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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Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is D
Explanation
Rationale:
A. Acute conditions: Acute care focuses on the diagnosis and treatment of sudden and severe medical conditions that require immediate attention, such as heart attacks, strokes, or traumatic injuries.
B. Post-acute care: Post-acute care refers to services provided after an acute care hospital stay, such as rehabilitation or skilled nursing care, to help patients recover and regain independence.
C. Chronic conditions: Chronic care management involves the ongoing treatment and management of long-term health conditions, such as diabetes, hypertension, or arthritis.
D. Nursing home services: Nursing home services are a type of long-term care provided in residential facilities for individuals who require assistance with activities of daily living and
medical care on a long-term basis. These services are primarily associated with individuals who are unable to live independently due to age-related frailty, disability, or chronic illness.
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