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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
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.
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