Research shows that issues with access to both primary care and specialty care prevail in:
Preferred Provider Organization (PPO) plan
Medicare advantage plans.
Medicaid managed care.
Health Maintenance Organization (HMO) plans
The Correct Answer is D
Rationale:
A. Preferred Provider Organization (PPO) plan: PPO plans typically offer members greater flexibility in choosing healthcare providers and may not have as strict requirements for referrals to specialists, reducing barriers to access.
B. Medicare advantage plans: Medicare Advantage plans, also known as Medicare Part C, offer additional benefits beyond traditional Medicare, but they may not exhibit the same issues with access to primary and specialty care as other managed care plans.
C. Medicaid managed care: Medicaid managed care plans vary by state and may have different structures for accessing care, but they often emphasize primary care coordination and may not exhibit the same issues with access as HMO plans.
D. Health Maintenance Organization (HMO) plans: HMO plans typically require members to select a primary care physician (PCP) and obtain referrals from the PCP to see specialists. This structure can create barriers to accessing specialty care, particularly if there are limitations in provider networks or delays in obtaining referrals.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Health Maintenance Organization (HMO): HMOs were promoted as an alternative to
traditional fee-for-service models and typically employ stringent utilization controls, such as requiring members to select a primary care physician (PCP) and obtain referrals for specialist care.
B. Medicare Advantage (Part C): Medicare Advantage plans, while offering alternatives to
traditional Medicare fee-for-service, may not necessarily employ the tightest utilization controls compared to HMOs.
C. Preferred Provider Organization (PPO): PPOs offer more flexibility in choosing healthcare providers and typically have less stringent utilization controls compared to HMOs.
D. Point of Service (POS): POS plans combine elements of HMOs and PPOs, allowing members to choose between in-network and out-of-network care, but may not have as tight utilization controls as pure HMOs.
Correct Answer is D
Explanation
A. Pharmacy services available: While having pharmacy services available may be beneficial for patient care, it does not directly address the importance of organizational integration.
B. Provides food services to meet the nutritional and therapeutic requirements of the patients: While important for patient care, providing food services does not fully capture the importance of organizational integration.
C. There is maintenance of medical records on each patient: Maintaining medical records is essential for patient care but does not address the broader importance of organizational
integration.
D. It is necessary for economic reasons: Organizational integration refers to the coordination and alignment of different aspects of a healthcare organization, including clinical, administrative, and financial functions. Integration is crucial for optimizing efficiency, reducing duplication of services, improving communication, and ultimately achieving cost savings and better patient outcomes.
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