Increased demands for performance information have resulted in the development of various health plan report cards. With respect to most of the report cards currently available, it is correct to say

1. A. that they are focused primarily on health maintenance organization (HMO) plans
2. B. that they are based on data collected for the Health Plan Employer Data and Information Set (HEDIS) 3.0
3. C. that they are used to rank the performance of various health plans
4. D. all of the above

Correct Answer: D

The paragraph below contains two pairs of phrases enclosed in parentheses. Select the phrase in each pair that correctly completes the paragraph. The select the answer choice containing the two phrases you have selected.
Calvin Montrose, age 75, has difficulty performing basic self-care activities, such as bathing, dressing, and eating, without assistance. This information indicates that Mr. Montrose needs assistance with (activities of daily living / instrumental activities of daily living) that are used to measure his (functional status / health status).

1. A. activities of daily living / functional status
2. B. activities of daily living / health status
3. C. instrumental activities of daily living / functional status
4. D. instrumental activities of daily living / health status

Correct Answer: A

The paragraph below contains two pairs of terms or phrases enclosed in parentheses. Determine which term or phrase in each pair correctly completes the paragraph. Then select the answer choice containing the terms or phrases that you have chosen.
The Millway Health Plan received a 15% reduction in the price of a particular pharmaceutical based on the volume of the drug Millway purchased from the manufacturer. This reduction in price is an example of a (rebate / price discount) and (is / is not) dependent on actual provider prescribing patterns.

1. A. rebate / is
2. B. rebate / is not
3. C. price discount / is
4. D. price discount / is not

Correct Answer: D

Maxwell Midler’s health plan operates a drug formulary that includes a typical three-tier copayment structure with required copayments of $5, $10, and $25. Mr. Midler recently filled a prescription for a $75 drug that was not included in the formulary. According to the plan’s formulary copayment structure, the amount that Mr. Midler was required to pay for his prescription was

1. A. $5
2. B. $10
3. C. $25
4. D. $75

Correct Answer: C

One method of transferring the information in electronic medical records (EMRs) is through a health information network (HIN). The following statements are about HINs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

1. A. A HIN may afford a health plan better measurements of outcomes and provider performance.
2. B. The use of a HIN typically increases a health plan’s exposure to liability for poor care.
3. C. Most HINs are Internet-based rather than built on proprietary computer networks.
4. D. Currently, the majority of health plans do not have HINs that are capable of transferring medical records among their network providers.

Correct Answer: B