Podcast
Questions and Answers
What is the main reason it was expensive to process a large number of 'small' claims?
What is the main reason it was expensive to process a large number of 'small' claims?
- Pharmacy Benefits Manager
- Special processing industry (correct)
- Rx benefit carve-out
- High deductibles
Which health plan type had the highest enrollment in 2023?
Which health plan type had the highest enrollment in 2023?
- PPO (correct)
- HMO
- POS
- HDHP/SO
What does HMO stand for?
What does HMO stand for?
- Point of Service plan
- Health Management Organization (correct)
- Preferred Provider Organization
- High Deductible Health Plan
Which term is a synonym for Managed Care Organization (MCO)?
Which term is a synonym for Managed Care Organization (MCO)?
How is 'Managed Care' broadly defined?
How is 'Managed Care' broadly defined?
In the context of the text, how would you describe 'Managed Care'?
In the context of the text, how would you describe 'Managed Care'?
'POS' stands for:
'POS' stands for:
'HDHP/SO' stands for:
'HDHP/SO' stands for:
What did the health insurance that existed in the past protect individuals from?
What did the health insurance that existed in the past protect individuals from?
How did Blue Cross initially operate in terms of covering hospital costs?
How did Blue Cross initially operate in terms of covering hospital costs?
What was the main purpose of Blue Shield when it was established?
What was the main purpose of Blue Shield when it was established?
How did the concept of Blue Cross and Blue Shield differ in terms of payments?
How did the concept of Blue Cross and Blue Shield differ in terms of payments?
How did the need for more than one hospital arise in the context of early health insurance?
How did the need for more than one hospital arise in the context of early health insurance?
What was the role of central location premiums in early health insurance?
What was the role of central location premiums in early health insurance?
What did Blue Shield mainly focus on covering?
What did Blue Shield mainly focus on covering?
What was the main purpose behind starting Blue Cross?
What was the main purpose behind starting Blue Cross?
What is the original purpose of health insurance?
What is the original purpose of health insurance?
How do prepaid prescription programs differ from the principles of health insurance?
How do prepaid prescription programs differ from the principles of health insurance?
What is the main objective of managed health care?
What is the main objective of managed health care?
How does capitation reimbursement differ from fee-for-service reimbursement?
How does capitation reimbursement differ from fee-for-service reimbursement?
What is a key difference between managed care and consumer-driven health?
What is a key difference between managed care and consumer-driven health?
How does managed care impact pharmacy?
How does managed care impact pharmacy?
Which type of reimbursement aligns with the principles of managed care organizations (MCOs)?
Which type of reimbursement aligns with the principles of managed care organizations (MCOs)?
'Why Study Private Health Insurance?' What is one reason mentioned in the text for studying private health insurance?
'Why Study Private Health Insurance?' What is one reason mentioned in the text for studying private health insurance?
What was the predominant provider reimbursement model from the 18th century through the 1980s?
What was the predominant provider reimbursement model from the 18th century through the 1980s?
Why did the medical care system lack the incentive to lower costs under fee-for-service reimbursement?
Why did the medical care system lack the incentive to lower costs under fee-for-service reimbursement?
What triggered cost concerns about healthcare benefits for employers in the 1970s?
What triggered cost concerns about healthcare benefits for employers in the 1970s?
Why did insurance companies start to be more cost-conscious on behalf of their client companies in the 1970s?
Why did insurance companies start to be more cost-conscious on behalf of their client companies in the 1970s?
What is the evolution of managed care characterized by?
What is the evolution of managed care characterized by?
Which term describes any movement away from strict payment of services towards governing medical services provision?
Which term describes any movement away from strict payment of services towards governing medical services provision?
What was the motivation for insurance companies to become more cost-conscious on behalf of their client companies?
What was the motivation for insurance companies to become more cost-conscious on behalf of their client companies?
Why did employers find healthcare benefits increasingly expensive in the 1970s?
Why did employers find healthcare benefits increasingly expensive in the 1970s?
What is the primary purpose of Utilization Review (UR)?
What is the primary purpose of Utilization Review (UR)?
In which situation is Peer Review most easily conducted?
In which situation is Peer Review most easily conducted?
Why is Utilization Review considered necessary in the medical field?
Why is Utilization Review considered necessary in the medical field?
What is the role of peer review in a staff-model HMO?
What is the role of peer review in a staff-model HMO?
Why might someone have to pay higher prices for their choice under Utilization Review?
Why might someone have to pay higher prices for their choice under Utilization Review?
What does Peer Review primarily focus on?
What does Peer Review primarily focus on?
How does Utilization Review help guard against unacceptable variation in medical practice?
How does Utilization Review help guard against unacceptable variation in medical practice?
Why is Peer Review challenging when providers work in different settings?
Why is Peer Review challenging when providers work in different settings?
