HCM 360 Exam 3 questions well
answered graded A+ 2025/2025
passed
What is Managed Care? - correct answer ✔✔Organized approach to deliver comprehensive
health care services to enrolled members through efficient management of services and
payment arrangements with providers in the form of managed care plans or MCOs.
Evolution of Managed Care - correct answer ✔✔First private health insurance plan was based
on capitation. Known as the Baylor Plan(1929).
Reasons for growth in Managed Care - correct answer ✔✔Flaws in the fee for service model.
(uncontrolled utilization, uncontrolled prices and payment
Closed vs Open Panels - correct answer ✔✔Closed: in network; services obtained from
providers outside the panel are not covered by the plan.
Open: out of network; plan allows access to providers outside the panel, but the enrollee would
have to pay higher out of pocket costs.
Types of MCOs( HMO, PPO, POS) - correct answer ✔✔HMO: Health Maintenance Organization;
the enrollee is generally required to choose a PCP from a panel of physicians. All health care
must be obtained from in network hospitals and providers. Capitation as method of payment)
PPO: Preferred Provider Organization; establishes contracts with a select group of physicians
and hospitals. Allows an open panel option. Capitation not a payment method.
POS: Point of service plans; combined HMO and PPO options. Capitation payment.
Mergers and Acquisitions - correct answer ✔✔Mergers: the mutual agreement to unify two or
more organizations into a single entity.
answered graded A+ 2025/2025
passed
What is Managed Care? - correct answer ✔✔Organized approach to deliver comprehensive
health care services to enrolled members through efficient management of services and
payment arrangements with providers in the form of managed care plans or MCOs.
Evolution of Managed Care - correct answer ✔✔First private health insurance plan was based
on capitation. Known as the Baylor Plan(1929).
Reasons for growth in Managed Care - correct answer ✔✔Flaws in the fee for service model.
(uncontrolled utilization, uncontrolled prices and payment
Closed vs Open Panels - correct answer ✔✔Closed: in network; services obtained from
providers outside the panel are not covered by the plan.
Open: out of network; plan allows access to providers outside the panel, but the enrollee would
have to pay higher out of pocket costs.
Types of MCOs( HMO, PPO, POS) - correct answer ✔✔HMO: Health Maintenance Organization;
the enrollee is generally required to choose a PCP from a panel of physicians. All health care
must be obtained from in network hospitals and providers. Capitation as method of payment)
PPO: Preferred Provider Organization; establishes contracts with a select group of physicians
and hospitals. Allows an open panel option. Capitation not a payment method.
POS: Point of service plans; combined HMO and PPO options. Capitation payment.
Mergers and Acquisitions - correct answer ✔✔Mergers: the mutual agreement to unify two or
more organizations into a single entity.
