RMI 3501 Exam 3 Questions and Answers Latest Version 2025 Already Passed
When an ER or insurer says they want to engage in healthcare cost containment, what is a realistic goal?
- Answers Reduce the rate of growth in HC costs to an acceptable level for the ER
What are the three broad strategies of HCCC - Answers 1. Reduce frequency (# of units utilized)
2. Reduce severity (price paid for unit)
3. Change the mix of services
What are the three characteristics of cost sharing arrangements? - Answers 1. deductibles, coinsurance,
copayment
2. basic controls on moral hazard
3. CDHPS
(all examples of POS cost-sharing)
What does a cost sharing arrangement help to control? - Answers # of units utilized (frequency)
True or false: waiving copay for generic brands helps control demand for HCGS - Answers TRUE
True or false: Contributory financing is a form of cost sharing - Answers FALSE - this is not cost sharing
because it does not reduce healthcare utilization
What is the purpose of a wellness program? - Answers Make employees healthier so they consume less
healthcare
What are some examples of wellness programs? - Answers onsite gyms, stop smoking programs, weight
management
What is the top down strategy? - Answers Micro-managing providers to control the supply of services
e.g. claims review, utilization review
What is the bottom up strategy? - Answers Pay providers by salary or capitation to reduce utilization of
services
What are two ways to lower the price paid per unit? - Answers 1. Negotiated Pricing
2. Reference Based Pricing + Consumer Information
What is negotiated pricing? - Answers negotiate discounts with providers to lower price paid per unit
, what are the negatives to negotiated pricing? - Answers 1. Could result in cost shifting to the patient (i.e.
balance billing)
2. Could create a utilization offset
What is a utilization offset? - Answers Give patients more services that they may not need to make up
for discounted rates
What is the benefit to referenced based pricing with consumer information? - Answers Insurer tells
consumer the price they should expect to pay for a procedure. This allows the consumer to be able to
"shop around" and weed out potentially inflated prices.
Has the advantage of lowering the cost of healthcare for the whole market
How can an insurer change the mix of services utilized? - Answers Substitute a less costly service for a
more costly service
Provide incentives for patients and providers to make this substitution
What is the difference between non-contributory and contributory financing? - Answers Non-
contributory - ER pays the full cost of the plan "defined benefit"
Contributory - "Defined contribution" - ER pays less than the full cost, EE becomes more conscious about
their consumption
What is the consumerism approach? - Answers EE's see the true cost of the plan options
EE is given a voucher to spend on plan of their choice
voucher often less than the cost of any plan option
What happens in a private exchange? - Answers EE is walked through plan choices and spends "Credits"
assigned to EE
good way to market voluntary benefits
Why is there a moral hazard problem with most health insurance plans? - Answers Characterized by low
deductibles and low OOP maximums
does not provide incentive for patients to behave as traditional consumers because they pay very little
What are the three components of a CDHP? - Answers 1. High deductible health plan (HDHP) + MUCH
higher OOP Max
When an ER or insurer says they want to engage in healthcare cost containment, what is a realistic goal?
- Answers Reduce the rate of growth in HC costs to an acceptable level for the ER
What are the three broad strategies of HCCC - Answers 1. Reduce frequency (# of units utilized)
2. Reduce severity (price paid for unit)
3. Change the mix of services
What are the three characteristics of cost sharing arrangements? - Answers 1. deductibles, coinsurance,
copayment
2. basic controls on moral hazard
3. CDHPS
(all examples of POS cost-sharing)
What does a cost sharing arrangement help to control? - Answers # of units utilized (frequency)
True or false: waiving copay for generic brands helps control demand for HCGS - Answers TRUE
True or false: Contributory financing is a form of cost sharing - Answers FALSE - this is not cost sharing
because it does not reduce healthcare utilization
What is the purpose of a wellness program? - Answers Make employees healthier so they consume less
healthcare
What are some examples of wellness programs? - Answers onsite gyms, stop smoking programs, weight
management
What is the top down strategy? - Answers Micro-managing providers to control the supply of services
e.g. claims review, utilization review
What is the bottom up strategy? - Answers Pay providers by salary or capitation to reduce utilization of
services
What are two ways to lower the price paid per unit? - Answers 1. Negotiated Pricing
2. Reference Based Pricing + Consumer Information
What is negotiated pricing? - Answers negotiate discounts with providers to lower price paid per unit
, what are the negatives to negotiated pricing? - Answers 1. Could result in cost shifting to the patient (i.e.
balance billing)
2. Could create a utilization offset
What is a utilization offset? - Answers Give patients more services that they may not need to make up
for discounted rates
What is the benefit to referenced based pricing with consumer information? - Answers Insurer tells
consumer the price they should expect to pay for a procedure. This allows the consumer to be able to
"shop around" and weed out potentially inflated prices.
Has the advantage of lowering the cost of healthcare for the whole market
How can an insurer change the mix of services utilized? - Answers Substitute a less costly service for a
more costly service
Provide incentives for patients and providers to make this substitution
What is the difference between non-contributory and contributory financing? - Answers Non-
contributory - ER pays the full cost of the plan "defined benefit"
Contributory - "Defined contribution" - ER pays less than the full cost, EE becomes more conscious about
their consumption
What is the consumerism approach? - Answers EE's see the true cost of the plan options
EE is given a voucher to spend on plan of their choice
voucher often less than the cost of any plan option
What happens in a private exchange? - Answers EE is walked through plan choices and spends "Credits"
assigned to EE
good way to market voluntary benefits
Why is there a moral hazard problem with most health insurance plans? - Answers Characterized by low
deductibles and low OOP maximums
does not provide incentive for patients to behave as traditional consumers because they pay very little
What are the three components of a CDHP? - Answers 1. High deductible health plan (HDHP) + MUCH
higher OOP Max
