MANAGED CARE OVERVIEW
For Primary Care and Specialist
Post-Test - 2007
1. In the 2007 settlement process, there is no opportunity to share in any surplus in the hospital pool in HAP and BCN.
True False
2. Which of the following are opportunities to reduce drug costs?
Use e-prescribing Optimize dosage regimens Use generic and lower cost drug alternatives All of the above
3. Strategies to reduce Emergency Center (EC) use include:
Educate members about where to seek after hours care. Contact members with high EC use. Allow time in office schedule to see members with urgent conditions. All of the above.
4. Recognition for Excellence Physician Practice Program defines quality and utilization indicators that allow PCP’s and Specialists to recover their withhold upon meeting defined targets.
5. Both BCN and HAP have disease management programs that physicians/health care providers should enroll appropriate members.
6. Health plans are using physician-profiling systems to provide performance-ranking data for both PCP’s and Specialists.
7. With pay-for-performance, physician reimbursement and participation in health plans may depend on the physician's performance in both quality and efficiency measures.
8. In the 2007 PGIP measurements include reducing costs in all these drug classes EXCEPT:
Proton Pump Inhibitors Antidepressants Antibiotics Statins
9. The 2008 PGIP includes the following:
Practice transformation to quality improvement model Components of a Patient Center Medical Home Population Management All of the above
10. Episode of Treatment Groups (ETG’s) are the nationally recognized tool to adjust for patient severity and determine resources a physician is utilizing in managing a patient’s care.
True False PHYSICIAN NAME
DATE OF POST-TEST PLEASE COMPLETE THIS POST-TEST AND PRESS SUBMIT, YOUR TEST WILL THEN BE SUBMITTED AND YOU WILL BE SHOWN A CONFIRMATION PAGE .
