Steps used to control costs of managed care include: - ANS Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
All of the above
DRG is used to classify - ANS Inpatient admissions for the purpose of reimbursing hospitals for
each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred
Identify the various types of private health plan coverage - ANS HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher
patient out-of-pocket expenditures for treatments that can serve to reduce utilization/costs.
All of the above
Managed care organizations (MCO) exist primarily in four forms: - ANS Health Maintenance
Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
All of the above
Identify the various types of government‐sponsored health coverage: - ANS Medicare -
Government; Beneficiaries enrolled in such plans, but, participation in these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll in a managed
care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
All of the above
Identify some key drivers of increasing healthcare costs - ANS Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed to reward volume
rather than quality, outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
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