History & Policy
Which of the following best represents a paradox of the U.S. health care system?
High spending with persistent disparities
Name the monthly management program for Medicare patients with two or more chronic conditions.
Chronic Care Management (CCM)
This phenomenon occurs when reduced out-of-pocket costs encourage patients to consume low-value healthcare services, ultimately increasing premiums for all enrollees.
Moral Hazard
This trust fund finances Medicare Part A and is primarily funded through payroll taxes.
Hospital Insurance (HI) Trust Fund
This organized list of approved medications is designed to promote safe, effective, and cost-conscious drug therapy within a health care system.
What is a formulary?
This 19th-century disease theory emphasized balance of bodily fluids rather than microorganisms
Humoralism
Name two settings where you see ambulatory care?
Primary Care and Family Practice
Hospital Clinics
Community Health Clinics( FQHC)
Government Institutions -Veterans Affairs (VA) and Indian Health Service (IHS)
This insurance problem occurs when individuals buy coverage only when they expect to need it, raising premiums for future policyholders.
adverse selection
This group represents a minority of Medicaid enrollees but accounts for the majority of Medicaid spending.
Eldery & Disabled
This process is a criteria-based, ongoing, and prospective review of medication use designed to evaluate appropriateness and outcomes.
What is Drug Utilization Evaluation (DUE)?
This 1910 report reformed medical education and led to the closure of substandard medical schools.
Flexner Report
This agreement allows pharmacists to initiate or adjust medications under defined conditions.
Collaborative Practice Agreement (CPA)
This organization arose in the 1970s to manage prescription drug benefits due to high administrative costs and large claim volumes.
Pharm. Benefit Manager
This Medicare part covers outpatient physician services, preventive care, and durable medical equipment.
Part B
This pharmacist-required process in long-term care facilities involves a systematic review of each resident’s medication regimen to identify unnecessary drugs, duplications, or adverse effects.
What is Medication Regimen Review (MRR)?
This term describes formally trained physicians who practiced “heroic medicine” in the 19th century.
Who were orthodox (allopathic) practitioners?
This condition occurs two to three times more frequently in patients with diabetes and is often underdiagnosed, negatively impacting adherence and mortality.
Depression
This type of cost sharing requires the patient to pay a fixed percentage of the cost of a service, commonly 20%.
Coinsurance
This Medicaid financing structure determines the federal share of program costs and is at least 50% for all states
Federal Medicaid Assistance Percentage (FMAP)
This committee is responsible for evaluating clinical evidence and economic data to guide medication selection and formulary decisions within a hospital or health system.
What is the Pharmacy and Therapeutics (P&T) Committee?
These public insurance programs were implemented in the 1960s to expand access to care.
Medicare and Medicaid
What is the partnership between qualified pharmacists and prescribing clinicians to manage a patient’s drug therapy, as defined within the context of a collaborative practice agreement (CPA).
Collaborative drug therapy management (CDTM)
This managed care model typically requires patients to stay in-network and obtain referrals from a primary care provider.
Continued growth, enrollment of over half of Medicare beneficiaries, and the largest share of total Medicare spending describe this part of Medicare.
Medicare Part C
List 2 factors determining LTC needs?
Level of disability, availability of informal caregivers, financial circumstances, availability of public programs, and personal circumstances