WGU Healthcare Ecosystems D391 - Questions
Answered Correctly By Expert
Which health plan is regulated under the Employee Retirement
Income Security Act (ERISA)? Correct Answer - Self-Insured
Medicare has four parts, A, B, C, and D: Correct Answer -
Medicare Part A is hospital coverage. Part B is Medicare's principal
benefit covering physician and other outpatient-provider services.
1997, significant changes came to Medicare, creating Medicare Part
C. The government worked with private Health Maintenance
Organizations (HMOs) to participate in Part C, called Medicare
Advantage (MA). This is where Parts A and B are covered in an HMO
care delivery model. 2003, Medicare Part D evolved under the
Medicare Prescription Drug, Improvement, and Modernization Act
(MMA).
TRICARE Correct Answer - military health plan that provides
services for active duty personnel and their families, survivors of
military personnel and retired military personnel and their families
The Federal Trade Commission (FTC) Correct Answer - Has a
role in MA plans. Because MA is a competitive consumer benefit, the
FTC is responsible for enforcing antitrust laws.
Nixon administration HMO act of 1973 Correct Answer -
health maintenance organization= affordable and accessible
FOUR PAYER MODELS: Correct Answer - Beveridge, Bismarck,
National Health Insurance, and the Out-of-pocket model. The US is a
Bis/Bev model.
, Fee for service model Correct Answer - Reimbursement for
providers was based on the number of services in a visit. Expensive.
Health maintenance organizations Correct Answer - Limited
coverage but controlled costs. Paid capitation payment and restricts
patients to a preferred list of providers.
ACA Affordable Care Act of 2010 replaced the FFS model. Correct
Answer - Medicare and Medicaid managed organizations (MCOs)
are mandated by the ACA. They had to transition to value-based
care. VBC model and capitated fees. Many MCO's transitioned their
business to VBC models
VBC- Value based care. Quality over quantity Correct Answer -
An improvement to provider performance. Healthcare aligns with
patient outcomes. Govt. Regulates healthcare customer service,
skills, and compliance processes. Focus on wellness and prevention.
Moral Hazard Correct Answer - Consumers buy unnecessary
additional healthcare because they do not receive the full benefit.
Individuals incur no consequence for a decision, allowing for
extravagant choices.
Adverse Selection Correct Answer - Consumers do not
purchase health insurance until they need coverage. The insured has
information that the insurer does not. Cost below the true risk level.
5 Main funding models of the U.S. Healthcare system Correct
Answer - The National Health Insurance Model (single-payer
model), Bismarck Model (a combination of payers), Beveridge,
Bev/Bis hybrid, Self-Funded.
Bismarck Correct Answer - A social health insurance model.
Answered Correctly By Expert
Which health plan is regulated under the Employee Retirement
Income Security Act (ERISA)? Correct Answer - Self-Insured
Medicare has four parts, A, B, C, and D: Correct Answer -
Medicare Part A is hospital coverage. Part B is Medicare's principal
benefit covering physician and other outpatient-provider services.
1997, significant changes came to Medicare, creating Medicare Part
C. The government worked with private Health Maintenance
Organizations (HMOs) to participate in Part C, called Medicare
Advantage (MA). This is where Parts A and B are covered in an HMO
care delivery model. 2003, Medicare Part D evolved under the
Medicare Prescription Drug, Improvement, and Modernization Act
(MMA).
TRICARE Correct Answer - military health plan that provides
services for active duty personnel and their families, survivors of
military personnel and retired military personnel and their families
The Federal Trade Commission (FTC) Correct Answer - Has a
role in MA plans. Because MA is a competitive consumer benefit, the
FTC is responsible for enforcing antitrust laws.
Nixon administration HMO act of 1973 Correct Answer -
health maintenance organization= affordable and accessible
FOUR PAYER MODELS: Correct Answer - Beveridge, Bismarck,
National Health Insurance, and the Out-of-pocket model. The US is a
Bis/Bev model.
, Fee for service model Correct Answer - Reimbursement for
providers was based on the number of services in a visit. Expensive.
Health maintenance organizations Correct Answer - Limited
coverage but controlled costs. Paid capitation payment and restricts
patients to a preferred list of providers.
ACA Affordable Care Act of 2010 replaced the FFS model. Correct
Answer - Medicare and Medicaid managed organizations (MCOs)
are mandated by the ACA. They had to transition to value-based
care. VBC model and capitated fees. Many MCO's transitioned their
business to VBC models
VBC- Value based care. Quality over quantity Correct Answer -
An improvement to provider performance. Healthcare aligns with
patient outcomes. Govt. Regulates healthcare customer service,
skills, and compliance processes. Focus on wellness and prevention.
Moral Hazard Correct Answer - Consumers buy unnecessary
additional healthcare because they do not receive the full benefit.
Individuals incur no consequence for a decision, allowing for
extravagant choices.
Adverse Selection Correct Answer - Consumers do not
purchase health insurance until they need coverage. The insured has
information that the insurer does not. Cost below the true risk level.
5 Main funding models of the U.S. Healthcare system Correct
Answer - The National Health Insurance Model (single-payer
model), Bismarck Model (a combination of payers), Beveridge,
Bev/Bis hybrid, Self-Funded.
Bismarck Correct Answer - A social health insurance model.
