Which of the following was promoted as an alternative for fee-for-service and employs the tightest utilization controls?
Health Maintenance Organization (HMO)
Medicare Advantage (Part C)
Preferred Provider Organization (PPO)
Point of Service (POS)
The Correct Answer is A
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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Concurrent: Concurrent utilization review involves the ongoing monitoring of a patient's care and recovery while they are still receiving treatment. This type of review focuses on ensuring that the care provided is appropriate and that the patient is progressing as expected.
B. Preauthorization: Preauthorization involves obtaining approval from a health insurer before a service is provided to ensure it will be covered. It does not focus on monitoring a patient's recovery.
C. Retrospective: Retrospective review involves evaluating the care provided to a patient after the treatment has been completed. It looks at the appropriateness of care but does not monitor ongoing recovery.
D. Prospective: Prospective review involves evaluating the necessity of a treatment before it begins. It does not include ongoing monitoring of a patient's prognosis for recovery.
Correct Answer is B
Explanation
Rationale:
A. Waste management, cost containment, and insurance companies: While these factors are important components of healthcare delivery, they do not encompass the three major cornerstones.
B. Cost, access, and quality: Cost, access, and quality are widely recognized as the three major cornerstones of healthcare delivery. Cost refers to the affordability and sustainability of
healthcare services, access pertains to the availability and timeliness of care, and quality involves the effectiveness, safety, and patient-centeredness of care.
C. Doctors, nurses, and waste management: While healthcare professionals and waste
management are integral to healthcare delivery, they are not the three major cornerstones.
D. Insurance companies, doctors, and nurses: While insurance companies and healthcare professionals are important stakeholders in healthcare delivery, they are not the three major cornerstones.
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