MHA 707 Exam C questions with verified answers
Accounts in the NHEA Ans✓✓✓ National Health Expenditures: NHE
Health Consumption Expenditures: HCE
Personal Health Care: PHC
Adverse Selection Ans✓✓✓ the situation in which one party to a transaction
takes advantage of knowing more than the other party to the transaction
the sicker people likely want more insurance, compared to those who are healthy
Age-Adjusted Mortality Rate Ans✓✓✓ A mortality rate statistically modified to
eliminate the effect of different age distributions in the different populations.
Americans Stat on Health Ins Coverage Ans✓✓✓ 92% of the US population have
some sort of ins (8% or 26.4 M uninsured)
Baker and Chassin Four Criteria for All Out Measure Ans✓✓✓ Strong evidence
should exist that good medical care should exist leads to improvement in the
outcome within the same time period for the measure
The outcome should be measurable with a high degree of precision
The risk adjustment methodology should include accurately measuring the risk
factors most strongly associated with the outcome
Implementation of the outcome measure must have little chance of inducing
unintended adverse consequences
Barriers of HIE Dream Ans✓✓✓ -Funding
,-Lack of interoperability
-Pt can access their own health info
-Providers lack access pt. data, due to multiple provider maintaining different
pieces of data
-Payers lack access to clinical data to access the value of services provided to their
customers
Benchmarking Ans✓✓✓ a process by which a company compares its
performance with that of high-performing organizations
can be average or mediocre
can be used by previous performance review
Benchmarking Ans✓✓✓ current starting point of stat/data
Determines quality access equity cost and efficiency
Capitation Ans✓✓✓ fixed payment per person to the health care provider for an
agreed-on array of services during a contract period (per member/per month).
Payment is the same no matter the amount or type of service. May put the
physician at odds with the patient
Chronic Disease and Mental Health Diseases in NHE (percentage) Ans✓✓✓ 90%
Among the top 5% of users account for about half of the spending
Clinical Outcomes Ans✓✓✓ Consequences of health care interventions that are
specific to persons who received care
, Begins with provider-patient interaction and its subsequent clinical processes and
outcomes
Have to have scientifically valid methods
CMS Core Quality Measures Intentions Ans✓✓✓ -develop measures that are
EBM and generate valuable info on quality
-help consumer decisions
-useful for value based purchasing and P4P
-reduce variability in measure selections
-decrease provider burden to collect
Coinsurance Ans✓✓✓ a type of insurance in which the insured pays a share of
the payment made against a claim.
Ex 80/20
Copayment Ans✓✓✓ a small fixed fee paid by the patient at the time of an office
visit
Cost/Cost Plus Ans✓✓✓ how hospitals/providers describe payments received for
services they have already provided. The organization tracks all the costs
associated with each customer and then asks to be paid that amount. Contracts
specific that the organization will be reimbursed for actual cost plus an additional
percentage of cost (includes built in profit)
Accounts in the NHEA Ans✓✓✓ National Health Expenditures: NHE
Health Consumption Expenditures: HCE
Personal Health Care: PHC
Adverse Selection Ans✓✓✓ the situation in which one party to a transaction
takes advantage of knowing more than the other party to the transaction
the sicker people likely want more insurance, compared to those who are healthy
Age-Adjusted Mortality Rate Ans✓✓✓ A mortality rate statistically modified to
eliminate the effect of different age distributions in the different populations.
Americans Stat on Health Ins Coverage Ans✓✓✓ 92% of the US population have
some sort of ins (8% or 26.4 M uninsured)
Baker and Chassin Four Criteria for All Out Measure Ans✓✓✓ Strong evidence
should exist that good medical care should exist leads to improvement in the
outcome within the same time period for the measure
The outcome should be measurable with a high degree of precision
The risk adjustment methodology should include accurately measuring the risk
factors most strongly associated with the outcome
Implementation of the outcome measure must have little chance of inducing
unintended adverse consequences
Barriers of HIE Dream Ans✓✓✓ -Funding
,-Lack of interoperability
-Pt can access their own health info
-Providers lack access pt. data, due to multiple provider maintaining different
pieces of data
-Payers lack access to clinical data to access the value of services provided to their
customers
Benchmarking Ans✓✓✓ a process by which a company compares its
performance with that of high-performing organizations
can be average or mediocre
can be used by previous performance review
Benchmarking Ans✓✓✓ current starting point of stat/data
Determines quality access equity cost and efficiency
Capitation Ans✓✓✓ fixed payment per person to the health care provider for an
agreed-on array of services during a contract period (per member/per month).
Payment is the same no matter the amount or type of service. May put the
physician at odds with the patient
Chronic Disease and Mental Health Diseases in NHE (percentage) Ans✓✓✓ 90%
Among the top 5% of users account for about half of the spending
Clinical Outcomes Ans✓✓✓ Consequences of health care interventions that are
specific to persons who received care
, Begins with provider-patient interaction and its subsequent clinical processes and
outcomes
Have to have scientifically valid methods
CMS Core Quality Measures Intentions Ans✓✓✓ -develop measures that are
EBM and generate valuable info on quality
-help consumer decisions
-useful for value based purchasing and P4P
-reduce variability in measure selections
-decrease provider burden to collect
Coinsurance Ans✓✓✓ a type of insurance in which the insured pays a share of
the payment made against a claim.
Ex 80/20
Copayment Ans✓✓✓ a small fixed fee paid by the patient at the time of an office
visit
Cost/Cost Plus Ans✓✓✓ how hospitals/providers describe payments received for
services they have already provided. The organization tracks all the costs
associated with each customer and then asks to be paid that amount. Contracts
specific that the organization will be reimbursed for actual cost plus an additional
percentage of cost (includes built in profit)
