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 D
Explanation
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.
Correct Answer is A
Explanation
Rationale:
A. Psychiatric hospital: Psychiatric hospitals specialize in the treatment of mental illnesses and would be the appropriate referral for a patient diagnosed with a mental illness.
B. Rehabilitation hospital: Rehabilitation hospitals focus on providing intensive rehabilitation services for patients recovering from injuries, surgeries, or acute medical conditions, rather than mental health treatment.
C. Teaching hospital: Teaching hospitals are medical centers affiliated with medical schools where medical students, residents, and interns receive training. While they may offer psychiatric services, they are not specialized in the treatment of mental illness.
D. Children's hospital: Children's hospitals primarily provide healthcare services to pediatric
patients, including medical and surgical care, but they may not specialize in psychiatric treatment for mental illnesses.
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