Question 1

Diversification is not achieved through horizontal integration.

Accepted Answer

A) True 
 B)False

Question 2

Two organizations cease to exist, and a new corporation is formed.

Accepted Answer

A)  Acquisition
B)  Merger
C)  Joint venture
D)  Alliance

Question 3

Concurrent UR in a hospital will be primarily concerned with the

Accepted Answer

A)  disease process
B)  length of stay
C)  preauthorizations
D)  quality management

Question 4

Which HMO model is likely to provide the greatest control over the practice patterns of physicians?

Accepted Answer

A)  Staff model
B)  Group model
C)  Network model
D)  IPA model

Question 5

Closed-panel plan.

Accepted Answer

A)  No new physicians can be added to the plan
B)  New enrollees are not accepted by the plan
C)  The enrollee cannot switch from one plan to another
D)  The enrollee is restricted to the providers on the panel

Question 6

Which HMO model is likely to require heavy capital outlays to expand into new markets?

Accepted Answer

A)  Staff model
B)  Group model
C)  Network model
D)  IPA model

Question 7

In the term, managed care, 'manage' refers to

Accepted Answer

A)  management of utilization
B)  management of premiums
C)  management of risk
D)  management of the supply of services

Question 8

Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?

Accepted Answer

A)  Staff model
B)  Group model
C)  Network model
D)  IPA model

Question 9

Gatekeeping ______ secondary care services.

Accepted Answer

A)  bypasses
B)  encompasses the delivery of
C)  requires a referral for
D)  does not control

Question 10

Utilization is better controlled under a closed-panel plan than under an open-panel plan.

Accepted Answer

A) True 
 B)False

Question 11

What is the ultimate aim of a highly integrated organization?

Accepted Answer

A)  Deliver a seamless array of services
B)  Bring physicians and hospitals together to compete with managed care
C)  Become a risk bearing entity
D)  Obtain government contracts to participate in Medicaid and Medicare Advantage

Question 12

Managed care was initially welcomed by

Accepted Answer

A)  employers
B)  workers
C)  private insurance
D)  the government

Question 13

Fee for service promoted

Accepted Answer

A)  price controls
B)  moral hazard
C)  provider-induced demand
D)  both moral hazard and provider-induced demand

Question 14

Capitation is best described as

Accepted Answer

A)  monthly lump sum payment regardless of utilization
B)  monthly lump sum payment regardless of cost
C)  fixed monthly fee per member
D)  payments capped to a maximum cost for delivering services

Question 15

By law, an HMO is prohibited from having an exclusive contract with a group practice.

Accepted Answer

A) True 
 B)False

Question 16

Closely associated with concurrent UR is the function of

Accepted Answer

A)  preauthorization
B)  rehabilitation
C)  practice profiling
D)  discharge planning

Question 17

An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.

Accepted Answer

A)  Acquisition
B)  Merger
C)  Joint venture
D)  Alliance

Question 18

Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?

Accepted Answer

A)  Tax Equity and Fiscal Responsibility Act of 1982
B)  Balanced Budget Act of 1997
C)  Medicare Prescription Drug, Improvement, and Modernization Act of 2003
D)  Deficit Reduction Act of 2005

Question 19

What type of integration is represented by a chain of nursing homes?

Accepted Answer

A)  Vertical integration
B)  Network
C)  Horizontal integration
D)  Diversification

Question 20

Among HMOs, which model is the most successful in terms of the share of all enrollments?

Accepted Answer

A)  Staff model
B)  Group model
C)  Network model
D)  IPA model

Exam 9: Managed Care and Integrated Organizations

Concurrent UR in a hospital will be primarily concerned with the

Correct AnswerverifiedShow Answer

Two organizations cease to exist, and a new corporation is formed.

Correct AnswerverifiedShow Answer

By law, an HMO is prohibited from having an exclusive contract with a group practice.

Correct AnswerverifiedShow Answer

Capitation is best described as

Correct AnswerverifiedShow Answer

What is the ultimate aim of a highly integrated organization?

Correct AnswerverifiedShow Answer

Gatekeeping ______ secondary care services.

Correct AnswerverifiedShow Answer

Which HMO model is likely to provide the greatest control over the practice patterns of physicians?

Correct AnswerverifiedShow Answer

An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.

Correct AnswerverifiedShow Answer

Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?

Correct AnswerverifiedShow Answer

Utilization is better controlled under a closed-panel plan than under an open-panel plan.

Correct AnswerverifiedShow Answer

In the term, managed care, 'manage' refers to

Correct AnswerverifiedShow Answer

Which HMO model is likely to require heavy capital outlays to expand into new markets?

Correct AnswerverifiedShow Answer

Fee for service promoted

Correct AnswerverifiedShow Answer

Among HMOs, which model is the most successful in terms of the share of all enrollments?

Correct AnswerverifiedShow Answer

Managed care was initially welcomed by

Correct AnswerverifiedShow Answer

What type of integration is represented by a chain of nursing homes?

Correct AnswerverifiedShow Answer

Closely associated with concurrent UR is the function of

Correct AnswerverifiedShow Answer

Diversification is not achieved through horizontal integration.

Correct AnswerverifiedShow Answer

Closed-panel plan.

Correct AnswerverifiedShow Answer

Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?

Correct AnswerverifiedShow Answer

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