Private Insurance and Therapy (Chapter7)

Question 1

Managed care health insurance plans expand the role of the insurer using 3 principles. Which of the following is NOT a principle that MCOs use?

Answer 1

Determine the appropriateness of the care provided

Question 2

This is an ongoing process of utilization review implemented by MCOs to improve quality over time. An application of this process is a report card.

Answer 2

Benchmarking

Question 3

The following describes this managed care principle: The financial risk of health care is bore by the insurer, therefore actuarial analysis is of the utmost importance. A common payment system under this principle is the bundled payment system.

Answer 3

Payment Mechanism that Reward Efficiency

Question 4

The following describes this managed care product: It serves beneficiaries for a fixed fee and provide both financing and delivery of services. It utilizes a gatekeeper to pre-approve. Beneficiaries access with pre-approval only from providers on a panel.

Answer 4

Health Maintenance Organizations (HMO)

Question 5

The following describes this managed care product: This model is often used in conjunction with PPOs. It allows individuals greater control over their health care utilization and subsequently over their health care spending. At the same time, these plans discourage over use of health services that raise costs in the system.

Answer 5

Consumer-Directed Health Plans

Question 6

There are 4 models of how provider contracts are established. The following describes this model: This model is similar to the group model, but it contracts with multiple provider group practices, including both primary care and speciality groups. It may offer greater geographical coverage than the group model, and is known for being significantly less integrated than other models.
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Answer 6

Network Model

Question 7

There are 4 models of how provider contracts are established. The following describes this model: This model includes a contract with individual providers or small provider groups for the purpose of managed care contracting. Providers keep individual and group practices, thus, they are able to see patients from multiple HMOs. It is most commonly used by private practice OTs and PTs.

Answer 7

Independent Practice Associations

Question 8

Which of the following is NOT a common form of insurance?

Answer 8

Communication Insurance