HMAP 5300 FINAL EXAM 2025 ACTUAL EXAM WITH COMPLETE QUESTIONS AND CORRECT ANSWERS RATED A+
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Course
HMAP 5300
Institution
HMAP 5300
HMAP 5300 FINAL EXAM 2025 ACTUAL
EXAM WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+HMAP 5300 FINAL EXAM 2025 ACTUAL
EXAM WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
HMAP 5300 FINAL EXAM 2025 ACTUAL
EXAM WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS RATED A+
The Donabedian Model includes all of the following elements
except: Correct Answer Cost
Parts of the Donabedian Model:
-Process
-Structure
-Outcome
What is the purpose of clinical practice guidelines? Correct
Answer All of the above:
-to provide a plan to manage a clinical problem based on
evidence or consensus
-to lower costs
-to improve outcomes
What is the Health Plan Employer Data and Information Set
(HEDIS)? Correct Answer A quality report card
HEDIS data is collected through a combination of surveys,
medical record audits, and claims data. The data collected
provides information regarding customer satisfaction, specific
health care measures, and structural components that ensure
quality of care.
A service is cost-efficient when: Correct Answer The benefit
received is greater than the cost incurred to provide the service
Whether payment for healthcare services is made by the
government or by private insurance company, individual patients
,pay a price far higher than the actual cost of services. Correct
Answer False, patients pay far less thus the concern of morale
hazard or overuse because you are not worried about the entire
cost
Prevention and lifestyle behavior changes to promote health are
not major foci of the medical model Correct Answer True, the
medical model emphasizes clinical diagnoses and medical
interventions to treat disease or symptoms of disease, but fails to
account for prevention of disease and health promotion.
Healthcare costs for the elderly are nearly three times more than
those for the non-elderly Correct Answer True, hence concern
about aging populations
Critical pathways are outcome-based and patient-centered case
management tools that facilitate the coordination of care Correct
Answer True,
may include treatments, medications, diagnostic tests, diet,
activity regimens, consultations, discharge planning, and patient
education.
Managed care was initially welcomed by Correct Answer
Employers
Under the fee-for-service system, providers had the incentive to
Correct Answer Deliver more services than what would be
medically necessary because a greater volume would increase
their revenues
Under capitation, risk is shifted from: Correct Answer The MCO
to the Provider.
,Capitation is a fixed amount of money per patient per unit of time
paid in advance to the physician for the delivery of health care
services.
You will only get paid this much to treat the condition, and if it is
not treated you are medically liable
Self-care with professional support is referred to as: Correct
Answer Disease management
an approach to patient care that seeks to limit preventable events
by maximizing patient adherence to prescribed treatment and
health-promoting behaviors.
Monitoring of physician-specific practice patterns refers to:
Correct Answer Practice profiling
used to monitor the cost-effectiveness and quality of a certain
physician or practice
Which HMO model is likely to require heavy capital outlays to
expand into new markets? Correct Answer Staff model
staff models = HMO employs its own salaried physicians. based
on performance physicians get bonuses. Offers HMOs greater
control over practice patterns and physicians.
Group model = HMO contracts with a single multispecialty group
practice and constracts separately with one or more hospitals to
provide comprehensive services to its members. The group
practice employs the physician as opposed to the HMO directly
like in the staff model.
Network model = HMO contracts with more than one medical
group practice. This model is adaptable to large metropolitan
areas and wide geographic areas. less utilization control for HMO.
, Independent Practice Association Model (IPA) = legal entity
separate from the HMO. The IPA contracts both independent solo
practitioners and group practices. The HMO then contracts with
the IPA instead of with physicians or practices. The IPA acts as
an intermediary representing a large number of physicians. The
IPA often shares risks with the physicians and assumes the
responsibility for utilization management and quality assessment.
What is the purpose of risk sharing with providers? Correct
Answer It makes providers cost-conscious
A form of capitaion. incentivizes prudence among providers.
eliminates provider-induced demand.
Capitation is best described as: Correct Answer a fixed monthly
fee per member
One distinguishing feature of HMOs is that they use discounted
fees as the primary method of paying providers Correct Answer
False, pre-paid capitation
What is the central role of health services financing in the U.S.?
Correct Answer Fund health insurance
pay for health insurance premiums . physician reimbursements
depend on the premiums that are paid in.
Liberal reimbursement for a given technology will _____
innovation, diffusion, and utilization of that technology. Correct
Answer increase, because paid more to use it
In a general sense, what is the primary purpose of insurance?
Correct Answer Protect against risk
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