HTHRHSC 4370 - COM POL INFL HC TEST 2 WITH COR
ACOs c(Accountable cCare cOrganizations) c- cCORRECT cANS✔✔Provider-led corganizations cwhos
cfull ccontinuum cof ccare cand cbe caccountable cfor coverall ccosts cand cquality cof ccare cfor ca cdefine
Encourages ccollaboration
Why cwould cproviders cform cACOs? c- cCORRECT cANS✔✔Physicians cand chospitals care cat cthe c
cthe cpayer
The cgoal cis cto cnot cexceed cthe cglobal cbudgetary ctarget cand cto cperform ceffective ccare
ACOs cmove ctoward cwhat cmodel? c- cCORRECT cANS✔✔The cpopulation chealth cmodel
Car ccrash capproach c- cCORRECT cANS✔✔when csomething chappens, ctaking caction cagainst can
this cdoes cnot cwork cbecause cit conly csolves cthe cindividual cscenario
Plane ccrash capproach c- cCORRECT cANS✔✔taking caction cto cprevent csomething cfrom chappenin
example: chaving cthere cbe ca cflag cin cthe csystem cif can corder cis cplaced cfor ca cprescription cdrug c
Are cmore cpolicies cput cinto cplace cusing cthe cplane ccrash cor cthe ccar ccrash cmethod? c- cCORREC
cmethod
Primary cCare c- cCORRECT cANS✔✔Common chealth cproblems
Preventive cmeasures
80-90% cof cvisits cto cdoctor cor cother ccaregiver
cost ccontainment c- cCORRECT cANS✔✔trying cto ccontrol cthe crising ccost cof chealth ccare cand cac
cfor cevery cdollar cspent
secondary ccare c- cCORRECT cANS✔✔Problems crequiring cmore cspecialized cexpertise
Ex: chospital ccare
tertiary ccare c- cCORRECT cANS✔✔highly ccomplex ccare cand ctherapy cservices cfrom cpractitioner
cfacility
management cof crare cdisorders csuch cas ccancer
cost csharing c- cCORRECT cANS✔✔patients cpay cdirectly cout cof cpocket cfor csome cportion cof ccar
, reference cpricing c- cCORRECT cANS✔✔pricing ca cproduct cat ca cmoderate clevel cand cdisplaying ci
cmodel cor cbrand
supply climits c- cCORRECT cANS✔✔controls con cthe cnumber cof cphysicians cand cother ccaregivers
csuch cas cthe cnumber cof chospital cbeds cor cMRI cscanners
allows cphysicians cto cprioritize cpatients cand celiminate cunnecessary cservices
combats csupply cinduced cdemand
utilization cmanagement c- cCORRECT cANS✔✔the csurveillance cof cand cintervention cin cthe cclinica
cthe cpurpose cof ccontrolling ccosts c
-different cthan ccost csharing cbecause cthis cis cfocusing con cthe cphysician crather cthan cthe cpatient
little cevidence cof cthis csaving cmoney
vertical cintegration c- cCORRECT cANS✔✔consolidating cunder cone corganizational croof cand ccom
ccare, cfrom cprimary cto ctertiary ccare, cand cthe cfacilities cand cstaff cnecessary cto cprovide cthis cfull
ex:Kaiser-Permanente
Kaiser-Permanente c- cCORRECT cANS✔✔-largest cprepaid cgroup cpractice cHMO cin cthe cUS
-1. cKaiser cFoundation cHealth cPlan- chealth cinsurer
c2. cKaiser cFoundation cHospitals cCorporation- cowns cand cadministers cKaiser chospitals
c3. cPermanente cmedical cgroups- cphysician corganizations cthat cadminister cthe cgroup cpractices
virtual cintegration c- cCORRECT cANS✔✔an cintegration cof cservices cbased con ccontractual crelatio
cownership
Do cHMOs cdirectly cprovide chealth cservices cthrough ctheir cown chospitals cand cphysician corganiza
cCORRECT cANS✔✔NO
Preferred cProvider cOrganization c(PPO) c- cCORRECT cANS✔✔allows cpatients cto csee cphysicians
cnetwork, cwith cthe cstipulation cthat cpatients cpay ca chigher cshare cof cthe ccost cout cof cpocket cwhe
cphysicians cand chospitals
Health cMaintenance cOrganization c(HMO) c- cCORRECT cANS✔✔Combine cfinancing cand cdeliver
corganizational cstructure
Premiums cdirectly cpurchase chealth cservices, cin cadvance
Name cchange cfrom cprepaid cgroup cpractice cto chealth cmaintenance corganizations cto cbreak cfrom
cundertones
Also cemphasizes cpreventative ccare c
Now cHMO cis cNOT cnecessarily csynonymous cwith cprepaid cgroup cpractice
patient ccentered cmedical chome c- cCORRECT cANS✔✔a ccare cdelivery cmodel cwhereby cpatient ct
cthrough ctheir cprimary ccare cphysician cto censure cthey creceive cthe cnecessary ccare cwhen cand cw
cmanner cthey ccan cunderstand
rationing c- cCORRECT cANS✔✔denying ca cpotentially cbeneficial ctreatment cto ca cpatient con cthe cg
policy c- cCORRECT cANS✔✔A claw, cregulation, cprocedure, cadministrative caction, cincentive, cor cv
cgovernments cand cother cinstitutions
essential cto cpublic chealth
What cpolicies care chealth cpolicies? c- cCORRECT cANS✔✔ALL cpolicy cis chealth cpolicy
Policy cProcess c- cCORRECT cANS✔✔5 cordered cdomains cand c2 coverarching cdomains
5 cOrdered cDomains c- cCORRECT cANS✔✔1.Problem cidentification
ACOs c(Accountable cCare cOrganizations) c- cCORRECT cANS✔✔Provider-led corganizations cwhos
cfull ccontinuum cof ccare cand cbe caccountable cfor coverall ccosts cand cquality cof ccare cfor ca cdefine
Encourages ccollaboration
Why cwould cproviders cform cACOs? c- cCORRECT cANS✔✔Physicians cand chospitals care cat cthe c
cthe cpayer
The cgoal cis cto cnot cexceed cthe cglobal cbudgetary ctarget cand cto cperform ceffective ccare
ACOs cmove ctoward cwhat cmodel? c- cCORRECT cANS✔✔The cpopulation chealth cmodel
Car ccrash capproach c- cCORRECT cANS✔✔when csomething chappens, ctaking caction cagainst can
this cdoes cnot cwork cbecause cit conly csolves cthe cindividual cscenario
Plane ccrash capproach c- cCORRECT cANS✔✔taking caction cto cprevent csomething cfrom chappenin
example: chaving cthere cbe ca cflag cin cthe csystem cif can corder cis cplaced cfor ca cprescription cdrug c
Are cmore cpolicies cput cinto cplace cusing cthe cplane ccrash cor cthe ccar ccrash cmethod? c- cCORREC
cmethod
Primary cCare c- cCORRECT cANS✔✔Common chealth cproblems
Preventive cmeasures
80-90% cof cvisits cto cdoctor cor cother ccaregiver
cost ccontainment c- cCORRECT cANS✔✔trying cto ccontrol cthe crising ccost cof chealth ccare cand cac
cfor cevery cdollar cspent
secondary ccare c- cCORRECT cANS✔✔Problems crequiring cmore cspecialized cexpertise
Ex: chospital ccare
tertiary ccare c- cCORRECT cANS✔✔highly ccomplex ccare cand ctherapy cservices cfrom cpractitioner
cfacility
management cof crare cdisorders csuch cas ccancer
cost csharing c- cCORRECT cANS✔✔patients cpay cdirectly cout cof cpocket cfor csome cportion cof ccar
, reference cpricing c- cCORRECT cANS✔✔pricing ca cproduct cat ca cmoderate clevel cand cdisplaying ci
cmodel cor cbrand
supply climits c- cCORRECT cANS✔✔controls con cthe cnumber cof cphysicians cand cother ccaregivers
csuch cas cthe cnumber cof chospital cbeds cor cMRI cscanners
allows cphysicians cto cprioritize cpatients cand celiminate cunnecessary cservices
combats csupply cinduced cdemand
utilization cmanagement c- cCORRECT cANS✔✔the csurveillance cof cand cintervention cin cthe cclinica
cthe cpurpose cof ccontrolling ccosts c
-different cthan ccost csharing cbecause cthis cis cfocusing con cthe cphysician crather cthan cthe cpatient
little cevidence cof cthis csaving cmoney
vertical cintegration c- cCORRECT cANS✔✔consolidating cunder cone corganizational croof cand ccom
ccare, cfrom cprimary cto ctertiary ccare, cand cthe cfacilities cand cstaff cnecessary cto cprovide cthis cfull
ex:Kaiser-Permanente
Kaiser-Permanente c- cCORRECT cANS✔✔-largest cprepaid cgroup cpractice cHMO cin cthe cUS
-1. cKaiser cFoundation cHealth cPlan- chealth cinsurer
c2. cKaiser cFoundation cHospitals cCorporation- cowns cand cadministers cKaiser chospitals
c3. cPermanente cmedical cgroups- cphysician corganizations cthat cadminister cthe cgroup cpractices
virtual cintegration c- cCORRECT cANS✔✔an cintegration cof cservices cbased con ccontractual crelatio
cownership
Do cHMOs cdirectly cprovide chealth cservices cthrough ctheir cown chospitals cand cphysician corganiza
cCORRECT cANS✔✔NO
Preferred cProvider cOrganization c(PPO) c- cCORRECT cANS✔✔allows cpatients cto csee cphysicians
cnetwork, cwith cthe cstipulation cthat cpatients cpay ca chigher cshare cof cthe ccost cout cof cpocket cwhe
cphysicians cand chospitals
Health cMaintenance cOrganization c(HMO) c- cCORRECT cANS✔✔Combine cfinancing cand cdeliver
corganizational cstructure
Premiums cdirectly cpurchase chealth cservices, cin cadvance
Name cchange cfrom cprepaid cgroup cpractice cto chealth cmaintenance corganizations cto cbreak cfrom
cundertones
Also cemphasizes cpreventative ccare c
Now cHMO cis cNOT cnecessarily csynonymous cwith cprepaid cgroup cpractice
patient ccentered cmedical chome c- cCORRECT cANS✔✔a ccare cdelivery cmodel cwhereby cpatient ct
cthrough ctheir cprimary ccare cphysician cto censure cthey creceive cthe cnecessary ccare cwhen cand cw
cmanner cthey ccan cunderstand
rationing c- cCORRECT cANS✔✔denying ca cpotentially cbeneficial ctreatment cto ca cpatient con cthe cg
policy c- cCORRECT cANS✔✔A claw, cregulation, cprocedure, cadministrative caction, cincentive, cor cv
cgovernments cand cother cinstitutions
essential cto cpublic chealth
What cpolicies care chealth cpolicies? c- cCORRECT cANS✔✔ALL cpolicy cis chealth cpolicy
Policy cProcess c- cCORRECT cANS✔✔5 cordered cdomains cand c2 coverarching cdomains
5 cOrdered cDomains c- cCORRECT cANS✔✔1.Problem cidentification
