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MC101 - Quiz 1

 

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1)
One of the main themes of a managed system of care is 'containing costs' while also improving the quality of care.
 
True False
 
2)
One example of 'redesign of the delivery system' that is mentioned in this lesson, is the need for . . .
 
reduction of the pre-managed care Provider Fee Structure by 50%.
the Federal government to assume responsibility for all health care.
three or more HMOs doing business in the region at the same time.
shifting where and how the money is spent - like FEWER inpatient services and MORE community services
disqualification of current providers from participation.
 
3)
One issue in managed care is that the provider's clinical and professional beliefs may be contradicted by Care Management decisions.
 
True False
 
4)
This course makes the point that providers _________________ the services that they provide within the community, in response to managed care shifts.
 
can re-design or enhance
are discouraged from modifying
 
5)
The National Alliance For The Mentally Ill (NAMI) has historically expressed concern about whether the Managed Care industry is effectively balancing COST CONTROLS and the CARE for patients.
 
True False
 
6)
Which of the following statements is true, based upon information in this Lesson 1
 
HMOs must REDUCE the array of service options available to enrollees in order remain solvent.
HMO's are typically RESTRICTED from bringing new providers into the network because of Federal mandates.
Care Management is a process of coordinating services to those who request treatment FIRST.
HMOs are NOT allowed to shift where and how the health care funds are currently spent.
None of the above.
 
7)
Managed Care Companies CANNOT bring new providers into the network, because they are not allowed to take business away from the 'traditional providers' in the community.
 
True False
 
8)
Whether or not the managed care company loses money on a Risk Based CAPITATION contract depends upon WHICH of these things happening? _________________
 
Only a SMALL percentage of the total ENROLLED population will actually APPEAR AT THE DOOR for services.
Only a SMALL percentage of those who appear for services will require INTENSIVE (expensive) services.
BOTH of the above must happen, to avoid losing money.
 

 

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