HOM 5307 ttu test 1 from practice-test
Managed Care
PPOs do not accept capitation risk and enrollees who are willing to pay higher cost
sharing may access providers that are not in the contracted network. - ANSWERS True
Blue Cross began how - ANSWERS 1929, Baylor for teachers in Houston, TX
Blue Shield started how - ANSWERS as a physician service bureau in the 1930s
BBA - ANSWERS Balanced Budget Act, 1997; Reduces payment level to Medicare
and Choice plans in most of the country, below the rate of increase of medical costs &
imposes additional administrative burdens.
T/F: BBA of 1997 resulted in a major increase in HMO enrollment. - ANSWERS False
chargemaster - ANSWERS a list detailing the official rate charged by a hospital for
individual procedures, services, and goods
T/F: Health care cost inflation has remained consistent since 1995. - ANSWERS False:
increase MCO for all types of plans, making it harder to know one plan from another;
return of rapidly rising health care cost, though the issue is far more complex than
simply reducing HMO enrollment. -return of increasing cost sharing
Prior to the 1970s, HMOs were known as: - ANSWERS Prepaid Group Practices
(PGP), creation of western clinic in Tacoma, WA. the first HMO.
The original impetus of HMOs development came from: - ANSWERS Providers seeking
patient revenues, consumers seeking access to health care
The integral components of managed care are: - ANSWERS wellness and prevention,
primary care orientation, utilization management
Managed Care is best described as: - ANSWERS A broad and constantly changing
array of health plans employers, unions, and other purchasers of that care that attempt
to manage cost, quality, and access to that care
The managed care backlash resulted in the following: - ANSWERS A reduction in HMO
membership; new federal and state regulations; rising number of lawsuits; HMO adopt
an open access model that no longer requires PCP authorization; decline in total HMO
membership; growth in PPO; harder to know one from another; rapidly rising health care
costs; increasing cost sharing
Managed Care
PPOs do not accept capitation risk and enrollees who are willing to pay higher cost
sharing may access providers that are not in the contracted network. - ANSWERS True
Blue Cross began how - ANSWERS 1929, Baylor for teachers in Houston, TX
Blue Shield started how - ANSWERS as a physician service bureau in the 1930s
BBA - ANSWERS Balanced Budget Act, 1997; Reduces payment level to Medicare
and Choice plans in most of the country, below the rate of increase of medical costs &
imposes additional administrative burdens.
T/F: BBA of 1997 resulted in a major increase in HMO enrollment. - ANSWERS False
chargemaster - ANSWERS a list detailing the official rate charged by a hospital for
individual procedures, services, and goods
T/F: Health care cost inflation has remained consistent since 1995. - ANSWERS False:
increase MCO for all types of plans, making it harder to know one plan from another;
return of rapidly rising health care cost, though the issue is far more complex than
simply reducing HMO enrollment. -return of increasing cost sharing
Prior to the 1970s, HMOs were known as: - ANSWERS Prepaid Group Practices
(PGP), creation of western clinic in Tacoma, WA. the first HMO.
The original impetus of HMOs development came from: - ANSWERS Providers seeking
patient revenues, consumers seeking access to health care
The integral components of managed care are: - ANSWERS wellness and prevention,
primary care orientation, utilization management
Managed Care is best described as: - ANSWERS A broad and constantly changing
array of health plans employers, unions, and other purchasers of that care that attempt
to manage cost, quality, and access to that care
The managed care backlash resulted in the following: - ANSWERS A reduction in HMO
membership; new federal and state regulations; rising number of lawsuits; HMO adopt
an open access model that no longer requires PCP authorization; decline in total HMO
membership; growth in PPO; harder to know one from another; rapidly rising health care
costs; increasing cost sharing
