AHM-530 Exam AI-Powered | Exam-Dumps.net (Page: 5)

QUESTION: 21

The following statements are about factors that health plans should consider as they develop provider networks in rural and urban markets. Three of the statements are true, and one of the statements is false. Select the answer choice that contains the FALSE statement.

Compared to providers in urban areas, providers in rural areas are less likely to offer discounts to health plans in exchange for directed patient volume.
In urban areas, limiting the number of specialists on a panel usually affects the network's market appeal more than does limiting the number of primary care physicians.
The greatest opportunity to create competition in rural areas is among the specialty providers in other nearby communities.
Typically, hospital contracting is easier in urban areas than in rural areas.

Answer(s): B

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QUESTION: 22

Lakesha Frazier, a member of a health plan in a rural area, had been experiencing heart palpitations and shortness of breath. Ms. Frazier's primary care provider (PCP) referred her to a local hospital for an electrocardiogram. The results of the electrocardiogram were transmitted for diagnosis via high-speed data transmission to a heart specialist in a city 500 miles away. This information indicates that the results of Ms. Frazier's electrocardiogram were transmitted using a communications system known as

Anarrow network
An integrated healthcare delivery system
Telemedicine
Customized networking

Answer(s): C

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QUESTION: 23

A population's demographic factors--such as income levels, age, gender, race, and ethnicity--can influence the design of provider networks serving that population. With respect to these demographic factors, it is correct to say that

higher-income populations have a higher incidence of chronic illnesses than do lowerincome populations
compared to other groups, young men are more likely to be attached to particular providers
a population with a high proportion of women typically requires more providers than does a population that is predominantly male
Health plans should not recognize, in either the design of networks or the evaluation of provider performance, racial and ethnic differences in the member population

Answer(s): C

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QUESTION: 24

In developing a provider network in an large city with a high concentration of young families, the Gypsum Health Plan has set goals focused on the needs of that particular market. The following statements are about this situation. Three of the statements are true, and one of the statements is false. Select the answer choice that contains the FALSE statement.

Gypsum should attempt to recruit providers who offer extended office hours.
Gypsum can use the cost-effectiveness of its own existing networks as a benchmark for its cost-savings goals in this market.
Gypsum will most likely attempt to contract with HMOs.
Gypsum most likely should set lower cost-savings goals in this market than it would in a rural market with few young families.

Answer(s): D

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QUESTION: 25

The Gardenia Health Plan has a national reputation for quality care. When Gardenia entered a new market, it established a preferred provider organization (PPO), a health maintenance organization (HMO), and a point-of- service product (POS) to serve the plan members in this market. All of the providers included in the HMO or the POS are included in the broader provider panel of the PPO. The POS will be a typical two-level POS that offers a cost-based incentive plans for PCPs, and the HMO is a typical staff model HMO.

The network strategy that Gardenia is using to establish its range of healthcare plans is known as the

network-within-a-network approach
gatekeeper approach
tiered network approach
preferred tier approach

Answer(s): A

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QUESTION: 25