F) - -False
- 6. The same methodology used to pay a hospital for inpatient care is
usually also used to pay for outpatient care (T,F) - -False
- 7. The majority of prescriptions for behavioral health medications are
written by non psychiatrists (T, F) - -True
- 8. One potential negative consequence of drug formularies with high
copayments is:
A. Decreased use of the most cost-effective medications
B. Low copayments may be a barrier to adherence
C. Increased use of brand drugs
D. High copayments may be a barrier to adherence - -D. High copayments
may be a barrier to adherence
- 11. Electronic clinical support systems are important in disease
management (T, F) - -True
- 14. Electronic prescribing offers which of the following potential outcomes?
A. Improvement in physician drug formulary prescribing conformance
B. Reduction in drug interactions and resulting serious adverse effects
C. Reduction in prescribing and dispensing errors
D. All the above - -D. All the above
- 16. 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)?
A. Most plans do not cover specialty drugs, except under the medical
benefit,and specialty products, therefore, are of no serious cost consequence
to pharmacy benefits. The number of generic drugs is declining due to lower
manufacture costs and, as a result, traditional (non-specialty) drug products
remain the focus of most of the pharmacy budget increases.
B. Traditional drug costs are rising rapidly due to continued launch of new,
expensive brand drugs, with only a few approved genericas. The specialty
, market cost trend is declining as a result of biosimilar "generic" injectable
products imported from Europe.
C. Many expensive and popular traditional drugs are losing patent protection,
and generics are driving - -C. 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.
- 17. Two desirable outcomes of tiered prescription member copayments
are:
A. Pharmacy gross profits rise and physicians are paid a formulary incentive
B. Member costs increase and brand name drug use will double
C. Brand drug use increases and generic drug use declines
D. The use of less expensive generic drugs increases and members save
money by paying lower Tier 1 generic copayments - -D. The use of less
expensive generic drugs increases and members save money by paying
lower Tier 1 generic copayments
- 22. In the medical management area, committees serve to diffuse some
elements of responsibility and allow important input from the field into
procedure and policy or even into case-specific interpretation of existing
policy (T, F) - -True
- 25. The Manged Care backlash resulted in which of the following?
A. A reduction in HMO membership
B. New federal and state laws and regulations
C. Reduced administrative costs
D. A & B Only - -D. A & B Only
- 27. Fee-for-service payment is the most common method used by HMOs to
pay specialists (T, F) - -True
- 28. Basic elements of credentialing include:
A. Hospital privileges
B. Malpractice history
C. Medical license
D. Board Exams
E. All of the above - -E. All of the above
- 30. What specific factors other than diseases commonly affect severity of
illness?
A. Culture
B. Geographic location
C. Sex
D. Age
and Answers
2. The defining feature of a direct contract model is the HMO contracting
directly with a hospital to provide acute services to its members (T,F) - -
False
- 3. Hospitals purchased physician practices and employed physicians in the
1990s, but will no longer do so (T,F) - -False
- 6. The same methodology used to pay a hospital for inpatient care is
usually also used to pay for outpatient care (T,F) - -False
- 7. The majority of prescriptions for behavioral health medications are
written by non psychiatrists (T, F) - -True
- 8. One potential negative consequence of drug formularies with high
copayments is:
A. Decreased use of the most cost-effective medications
B. Low copayments may be a barrier to adherence
C. Increased use of brand drugs
D. High copayments may be a barrier to adherence - -D. High copayments
may be a barrier to adherence
- 11. Electronic clinical support systems are important in disease
management (T, F) - -True
- 14. Electronic prescribing offers which of the following potential outcomes?
A. Improvement in physician drug formulary prescribing conformance
B. Reduction in drug interactions and resulting serious adverse effects
C. Reduction in prescribing and dispensing errors
D. All the above - -D. All the above
- 16. 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)?
A. Most plans do not cover specialty drugs, except under the medical
benefit,and specialty products, therefore, are of no serious cost consequence
to pharmacy benefits. The number of generic drugs is declining due to lower
manufacture costs and, as a result, traditional (non-specialty) drug products
remain the focus of most of the pharmacy budget increases.
B. Traditional drug costs are rising rapidly due to continued launch of new,
expensive brand drugs, with only a few approved genericas. The specialty
, market cost trend is declining as a result of biosimilar "generic" injectable
products imported from Europe.
C. Many expensive and popular traditional drugs are losing patent protection,
and generics are driving - -C. 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.
- 17. Two desirable outcomes of tiered prescription member copayments
are:
A. Pharmacy gross profits rise and physicians are paid a formulary incentive
B. Member costs increase and brand name drug use will double
C. Brand drug use increases and generic drug use declines
D. The use of less expensive generic drugs increases and members save
money by paying lower Tier 1 generic copayments - -D. The use of less
expensive generic drugs increases and members save money by paying
lower Tier 1 generic copayments
- 22. In the medical management area, committees serve to diffuse some
elements of responsibility and allow important input from the field into
procedure and policy or even into case-specific interpretation of existing
policy (T, F) - -True
- 25. The Manged Care backlash resulted in which of the following?
A. A reduction in HMO membership
B. New federal and state laws and regulations
C. Reduced administrative costs
D. A & B Only - -D. A & B Only
- 27. Fee-for-service payment is the most common method used by HMOs to
pay specialists (T, F) - -True
- 28. Basic elements of credentialing include:
A. Hospital privileges
B. Malpractice history
C. Medical license
D. Board Exams
E. All of the above - -E. All of the above
- 30. What specific factors other than diseases commonly affect severity of
illness?
A. Culture
B. Geographic location
C. Sex
D. Age
