HMGT 6331 - FINAL EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
"3 legged stool" Correct Answers - regulatory overhaul of
private insurance market
- coverage mandates (disincentives)
- coverage expansion (subsidy incentive)
"False economy" Correct Answers the tendency to focus
entirely on price while failing to account for the true cost of the
choice one has made; penny-wise and pound foolish; saves
money initially, but over time, creates more waste and cost
- opening up more hospital beds
"Rules of the game" Correct Answers help determine the ways
we can coop- erate (and compete) with one another
ACA objectives Correct Answers - sought to improve access
with regulatory changes and coverage expansion
- sought to reduce the uninsured
Acountable Care Organizations Correct Answers Provide
coordinated high-quality care to their medicare patients
Advantages of free market economy Correct Answers -
Efficient allocation of resources
- Competition
- Innovation and economic growth
- Choice (competition creates profit Incentive creates choice)
- Absence of regulation
,Advantages of Medicare over Medicaid Correct Answers - less
suspicion/skepticism
- strong/well funded
- beneficiaries are frequent voting population
Adverse selection Correct Answers asymmetrical information
(if I know I'm young and healthy then I'm probably going to skip
the risk pool)
- response to: healthy people choosing no insurance or less
insurance and sick people choosing more insurance that will pay
out much more in claims
Alternatives to entitlement programs Correct Answers - block
grants
- private charity
- HSA accounts
All subsidized because ..... TAX FREE
Anti-kickback Law Correct Answers prohibits the solicitation,
receiving, offering, or paying of any remuneration directly or
indirectly in cash or in kind in exchange.
OUTSIDE REFERRAL
APM potential for innovation Correct Answers - Population
health management
- Fraud detection and prevention
- Patient engagement and adherence
, - Continuous learning and optimization
- Clinical decision support
- Predictive analytics for resource allocation
- Risk stratification and patient identification
APMS Correct Answers models that tie reimbursements to
various aspects f healthcare performance; they reward value
over volume
Availability Heuristic Correct Answers estimating the
likelihood of events based on their availability in memory; if
instances come readily to mind (perhaps because of their
vividness), we presume such events are common
Bundled payments Correct Answers a payment method in
which healthcare providers are paid a set amount for an episode
or cycle of care
Capitation Correct Answers payment to a provider that covers
each plan member's health care services for a certain period of
time
Challenges in APM implementation Correct Answers -
regulations: stark vs. antikickback
- patient engagement/accountability
- transition period: keeping things connected and aligned
Challenges of Medicare Correct Answers - baby boomers have
went from contributors to beneficiaries
- worker to beneficiary ratio (gains in workforce productivity)
COMPLETE SOLUTIONS
"3 legged stool" Correct Answers - regulatory overhaul of
private insurance market
- coverage mandates (disincentives)
- coverage expansion (subsidy incentive)
"False economy" Correct Answers the tendency to focus
entirely on price while failing to account for the true cost of the
choice one has made; penny-wise and pound foolish; saves
money initially, but over time, creates more waste and cost
- opening up more hospital beds
"Rules of the game" Correct Answers help determine the ways
we can coop- erate (and compete) with one another
ACA objectives Correct Answers - sought to improve access
with regulatory changes and coverage expansion
- sought to reduce the uninsured
Acountable Care Organizations Correct Answers Provide
coordinated high-quality care to their medicare patients
Advantages of free market economy Correct Answers -
Efficient allocation of resources
- Competition
- Innovation and economic growth
- Choice (competition creates profit Incentive creates choice)
- Absence of regulation
,Advantages of Medicare over Medicaid Correct Answers - less
suspicion/skepticism
- strong/well funded
- beneficiaries are frequent voting population
Adverse selection Correct Answers asymmetrical information
(if I know I'm young and healthy then I'm probably going to skip
the risk pool)
- response to: healthy people choosing no insurance or less
insurance and sick people choosing more insurance that will pay
out much more in claims
Alternatives to entitlement programs Correct Answers - block
grants
- private charity
- HSA accounts
All subsidized because ..... TAX FREE
Anti-kickback Law Correct Answers prohibits the solicitation,
receiving, offering, or paying of any remuneration directly or
indirectly in cash or in kind in exchange.
OUTSIDE REFERRAL
APM potential for innovation Correct Answers - Population
health management
- Fraud detection and prevention
- Patient engagement and adherence
, - Continuous learning and optimization
- Clinical decision support
- Predictive analytics for resource allocation
- Risk stratification and patient identification
APMS Correct Answers models that tie reimbursements to
various aspects f healthcare performance; they reward value
over volume
Availability Heuristic Correct Answers estimating the
likelihood of events based on their availability in memory; if
instances come readily to mind (perhaps because of their
vividness), we presume such events are common
Bundled payments Correct Answers a payment method in
which healthcare providers are paid a set amount for an episode
or cycle of care
Capitation Correct Answers payment to a provider that covers
each plan member's health care services for a certain period of
time
Challenges in APM implementation Correct Answers -
regulations: stark vs. antikickback
- patient engagement/accountability
- transition period: keeping things connected and aligned
Challenges of Medicare Correct Answers - baby boomers have
went from contributors to beneficiaries
- worker to beneficiary ratio (gains in workforce productivity)
