HOM exam 1 Exam Questions and Answers (Solved Papers) Prior to the 1970s, health maintenance organizations were known as - Correct Answers ✅Prepaid group practices The original impetus of HMOs development came from - Correct Answers ✅Providers seeking patient revenues Consumers seeking access to health care Employers The integral components of managed care are - Correct Answers ✅Wellness and prevention Primary care orientation Utilization management Managed care is best described as - Correct Answers ✅A broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to that care The managed care backlash resulted in which of the following
- Correct Answers ✅A reduction in HMO membership
New federal and state laws and regulations True/false? PPOs differ from HMOs because they do not accept capitation risk and enrollees are willing to pay higher 1 / 3
HOM exam 1 Exam Questions and Answers (Solved Papers) cost sharing may access providers that are not in the contracted network - Correct Answers ✅True True/false? Blue cross began as a physician service bureau in the 1930s - Correct Answers ✅False True/false? The balance budget act (BBA) of 1997 resulted in a major increase in HMO enrollment - Correct Answers ✅False True/false? Health care cost inflation has remained consistent since 1995 - Correct Answers ✅False Briefly explain how the HMO act of 1973 may have retarded HMO development in the few years after its enactment - Correct Answers ✅The act imposed requirements on HMOs but not on indemnity carriers or self insured groups, thereby reducing the ability of HMOs to compete. In addition because the government was slow to issue the act's regulations, employers were reluctant to contract with HMOs until they knew the rules under which they would be operating Briefly explain how the HMO Act of 1973 contributed to the growth of managed care - Correct Answers ✅The HMO Act of 1973 authorized start up funding and ensured access to employer based insurance. The dual choice provision required any employer with more than 25 employees to offer at least 2 / 3
HOM exam 1 Exam Questions and Answers (Solved Papers) one closed panel and one open panel HMO. In addition, federal qualification was perceived as an endorsement (a seal of good housekeeping) by the government in that the HMO met certain standards True/false? HMOs are licensed as health insurance companies
- Correct Answers ✅False
- / 3
True/false? An IPA is an HMO that contracts directly with physicians and hospitals - Correct Answers ✅False True/false? The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members. - Correct Answers ✅False. Direct contracting refers to direct contracts between the HMO and the physicians. Almost all models of HMOs contract directly with hospitals True/false? An IDS can be described as a legal entity consisting of more than one type of provider to manage a population's health care and/or contract with a payer organization - Correct Answers ✅True True/false? The GPWW requires the participation of a hospital and the formation of a group practice - Correct Answers ✅False