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Free AHM-250 Exam Braindumps
Healthcare Management: An Introduction Questions 126–130 (page: 27)

Updated On: 10-Feb-2026
Page 27 of 74
PDF with 367 Questions

One characteristic of disease management programs is that they typically

  1. focus on individual episodes of medical care rather than on the comprehensive care of the patient over time
  2. are used to coordinate the care of members with any type of disease, either chronic or nonchronic
  3. focus on managing populations of patients who have a specific chronic illness or medical condition, but do not focus on patient populations who are at risk of developing such an illness or condition
  4. use clinical practice processes to standardize the implementation of best practices among providers

Answer(s): D



One characteristic of the accreditation process for MCOs is that

  1. an accrediting agency typically conducts an on-site review of an MCO's operations, but it does not review an MCO's medical records or assess its member service systems
  2. each accrediting organization has its own standards of accreditation
  3. the accrediting process is mandatory for all MCOs
  4. government agencies conduct all accreditation activities for MCOs

Answer(s): B



One component of information systems used by health plans incorporates membership data and information about provider reimbursement arrangements and analyzes transactions according to contract rules. This information system component is known as

  1. A contract management system
  2. A credentialing system
  3. A legacy system
  4. An interoperable communication system

Answer(s): A



One device that PBM plans use to manage both the cost and use of pharmaceuticals is a formulary. A formulary is defined as

  1. a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications
  2. a reduction in the price of a particular pharmaceutical obtained by the PBM from the pharmaceutical manufacturer
  3. drugs ordered and delivered through the mail to the PBM's plan members at a reduced cost
  4. an identification card issued by the PBM to its plan members

Answer(s): A



One distinction that can be made between a staff model HMO and a group model HMO is that, in a staff model HMO, participating physicians are Back to Top

  1. Employees of the HMO
  2. Employees of a group practice that has contracted with the HMO
  3. Compensated primarily through capitation
  4. Limited to primary care physicians (PCPs)

Answer(s): A



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