An IPA is an HMO that contracts

The defining feature of a direct contract model is

HMOs are licensed as

A PHO is usually a separate business entity requiring the participation of a hospital

Hospitals purchased physician practices and employed physicians in

An IDS can be described as a

The GPWW requires the participation of a hospital

EPOs share similarities with

Commonly recognized HMOs include

PSOs, created by the BBA of 1997, proved to be

common characteristics of PPOs include

Advantages of an IPA include

Capitation is usually defined as

In what model does an HMO contract with more than one group practice

The integral components of managed care

Managed care is best described as

Prior to the 1970s, health maintenance organizations (HMOs)

The original impetus of HMOs development

Blue Cross began as a physician service bureau in

The Balance Budget Act (BBA) of 1997 resulted in a major increase in

The Managed care backlash resulted in

PPOs differ from HMOs because

Health care cost inflation has remained

Managed care plans perform onsite reviews

Hospital consolidation has been blocked more often than not by

The same methodology used to pay a hospital for inpatient care is usually also use to

Fee-for-service payment is the most common method used by HMOs to pay

In markets with high levels of managed care penetration, hospitals are usually paid

What forms of hospital payment contain no elements of risk sharing by the hospital
What are the basic ways to compensate open-panel PCPs

Consolidation in the payer industry has resulted in most hospitals being unable to

What term refers to an all-inclusive rate paid by the HMO for both institutional and profes

Payment to a facility for outpatient procedures may be increased on a case-by-case basis through

Capitation is a physician payment method preferred by many HMOs because

How are outlier cases determined by a hospital

Ancillary services are broadly divided into the what categories

Basic elements of credentialing include

What does a HOM consider when selecting a hospital during the network development

The HIPDB is a national health care fraud and abuse data collection program for the

Considerations for successful network development include geographic accessibility

State and federal regulations consistently apply network access standards to

Which organizations may conduct primary verification of a physician's credentials

Claims review is an example of

Utilization management seeks to reduce practice variation and

The most common measurement of inpatient utilization

The use of utilization guidelines targets

Hospital utilization varies by

Can specialist to also act as a primary care provider.

Nurse-on-call or medical advice programs are considered

UM focuses on telling doctors and hospitals

Physician behavior begins with

Academic detailing refers to

The most effective way to induce behavior changes in physicians is through

Peer pressure works through

Behavioral change tools include