Hint: Use the economic concept of opportunity cost. Key common characteristics of PPOs include: Selected provider panels Negotiated provider payment rates Consumer choice Utilization management. board of directors has final responsibility for all aspects of an independent HMO. A- Costs are predictable Established as independent health authorities to provide more local control and administration, these plans may constitute a single delivery system for all Medicaid enrollees in the jurisdiction . Scope of services. . Oil well}\\ c. A percentage of the allowable charge that the member is responsible for paying. Lower monthly premiums, lower out-of-pocket costs, which may or may not include a deductible. In contrast, PPOs tend not to require selection of a PCP, and you can usually see a specialist without a referral, and still have these costs covered. Which set of postoperative PPOs was used did not inu-ence the surgical procedure in any way. Blue Cross began as a physician service bureau in the 1930s. Experiences with mood can last for many weeks to many months, then seemingly change from one day to the next into the next mood. Qualified Health Plans (these are Obamacare plans that can be purchased with a subsidy) Catastrophic Plans (primarily available to people under age 30) Government-sponsored health insurance coverage (Medicare, Medicaid, etc.) The most common measurement of inpatient utilization is: Managed prescription drug programs must be flexible and customize pharmacy benefit designs to accommodate diverse financial and benefit richness desires of their customers, The typical practicing physician has a good understanding of what is happening with his or her patient between office visits, Blue Cross began as a physician service bureau in the 1930s, Fee-for-service physicians are financially rewarded for good disease management in most environments, Select the one technique for controlling drug benefits costs that MOST health plans and PBMs DO NOT routinely use. A- Enrollees per thousand bed days Concepts of Managed Care MIDTERM HA95.docx, Test Bank Exam 1 Principles of Managed Care 012820.docx, Your formal report will explore these issues in your major course of study/industry and will require that you recommend solutions to address the problem/issue (recommendation report). the most effective way to induce behavior changes in physician is through continuing medical education, T/F 28 related questions found What is a PPO plan? PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. In what model does an HMO contract with more than one group practice provide medical services to its members? He hires an attorney to determine whether he and Mary were legally married. True or False. How are outlier cases determined by a hospital? D- All the above, C- through the chargemaster 16. 'health plan employer data and information set' is the less widely used set of measures for reporting on managed behavioral healthcare. physician behavior begins with a mindset established in med school, academic detailing refers to: B- Episodes of care The characteristics of PPOs include flexibility and managed health care. Any programs that are not sold are donated to a recycling center and do not produce any revenue. 7 & 5 & 6 & 6 & 6 & 4 & 8 & 6 & 9 & 3 C- A constantly changing array of unions, and other purchasers of care that attempt to manage cost, quality, and access to that care D- All the above, D- all of the above *Pace quickened The choice of HMO vs. PPO should depend on your particular healthcare situation and requirements. Set up the null and alternative hypotheses for this hypothesis test. C- Case rate B- Geographic location Next, summarize of the article AND identify the issue the incident, 2 points Key common characteristics of PPOs do NOT include: Limited provider panels O Discounted payment rates Consumer choice O Utilization management Benefits limited to in-network care, The purpose of managed care is to provide more people with health coverage limit the services of private insurance reduce the cost of health care and maintain the quality of care add more services to, Basic benefits that must be included in all Medicare supplement (medigap) policies include all the following EXCEPT: A: The first 3 pints of blood each year B: the part B percentage participation for.