This agency’s accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan’s performance on selected effectiveness of care and member satisfaction measures.

1. A. American Accreditation HealthCare Commission/URAC (URAC)
2. B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
3. C. Community Health Accreditation Program (CHAP)
4. D. National Committee for Quality Assurance (NCQA)

Correct Answer: D

To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data:
* 1.Patient surveys are the most widely used source of disease-specific clinical information
* 2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers
* 3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status

1. A. All of the above
2. B. 1 and 2 only
3. C. 2 and 3 only
4. D. 3 only

Correct Answer: C

Some health plans administer a questionnaire known as the Behavioral Risk Factor Surveillance System (BRFSS) as part of their health risk assessment (HRA) processes. The following statements are about the BRFSS. If statements (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct statement.

1. A. This questionnaire was designed specifically for use by health plans.
2. B. Each health plan must use the same form of the questionnaire, with no additions or modifications.
3. C. This questionnaire monitors the prevalence of the major behavioral risks associated with illness and injury among adults.
4. D. All of the above statements are correct.

Correct Answer: C

The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP):
* 1. FEHBP plan members who have exhausted the health plan’s usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM)
* 2. All health plans that cover federal employees are required to develop and implement patient safety initiatives

1. A. Both 1 and 2
2. B. 1 only
3. C. 2 only
4. D. Neither 1 nor 2

Correct Answer: A

Health plans often use accreditation as a means of evaluating the quality of care delivered to plan members. Accreditation of subacute care providers is available from the

1. A. National Committee for Quality Assurance (NCQA)
2. B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
3. C. American Accreditation HealthCare Commission/URAC (URAC)
4. D. Foundation for Accountability (FACCT)

Correct Answer: B