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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Related Questions
Correct Answer is ["B","D","E"]
Explanation
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.
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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