HMP CH. 9 – Flashcards
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Under capitation, risk is shifted
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from the MCO to the provider
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Under the fee-for-service system, providers had the incentive to
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deliver more services than what would be medically necessary because a greater volume would increase their revenues
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Gatekeeping heavily depends on the services of a
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primary care physician
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An experienced health care professional, such as a nurse practitioner, coordinates an individual's total health care.
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case managment
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Review of overutilization or underutilization is undertaken as part of
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retrospective utilization review
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PPOs differentiated themselves by offering _____ option to enrollees.
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open panel
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Among HMOs, which model is the most successful in terms of the share of all enrollments?
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independent practce association (IPA) model
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How does risk adjustment affect payments to managed care plans?
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Risk adjustment takes into account the enrollees' health status
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What type of integration is represented by a chain of nursing homes?
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horizontal integration
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Antitrust legislation is intended to provide checks against
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anticompetitive behavior
