AHM 250 – Introduction to Health Management (Chapters 14–17) 2026 – Study
Guide and Key Concepts
medical management (or care management) - correct answer ✔✔ 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: - correct answer ✔✔
• 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 - correct answer ✔✔ programs are designed to help plan members stay healthy
and can reduce healthcare costs by reducing the need for diagnostic and therapeutic services,
pharmaceuticals, and inpatient hospital care.
health risk assessment (HRA)/ (or health risk appraisal) - correct answer ✔✔ 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: -
correct answer ✔✔ • 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 - correct answer ✔✔ are commonly included in health
promotion programs; they provide education to promote prenatal care and help identify high-
risk pregnancies.
Screening programs - correct answer ✔✔ 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.
Self-care programs - correct answer ✔✔ 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 - correct answer ✔✔ 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: - correct answer ✔✔ •
web-based decision support tools
• telephone triage programs
• shared decision-making programs
most common web based tools are the following - correct answer ✔✔ • 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 plan's drug formulary and how
members can save money by using certain drugs.
• Provider report cards—physician and hospital data to assist consumers in making decisions on
where to seek care.
• Personal health records (PHRs)
Personal health records (PHRs) - correct answer ✔✔ -usually created by Health insurer
-an application that enables a person to create, review, annotate, and maintain a record of her
health conditions, medications, allergies, vaccination history, visit history, and communications
with their healthcare providers, and to share this information with appropriate healthcare
providers.
Health and prevention information - correct answer ✔✔ education on health and fitness topics
and on the prevention and treatment of common conditions like hypertension and diabetes
Health risk tools and trackers - correct answer ✔✔ 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).
telephone triage programs (medical advice lines) - correct answer ✔✔ to help members
determine if they need medical attention and if so what kind.
Guide and Key Concepts
medical management (or care management) - correct answer ✔✔ 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: - correct answer ✔✔
• 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 - correct answer ✔✔ programs are designed to help plan members stay healthy
and can reduce healthcare costs by reducing the need for diagnostic and therapeutic services,
pharmaceuticals, and inpatient hospital care.
health risk assessment (HRA)/ (or health risk appraisal) - correct answer ✔✔ 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: -
correct answer ✔✔ • 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 - correct answer ✔✔ are commonly included in health
promotion programs; they provide education to promote prenatal care and help identify high-
risk pregnancies.
Screening programs - correct answer ✔✔ 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.
Self-care programs - correct answer ✔✔ 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 - correct answer ✔✔ 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: - correct answer ✔✔ •
web-based decision support tools
• telephone triage programs
• shared decision-making programs
most common web based tools are the following - correct answer ✔✔ • 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 plan's drug formulary and how
members can save money by using certain drugs.
• Provider report cards—physician and hospital data to assist consumers in making decisions on
where to seek care.
• Personal health records (PHRs)
Personal health records (PHRs) - correct answer ✔✔ -usually created by Health insurer
-an application that enables a person to create, review, annotate, and maintain a record of her
health conditions, medications, allergies, vaccination history, visit history, and communications
with their healthcare providers, and to share this information with appropriate healthcare
providers.
Health and prevention information - correct answer ✔✔ education on health and fitness topics
and on the prevention and treatment of common conditions like hypertension and diabetes
Health risk tools and trackers - correct answer ✔✔ 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).
telephone triage programs (medical advice lines) - correct answer ✔✔ to help members
determine if they need medical attention and if so what kind.
