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AHIP AHM 530 LATEST ACTUAL EXAM AND PRACTICE TEST QUESTIONS AND DETAILED CORRECT ANSWERS| AHM 530
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AHIP AHM 530 LATEST ACTUAL EXAM AND PRACTICE TEST QUESTIONS AND DETAILED CORRECT ANSWERS| AHM 530
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AHIP AHM 530 LATEST ACTUAL EXAM AND PRACTICE TEST QUESTIONS AND DETAILED CORRECT ANSWERS| AHM 530 The Azure Health Plan strives to ensure for its plan members the best possible level of care from its providers. In order to maintain such high standards, Azure uses a variety of quantitative and qualitative (be havioral) measures to determine the effectiveness of its providers. Azure then compares the clinical and operational practices of its providers with those of other providers outside the network, with the goal of identifying and implementing the practices t hat lead to the best outcomes. Qualitative measures that Azure could use to assess provider performance include an evaluation of how a. quickly the provider responds to plan members' inquiries b. effectively the provider communicates with plan members c. often the provider refers plan members for ancillary services d. many plan members visit the provider per month Correct Answer b. effectively the provider communicates with plan members Member satisfaction surveys help a health plan determine whether i ts providers are consistently delivering services to plan members in a manner that lives up to member expectations. Member satisfaction surveys allow the health plan to gather information about a. a member's reaction to services received during a specifi c encounter b. the reactions of specific subsets of the health plan's membership c. members' positive and negative experience with the plan's services d. All of the above Correct Answer d. All of the above The Edgewood Health Plan uses a combination of structural, process, outcomes, and customer satisfaction measures to evaluate its network providers' performance. Edgewood would correctly use outcome measures to evaluate a provider's a. compliance with specific regulatory or accrediting requirements b. appropriate use of specified procedures c. patient progress following treatment d. patient perceptions about how well the provider addresses medical problems Correct Answer c. patient progress following treatment Dr. Sylvia Volin and Dr. Andrew Liu ar e obstetrician/gynecologists who participate in the same provider network. Dr. Volin treats many high -risk patients, whereas Dr. Liu's patients are generally healthy and rarely present complications. As a result, Dr. Volin typically uses medical resources at a much higher rate than does Dr. Liu. In order to equitably compare Dr. Volin's performance with Dr. Liu's performance, the health plan modified its evaluation to account for differences in the provider's patient populations and treatment protocols. the health plan modified Dr. volin's and Dr. Liu's perforamnce data by means of: a. case mix (severity) adjustment b. external performance standard c. Structural measures d. behavior modification Correct Answer a. case mix (severity) adjustment The Azure Health Plan strives to ensure for its plan members the best possible level of care from its providers. In order to maintain such high standards, Azure uses a variety of qu antitative and qualitative (behavioral) measures to determine the effectiveness of its providers. Azure then compares the clinical and operational practices of its providers with those of other providers outside the network, with the goal of identifying an d implementing the practices that lead to the best outcomes. The comparative method of evaluation that Azure uses to identify and implement the practices that lead to the best outcomes is known as a. case mix analysis b. outcomes research c. benchmarkin g d. provider profiling Correct Answer d. provider profiling Which of the following statements about historical developments about pharmacy networks is/are correct? I. The first pharmacy network was established as part of a prepaid medical service of Ba ylor University in the 1920s II. The first formally organized pharmacy network appeared in 1967 when the auto union negotiated a prepaid prescription drug program III. Early pharmacy networks were typically open panels IV. Early pharmacy networks were ty pically closed panels A. I and II b. I and III c. II and III d. II and IV Correct Answer c. II and III True or False? Closed pharmacy networks limit participation to a select group of pharmacies Correct Answer true True or false? conditions that le nd themselves to disease state management (DSM) generally are acute conditions that require surgical intervention Correct An swer false Common cost -sharing strategies for prescription drugs include which of the following: I. co-payments II. co -insurance III. Therapeutic case management IV. Drug tiers a. I and II b. I, III, and IV c. I, II, and III d. I, II, and IV Correct Answer d. I, II, and IV True or false? therapeutic substitution is another name for generic substitution of brand name drugs Correct Answer false Which of the following statements is correct? a. state laws and Medicaid insurance plans generally mandate that p harmacies dispense brand name drugs b. mail order programs are considered a utilization management tool often used in managed care pharmacy programs c. pharmacy networks, unlike other provider networks, are designed to primarily deliver servicesThe benefits of buying summaries with Stuvia:
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