#1
Which of the following is a characteristic of Managed Care Plans?
They emphasize preventive care and wellness programs.
ExplanationEmphasis on preventive care and wellness.
#2
What is the main goal of utilization management in managed care?
To limit unnecessary healthcare services
ExplanationGoal: Limiting unnecessary services.
#3
What is a common feature of Accountable Care Organizations (ACOs)?
They are accountable for the cost and quality of care for a defined population.
ExplanationAccountability for cost and quality.
#4
What is a primary focus of disease management programs in managed care?
To improve outcomes for patients with specific chronic conditions
ExplanationImproving outcomes for chronic conditions.
#5
What is the primary purpose of a formulary in managed care?
To limit patient access to medications
ExplanationLimiting patient access to medications.
#6
Which entity typically assumes financial risk in a capitated payment model?
Healthcare providers
ExplanationHealthcare providers assume financial risk.
#7
How does a Health Maintenance Organization (HMO) control costs?
By requiring referrals from primary care physicians
ExplanationCost control via primary care referrals.
#8
What is the concept of 'gatekeeping' in managed care?
Requiring patients to see a primary care physician before accessing specialists
ExplanationPrimary care referral before specialist.
#9
How do Accountable Care Organizations (ACOs) incentivize providers to improve quality and reduce costs?
By offering shared savings and bonuses for meeting targets
ExplanationIncentives via shared savings and bonuses.
#10
What is the purpose of risk adjustment in managed care?
To accurately reflect the health status of patient populations
ExplanationAccurate reflection of patient health status.
#11
In managed care, what is the role of a preferred provider organization (PPO)?
To encourage patients to seek out-of-network care
ExplanationEncouraging out-of-network care.
#12
What is the main difference between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO)?
PPOs require referrals for specialist visits, while HMOs do not.
ExplanationPPOs require specialist referrals, HMOs don't.
#13
In managed care, what is the purpose of case management?
To coordinate care for patients with complex medical needs
ExplanationCoordinating care for complex needs.
#14
How does managed care influence provider reimbursement models?
By transitioning to value-based reimbursement models
ExplanationTransition to value-based reimbursement.