Imagine you are an executive for BP,

1)The managed care phenomenon was welcomed mostly bya.employersb.workersc.private insuranced.the government2) With the growth of managed care, the balance of power in the medical marketplace swung towarda.providersb.the supply sidec.the demand sided.more regulation3) A managed care organization functions likea.a providerb.an insurerc.a regulatord.a financier4) What is the purpose of risk sharing with providers?a.It makes providers immune to costsb.It makes providers cost consciousc.It rewards providers for qualityd.It keeps insurance premiums low5)Capitation is best described asa.monthly lump sum payment regardless of utilizationb.monthly lump sum payment regardless of costc.per member per month paymentd.payments capped to a maximum cost for delivering services6)Under capitation, risk is shifteda.from the insured to the employerb.from the provider to the MCOc.from the employer to the MCOd.from the MCO to the provider7) Under which payment method is a fee schedule used?a.prospective paymentb.capitationc.discounted feesd.fee for service8)The HMO Act of 1973 requireda.health care providers to contract with HMOsb.managed care organizations to offer HMO alternativesc.insurers to switch to managed cared.employers to offer an HMO alternative to conventional health insurance9)In the term, managed care, ‘manage’ refers toa.management of utilizationb.management of premiumsc.management of riskd.management of the supply of services10)Under the fee-for-service system, providers had the incentive toa.deliver more services than what would be medically necessary because a greater volume would increase their incomesb.use less technology because they could increase their incomes by not using costly proceduresc.indiscriminate cost increases because they could get paid whatever they would charged.increase the level of quality in order to attract more patients11)In the beginning, why did HMOs only had limited appeal?a.HMOs faced resistance from employersb.The shadow pricing practices used by HMOs were declared illegalc.The HMOs had only limited ability to control costs.d.The insured wanted to maintain the choice of providers12)Closed-panel plan.a.No new physicians can be added to the planb.New enrollees are not accepted by the planc.The enrollee cannot switch from one plan to anotherd.The enrollee is restricted to the providers on the panel13)Gatekeeping heavily depends on the services of aa.primary care physicianb.case managerc.disease consultantd.nurse practitioner14)Gatekeeping emphasizesa.denial of specialized servicesb.closed-panel utilizationc.preventive and primary cared.secondary care15)Under _____ a primary care physician becomes the portal of entry to the health care delivery system.a.case managementb.utilization reviewc.gatekeepingd.closed-panel utilization16)Cost-effective management of care for patients who have complex medical conditions.a.Case managementb.Gatekeepingc.Utilization managementd.Managed care17)A primary care physician decides whether or not to refer a patient to a specialist.a.Preauthorizationb.Prospective utilization reviewc.Disease managementd.Closed-panel utilization18)Precertification is the responsibility ofa.the gatekeeperb.the case managerc.the health pland.the employer19)Under prospective utilization review, if a case is determined to be potentially complex and costly, it is referred toa.case managementb.concurrent utilization reviewc.appropriate specialistsd.discharge planners20)Concurrent UR in a hospital will be primarily concerned with thea.disease processb.length of stayc.preauthorizationsd.quality management21)Closely associated with concurrent UR is the function ofa.preauthorizationb.rehabilitationc.practice profilingd.discharge planning22)Review of patterns of practice is undertaken as part ofa.concurrent utilization reviewb.retrospective utilization reviewc.prospective utilization reviewd.case management23)Data collection and statistical analysis are often part ofa.concurrent utilization reviewb.retrospective utilization reviewc.prospective utilization reviewd.case management24)Monitoring of provider-specific practice patterns.a.concurrent utilization reviewb.retrospective utilization reviewc.case managementd.practice profiling25)When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?a.Specialty careb.Gatekeepingc.Mental healthd.Primary care26)Physicians are employees of the HMO.a.Preferred providersb.IPA modelc.Staff modeld.Independent practice association27)Which HMO model is likely to provide the greatest control over the practice patterns of physicians?a.Staff modelb.Group modelc.Network modeld.IPA model28)In which HMO model is the choice of physicians likely to be most restricted?a.Staff modelb.Group modelc.Network modeld.IPA model29)Which HMO model is likely to require heavy capital outlays to expand into new markets?a.Staff modelb.Group modelc.Network modeld.IPA model30)Who employs the physicians in the group practice model?a.The HMOb.The group practicec.The IPAd.The PPO31)A network model HMOa.employs its own network of physiciansb.exclusively uses the services of an independent practice associationc.owns a network of physicians and hospitalsd.contracts with more than one group practices32)Which model of HMO was specifically included in the HMO Act of 1973?a.Staff modelb.Group modelc.Network modeld.IPA model33)Under which model is an HMO relieved of the burden to establish contracts with providers and monitor utilization?a.Staff modelb.Group modelc.Network modeld.IPA model34)Who is likely to bear the most financial risk under the IPA model?a.The IPAb.The providersc.The HMOd.The employers35)Among HMOs, which model is predominant in the marketplace?a.Staff modelb.Group modelc.Network modeld.IPA model36)PPOs were created by ____ in response to HMOs’ growing market share.a.physiciansb.insurance companiesc.hospitalsd.independent contractors37)PPOs differentiated themselves by offering _____ options to enrollees.a.point of serviceb.no out-of-pocket paymentc.open-paneld.discount38)A hybrid between an HMO and a PPO.a.Point-of-service plansb.Mixed model HMOc.IPAd.Exclusive provider plans39)Which type of MCO has achieved the greatest success in member enrollment?a.HMOsb.PPOsc.POS plansd.Exclusive provider plans40)How are employers coping with the rising cost of health insurance premiums?a.They are dropping health benefits in large numbersb.They are enrolling a greater number of their employees into HMOsc.They are shifting costs to their employeesd.They are switching to high-deductible health plans in large numbers41)Which legislation was mainly responsible for giving states the authority to enroll a large number of Medicaid recipients into managed care?a.Tax Equity and Fiscal Responsibility Act of 1982b.Balanced Budget Act of 1997c.HMO Act of 1973d.Deficit Reduction Act of 200542)Which legislation was mainly responsible for the decline of Medicare enrollments in managed care after a rise in enrollments?a.Tax Equity and Fiscal Responsibility Act of 1982b.Balanced Budget Act of 1997c.Medicare Prescription Drug, Improvement, and Modernization Act of 2003d.Deficit Reduction Act of 200543)The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits a health plan to offer less than _____ of inpatient stay following a normal vaginal delivery.a.24 hoursb.48 hoursc.3 daysd.4 days44)The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits a health plan to offer less than _____ hours of inpatient stay following a Caesarean section.a.48b.72c.96d.12045)Which of the following is not an example of consolidation?a.Building of new facilitiesb.Acquiring an existing facilityc.Merging with an existing organizationd.Alliances among existing organizations46)Which of these organizations was specifically created to bring management expertise to physician group practices?a.Virtual organizationsb.Physician-hospital organizationsc.Provider-sponsored organizationsd.Management services organizations47)An organization ceases to exist as a separate entity and is absorbed into the purchasing corporation.a.Acquisitionb.Mergerc.Joint ventured.Alliance48)Two organizations cease to exist, and a new corporation is formed.a.Acquisitionb.Mergerc.Joint ventured.Alliance49)A new corporation created by two partnering organizations remains independent.a.Acquisitionb.Mergerc.Joint ventured.Alliance50)A type of integration that does not involve any joint ownership of assets.a.Acquisitionb.Mergerc.Joint ventured.Alliance51)What type of integration is represented by a chain of nursing homes?a.Vertical integrationb.Networkc.Horizontal integrationd.Diversification52)Regional health systems are oftena.horizontally integratedb.vertically integratedc.formed into virtual organizationsd.formed into alliances53)Antitrust legislation is intended to provide checks againsta.anticompetitive behaviorb.fraud and abusec.self-referral of patientsd.payments for patient referrals