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 B
Explanation
Rationale:
A. Has an organized physician staff: This describes one characteristic of managed care organizations (MCOs), but it does not fully define managed care itself.
B. Managed care is a mechanism of providing health care services: Managed care refers to a system or approach to healthcare delivery that aims to manage and coordinate healthcare services
to improve quality, control costs, and optimize outcomes. It involves mechanisms such as provider networks, utilization management, and financial incentives to achieve these goals.
C. An institution with at least six beds and that delivers diagnostic and therapeutic services for medical conditions: This describes a hospital rather than managed care.
D. Provide continuous nursing service under RNS: This describes a specific nursing service and is not a comprehensive definition of managed care.
Correct Answer is D
Explanation
A. Part-time or intermittent skilled nursing care: This type of care is more commonly provided by home health care agencies or skilled nursing facilities rather than adult foster care facilities.
B. Nursing care, psychosocial therapies, and rehabilitation: These services are typically offered in specialized healthcare facilities such as nursing homes or rehabilitation centers, not adult foster care facilities.
C. A social setting: While adult foster care facilities do provide a social environment, this is not their primary function.
D. Room, board, and personal care: Adult foster care facilities primarily provide room, board, and personal care services to individuals who need assistance with daily living activities but do not require intensive medical or nursing care.
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