Managed Care
Costs and Access
Health Policy
H.C. Settings
Misc.
100

In the 1990’s managed care made significant headway and achieved success in slowing h.c. expenditures by introducing this specific type of managed care plan 

HMO

100

Provide 3 reasons why the U.S. has high healthcare costs. 

3rd party payment, growth of technology, increase in elderly pop, medical model of care delivery, multipayer system and administrative costs, defensive medicine, waste and abuse, practice variations

100

There are five components of in a policy cycle (formation and implementation of policies) that are often undertaken by Congress and interest groups– list 2

Issue raising, policy design, building of public support, legislative decision-making and building of policy support, policy implementation

100

Provide 3 examples of outpatient care settings and/or methods of care delivery

Private practice, hospital outpatient clinics, mobile facilities, home care, hospice care, telephone triage, LTC, public health dept, comm. Health center, free clinics, CAM

100

American h.c. will be significantly affected by this trending change in the population

Aging population 

200

What was consumers' main complaint against managed care during the 1990s?

Lack of choice of providers

200

What three domains best predict access and access disparities?

Race, income, and occupation

200

Which historical policy is credited with having the greatest impact on the expansion of hospital beds in the United States?

Hill-Burton Act

200

The rapid growth of the aging population will require an increase in this specialty of medicine

Geriatrics 

200

As a result of decreasing public/private insurance reimbursement for hospitalizations, this type of health care service has increased over the past 20 years

Outpatient care 

300

Managed care is a mechanism of providing health care services in which a single organization takes on the management of these main functions. (Provide 2 of 4)

Financing, delivery, insurance, and payment

300

When analyzing health care quality, what three topics are evaluated?

Structure, process, outcome

300

There are 3 main challenges related to fully implementing the ACA - explain 2 of these. 

  • Supreme court made it optional for states to expand Medicaid eligibility, resulting in significant consequences for those states that opted out. So some make too much for MA, but not enough for marketplace subsidies.
  • Undocumented immigrants are excluded from the law
  • Subsidies for those with higher incomes are becoming less generous; thus they have difficulty affording premiums and deductibles
300

What is the largest source of financing for nursing home care?

Medicaid

300

A patient safety incident that results in death, severe harm, or permanent harm to a patient is known as this. 

A sentinel event

400

The ACA authorized formation of these to serve Medicare beneficiaries enrolled in traditional fee-for-service program.

Accountable Care Organizations (ACOs) were designed to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes.

400

List 2 strategies of cost containment the U.S. health care system has implemented

Health planning, price controls, peer review, competitive approaches, chronic disease management and prevention 


400

This type of medicine includes consideration of individual, environmental, and lifestyle factors

Precision medicine

400

Public health programs are evaluated for effectiveness through this mechanism. 

National surveillance systems

400

This method determines the appropriateness for utilization after services have already been delivered

Retrospective Utilization Review 

500

What are the three main distinguishing factors that differentiate HMOs, PPOs, and POS plans.

Choice of providers, delivery of services, payment and risk sharing

i.e. In-network/out of network; gatekeeping; limited specialty services; capitation and fee for service; risk sharing, etc.

500

List 2 developments in process improvements that have been utilized in U.S. healthcare

Clinical Practice Guidelines, Cost-Efficiency, Critical Pathways, Risk Management

500

Explain what factors rural Americans face with the U.S. health care system that predisposes them to vulnerability?

Poverty, lack of public health infrastructure, poorer access to health care, increased burden of disease (heart disease, stroke, diabetes, mental health, substance use), geographic maldistribution of health care professionals 

500

List 2 characteristics of the medical home model

Patient-centered access, team-based care, population health mgmt., care mgmt., care coordination/transitions, and performance measure/quality improvement

500

Provide 3 strategies to improve health and reduce disparities

Nutrition programs, Work/environment safety efforts, Primary care and prevention-oriented efforts, Coordinated care for chronically ill persons, community-based partnerships, culturally appropriate care, patient safety/medical error reduction

M
e
n
u