HAPP 452 Quiz # 2 Exam With
Accurate Solutions
What is an ACO or Accountable Care Organization - ANSWER - Is a provider led
organization whose mission is to manage the full continuum of care and be accountable
for the overall costs and quality of care for a defined population (Medicaid Population).
-Involves both Public and Private Payers
Causes of Attribution - ANSWER -Length of Enrollment.
-Original Medicare.
- Invisible to Beneficiary
Elements of a new care ACO's - ANSWER - Continuing patients included in the practice.
-Historical cost + inflation.
-Underlying Payments (FFS & Per Diem).
-Organizational Structures Vary (Vertically Integrated & Virtually Integrated).
What is a MCO or Managed Care Organization? - ANSWER - Comprised of large
companies that will be charged with managing Medicaid by contracting with a network
of providers.
-Not comprised of health providers (Physicians, Nurses).
Uninsured Populations - ANSWER - Low Income Adults.
- Latinos.
-The Unemployed.
-Small Firm Employees
-Residents of States without Medicaid Expansion.
Indemnity Plans (Volume) - ANSWER Fee-For-Service (FFS)
Usual/Customary
First Dollar Coverage
Payment Modification (Volume) - ANSWER Capitation,
, RBRVS,
SGR,
HMO,
UR,
DRGs,
PPS,
Population Health (Value) - ANSWER Global Budgets,
Value Based Purchasing,
Integrated Networks
Tax Benefits Associated with ESI (Employer Sponsored Insurance) - ANSWER -Tax
structure results in incentives to cover "small claims" and optional service.
-IRS does not consider employer paid health insurance as part of employee taxable
income: exempt from federal, state, social security taxes.
-The higher an employee's income, the greater the value of the exclusion from income
on employer-purchased health insurance
Consumer concern with prices charged - ANSWER As insurance becomes more
comprehensive patients concern with the prices charged decreases
Canada Health Care - ANSWER Purchaser: Provincial Government.
Single Payer System.
Insurer: No Private Insurance. Government provides insurance.
Providers: Private hospitals, private physicians/other practitioners.
Payment System: Fee For Service (FFS).
Universal and Social Insurance
Germany Health Care - ANSWER Purchaser: Government.
Non-Profit Sick Funds Organizations.
Insurer: non-profit sick funds organizations AND some individual private insurance.
Payment System: FFS, Global Budget.
Social Insurance Public Assistance
Reasons for High Prices of Health Care in U.S - ANSWER -Medicare accounts for 20% of
Accurate Solutions
What is an ACO or Accountable Care Organization - ANSWER - Is a provider led
organization whose mission is to manage the full continuum of care and be accountable
for the overall costs and quality of care for a defined population (Medicaid Population).
-Involves both Public and Private Payers
Causes of Attribution - ANSWER -Length of Enrollment.
-Original Medicare.
- Invisible to Beneficiary
Elements of a new care ACO's - ANSWER - Continuing patients included in the practice.
-Historical cost + inflation.
-Underlying Payments (FFS & Per Diem).
-Organizational Structures Vary (Vertically Integrated & Virtually Integrated).
What is a MCO or Managed Care Organization? - ANSWER - Comprised of large
companies that will be charged with managing Medicaid by contracting with a network
of providers.
-Not comprised of health providers (Physicians, Nurses).
Uninsured Populations - ANSWER - Low Income Adults.
- Latinos.
-The Unemployed.
-Small Firm Employees
-Residents of States without Medicaid Expansion.
Indemnity Plans (Volume) - ANSWER Fee-For-Service (FFS)
Usual/Customary
First Dollar Coverage
Payment Modification (Volume) - ANSWER Capitation,
, RBRVS,
SGR,
HMO,
UR,
DRGs,
PPS,
Population Health (Value) - ANSWER Global Budgets,
Value Based Purchasing,
Integrated Networks
Tax Benefits Associated with ESI (Employer Sponsored Insurance) - ANSWER -Tax
structure results in incentives to cover "small claims" and optional service.
-IRS does not consider employer paid health insurance as part of employee taxable
income: exempt from federal, state, social security taxes.
-The higher an employee's income, the greater the value of the exclusion from income
on employer-purchased health insurance
Consumer concern with prices charged - ANSWER As insurance becomes more
comprehensive patients concern with the prices charged decreases
Canada Health Care - ANSWER Purchaser: Provincial Government.
Single Payer System.
Insurer: No Private Insurance. Government provides insurance.
Providers: Private hospitals, private physicians/other practitioners.
Payment System: Fee For Service (FFS).
Universal and Social Insurance
Germany Health Care - ANSWER Purchaser: Government.
Non-Profit Sick Funds Organizations.
Insurer: non-profit sick funds organizations AND some individual private insurance.
Payment System: FFS, Global Budget.
Social Insurance Public Assistance
Reasons for High Prices of Health Care in U.S - ANSWER -Medicare accounts for 20% of
