AHM 250- Introduction To Health
Management (14-17) Questions And
Answers Latest Update
medical management (or care management) - Answers system that
health plans and their providers use to achieve and maintain both high
quality and cost-effectiveness
look up quality management
Medical management activities can be divided into three broad categories:
- Answers • Utilization management (UM) -manage the use of
medical services so that plan members receive necessary and appropriate
care in a cost-effective manner and in an appropriate setting.
• Clinical practice management -the development and implementation of
criteria and parameters for the delivery of healthcare services to plan
members
• Quality management (QM) -organization-wide process of measuring and
improving the quality of the healthcare and services a health plan's
members receive
Preventive care - Answers programs are designed to help plan
members stay healthy and can reduce healthcare costs by reducing the
, Q&A
need for diagnostic and therapeutic services, pharmaceuticals, and
inpatient hospital care.
health risk assessment (HRA)/ (or health risk appraisal) - Answers is
a process by which a health plan uses information about a plan member's
current health status, personal and family health history, and health-related
behaviors to determine the member's likelihood of experiencing specific
illnesses or injuries.
The preventive care initiatives most often adopted by health plans include
the following: - Answers • Immunization programs
• Health promotion programs (wellness programs) educate members and
motivate them to prevent illness and injury and promote good health
through lifestyle choices, such as stopping smoking, managing weight,
eating healthily, exercising, and managing stress.
-Maternity management programs are commonly included in health
promotion programs; they provide education to promote prenatal care and
help identify high-risk pregnancies.
• Screening programs
Maternity management programs - Answers are commonly included
in health promotion programs; they provide education to promote prenatal
care and help identify high-risk pregnancies.
Screening programs - Answers seek to determine if a health
condition is present even if a member has not experienced symptoms.
Commonly used screening tools include blood pressure measurements,
cholesterol level checks, fecal occult blood tests, and (for women) cervical
cancer screening and mammograms.
, Q&A
Self-care programs - Answers educate members on how to
distinguish between minor illnesses or injuries and serious conditions and
how to effectively treat minor problems with readily available means such
as diet, application of heat or cold, or over-the-counter medications
Decision support programs - Answers provide members with
educational materials and advice from healthcare professionals to help
them make informed healthcare decisions
The types of decision support programs health plans use most often are: -
Answers • web-based decision support tools
• telephone triage programs
• shared decision-making programs
most common web based tools are the following - Answers • Health
risk assessment (HRA)—an online questionnaire that helps a member
accurately determine his health status, gives him a personal risk
assessment, and directs him to next-step tools.
• Health risk tools and trackers—online tools with which members can
measure certain indicators of health risk (such as body mass index or BMI)
and track their progress toward meeting their health goals (such eating
more vegetables or exercising more regularly).
• Health and prevention information—education on health and fitness topics
and on the prevention and treatment of common conditions like
hypertension and diabetes.
• Drug information—comparisons of different drugs used for the same
conditions, and sometimes information on drug interactions and on the
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