PM 508 Health Services Delivery
Midterm Questions with All Correct
Answers 2025-2026 Updated.
deductible - Answer the amount a person has to pay our of pocket before the insurance
benefits are paid
What is "hot spotting" in healthcare? - Answer Process to identify high-cost individuals in a
defined region in the health care system. It is used to guide targeted intervention and follow-up
to better address patient needs, improve care quality, and reduce costs
Why is there an effort to move away from the fee-for-service (FFS) payment model? - Answer
Physicians will no longer be interested in a private practice model. Instead, they will want
affiliations and employment opportunities with health systems and hospitals. A shift from FFS
would also limit overuse and overtreatment
How are Accountable Care Organizations (ACO) different from managed care of the past? -
Answer - ACO works with providers
- Focus is on reducing per member cost, not on increasing revenue
Particular focus on taking care of neediest or high-risk patients
What are the important components of the PCMH (patient centered medical home) model? -
Answer - Personal clinician in physician-directed team oriented medical practice
- Emphasizes whole-person orientation and is patient-centered
- Care is coordinated and integrated
- Emphasis on quality and safety
- Enhanced access
Payment reform
What is care management or disease management? - Answer - Coordination or managing
care for individuals with multiple health care needs
- Goal is to improve care coordination and follow -up for individuals
Helps to manage an individual with a chronic disease over time because it can prevent
conditions from getting worse
Why is it particularly important to have an integrated delivery system when caring for
individuals with chronic conditions? - Answer There is an extension of care and smooth
transition and connection between primary care, specialists, hospital, and post acute care.
Integration means there is a continuum of care while trying to control the costs of health care.
, What are some problems with traditional (non-integrated) health care delivery models? -
Answer - Primary focus is addressing acute illness
- No emphasis on wellness and prevention
- FFS payment- emphasizes volume and not quality
- Lack of integration
- Individuals lack access to primary care and overuse of ED
- Financial incentives are not aligned with quality
- No cost containment tools other than denial of services
- Little control over technology
No capacity to assess efficacy
What are the main arguments made by the states that have refused to expand Medicaid? -
Answer - Medicaid needs reform with state flexibility
- Risk of bait and switch in federal matching funds
Large state budge impacts
What is Medicaid expansion? As part of the ACA, it was expected to expand coverage to which
population? What is the controversy? - Answer - Covers people with incomes up to 138% of
FPL including adults without children
○ Higher incomes up to 400% FPL can receive subsidies to purchase private insurance via
insurance exchanges
- Medicaid expansion is funded by fed govt: 100% intiial then 90%
States can opt-out of medicaid expansion
Describe the uninsured population in terms of income, employment status, age, and health
status. - Answer The uninsured population is typically low income families who are
unemployed or work part time. They are typically younger individuals
What is the current state of the Affordable Care Act? (i.e. enrollment, implementation of the
provisions, politics) - Answer
What are the key features of the Affordable Care Act (ACA)? - Answer - All Americans are
required to have health insurance
- Private insurance companies cannot discriminate against preexisting conditions or people
likely incur high medical costs
- State medicaid programs will be required to cover all persons and their dependents with
incomes below 138% of the federal poverty level
Midterm Questions with All Correct
Answers 2025-2026 Updated.
deductible - Answer the amount a person has to pay our of pocket before the insurance
benefits are paid
What is "hot spotting" in healthcare? - Answer Process to identify high-cost individuals in a
defined region in the health care system. It is used to guide targeted intervention and follow-up
to better address patient needs, improve care quality, and reduce costs
Why is there an effort to move away from the fee-for-service (FFS) payment model? - Answer
Physicians will no longer be interested in a private practice model. Instead, they will want
affiliations and employment opportunities with health systems and hospitals. A shift from FFS
would also limit overuse and overtreatment
How are Accountable Care Organizations (ACO) different from managed care of the past? -
Answer - ACO works with providers
- Focus is on reducing per member cost, not on increasing revenue
Particular focus on taking care of neediest or high-risk patients
What are the important components of the PCMH (patient centered medical home) model? -
Answer - Personal clinician in physician-directed team oriented medical practice
- Emphasizes whole-person orientation and is patient-centered
- Care is coordinated and integrated
- Emphasis on quality and safety
- Enhanced access
Payment reform
What is care management or disease management? - Answer - Coordination or managing
care for individuals with multiple health care needs
- Goal is to improve care coordination and follow -up for individuals
Helps to manage an individual with a chronic disease over time because it can prevent
conditions from getting worse
Why is it particularly important to have an integrated delivery system when caring for
individuals with chronic conditions? - Answer There is an extension of care and smooth
transition and connection between primary care, specialists, hospital, and post acute care.
Integration means there is a continuum of care while trying to control the costs of health care.
, What are some problems with traditional (non-integrated) health care delivery models? -
Answer - Primary focus is addressing acute illness
- No emphasis on wellness and prevention
- FFS payment- emphasizes volume and not quality
- Lack of integration
- Individuals lack access to primary care and overuse of ED
- Financial incentives are not aligned with quality
- No cost containment tools other than denial of services
- Little control over technology
No capacity to assess efficacy
What are the main arguments made by the states that have refused to expand Medicaid? -
Answer - Medicaid needs reform with state flexibility
- Risk of bait and switch in federal matching funds
Large state budge impacts
What is Medicaid expansion? As part of the ACA, it was expected to expand coverage to which
population? What is the controversy? - Answer - Covers people with incomes up to 138% of
FPL including adults without children
○ Higher incomes up to 400% FPL can receive subsidies to purchase private insurance via
insurance exchanges
- Medicaid expansion is funded by fed govt: 100% intiial then 90%
States can opt-out of medicaid expansion
Describe the uninsured population in terms of income, employment status, age, and health
status. - Answer The uninsured population is typically low income families who are
unemployed or work part time. They are typically younger individuals
What is the current state of the Affordable Care Act? (i.e. enrollment, implementation of the
provisions, politics) - Answer
What are the key features of the Affordable Care Act (ACA)? - Answer - All Americans are
required to have health insurance
- Private insurance companies cannot discriminate against preexisting conditions or people
likely incur high medical costs
- State medicaid programs will be required to cover all persons and their dependents with
incomes below 138% of the federal poverty level
