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P Mylin Study Stack
Additional for Chapter 3 - HI
| Question | Answer |
|---|---|
| Involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner | Case Management |
| Responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system | (MCO) Managed Care Organization |
| Includes activities that assess the quality of care provided in a health care setting | quality assurance program |
| HEDIS | Health Plan Employer Data and Information Set |
| EQRO | external quality review organization |
| QISMC | Quality Improvement System for Managed Care |
| NCQA | National Committee for Quality Assurance |
| Medicare and many states prohibit managed care contracts from containing ______________ | gag clauses |
| MSO | Management Service Organization |
| An organization of affiliated providers' sites (hospital, ambulatory surgical centers, or physician groups) that offer joint health care services to subscribers | (IDS) Integrated Delivery System |
| An alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a prepaid basis | (HMO) Health Maintenance Organization |
| Is usually offered either by a single insurance plan or as a joint venture among two or more insurance carriers, provides subscribers or employees with a choice of HMO, PPO, or traditional health insurance plans | triple option plan |
| The first known managed care program | Ross-Loos Medical Group 1929Los Angeles Dept. of Water & Power |
| Which act of ligislation permitted large employers to self-insure employee health care benefits? | (ERISA) of 1974: Employee Retirement Income Security Act |
| Allows individuals to withdraw tax-free funds for health care expenses that are not covered by a qualifying high-deductible health plan | MSA - Medical Savings Account |
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