- (Topic 3)
The feature that formed the foundation of Health Maintenance Act of 1973

1. A. Federal Qualification Requirements
2. B. Exemption from state laws
3. C. All of the above

Correct Answer: C

- (Topic 3)
The measures used to evaluate healthcare quality are generally divided into three categories: process, structure, and outcomes. An example of a process measure that can be used to evaluate a health plan's performance is the:

1. A. Percentage of adult plan members who receive regular medical checkups.
2. B. Number of plan members contracting an infection in the hospital.
3. C. Percentage of board certified physicians within the health plan's network.
4. D. Number of hospital admissions for plan members with certain medical conditions.

Correct Answer: A

- (Topic 3)
When determining physicians' fee reimbursements, the Blossom Managed Healthcare Group assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier, as shown below:
Weighted value for service × Money

1. A. discounted fee-for-service system
2. B. global capitation arrangement
3. C. withhold arrangement
4. D. relative value scale (RVS)

Correct Answer: D

- (Topic 3)
Which of the following is(are) CORRECT?
(A) Staff model HMOs can achieve maximum economies of scale but are heavily capital intensive.
(B) Staff model HMOs are closed panel.
(C) Staff model HMOs operate out of ambulatory care facilities.

1. A. A & B
2. B. None of the listed options
3. C. B & C
4. D. All of the listed options

Correct Answer: D

- (Topic 3)
Select the correct statement regarding TRICARE Extra plan options to military personnel’s.

1. A. Out of pocket expenses are generally high in tricare extra than TRICARE standard
2. B. Enrollment is not necessary to participate in TRICARE Extra
3. C. TRICARE Extra provides coordinated care managed by primary care case manager

Correct Answer: C