What three factors are critical in differentiating between the types of managed care organization (MCOs)?
CEO with responsibility for operations
Payment and risk-sharing
Organized physician staff
Choice of providers
Different ways of arranging services
Correct Answer : B,D,E
Rationale:
A. CEO with responsibility for operations: While the leadership structure may vary among different managed care organizations (MCOs), it is not one of the critical factors in differentiating between types of MCOs.
B. Payment and risk-sharing: Payment mechanisms and risk-sharing arrangements are crucial factors that differentiate between different types of MCOs, such as HMOs, PPOs, and POS plans.
C. Organized physician staff: While the organization of physician staff may vary among MCOs, it is not one of the critical factors in differentiating between types of MCOs.
D. Choice of providers: The availability of provider networks and the degree of member choice in selecting healthcare providers are important factors that differentiate between types of MCOs.
E. Different ways of arranging services: The methods by which healthcare services are arranged and delivered, such as through primary care gatekeepers or direct access to specialists, are critical factors that distinguish between different types of MCOs.
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Related Questions
Correct Answer is A
Explanation
Rationale:
A. Car model: The "Car model" is not a recognized model of Health Maintenance Organization (HMO). It seems to be a distractor in this context.
B. Network model: In the network model, the HMO contracts with multiple independent medical groups or practices to provide healthcare services to its members.
C. Group model: In the group model, the HMO contracts with a single medical group, which employs physicians and provides healthcare services to HMO members.
D. Staff model: In the staff model, the HMO directly employs physicians and other healthcare providers who deliver services to its members.
Correct Answer is D
Explanation
Rationale:
A. Place caps on the rise of health insurance premiums: This option does not align with the main purpose of the Health Maintenance Organization (HMO) Act of 1973, which aimed to promote
the development of HMOs as an alternative to traditional fee-for-service models rather than directly addressing insurance premiums.
B. Transfer the control of HMOs from the federal government to private companies: The HMO Act of 1973 aimed to encourage the establishment of HMOs by providing federal grants and
loans, but it did not involve transferring control from the government to private companies.
C. Rein in the growing power of managed care: The HMO Act of 1973 actually facilitated the growth of managed care by providing federal support for the establishment of HMOs, rather than attempting to rein in their power.
D. Provide an alternative to fee-for-service: The primary purpose of the HMO Act of 1973 was to promote and facilitate the development of Health Maintenance Organizations (HMOs) as an
alternative healthcare delivery model to traditional fee-for-service arrangements. HMOs were intended to emphasize preventive care, cost containment, and coordination of services.
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