Free AHM-250 Exam Braindumps

- (Topic 1)
By offering a comprehensive set of healthcare benefits to its members, an HMO ensures that its members obtain quality, cost-effective, and appropriate medical care. Ways that an HMO provides comprehensive care include

1. A. coordinating care across a variety of benefits
2. B. emphasizing preventive care by covering many preventive services either in full or with a small copayment
3. C. offering its members access to wellness programs
4. D. All of the above

Correct Answer: D

- (Topic 3)
The Stateside Health Plan uses the following outcomes measures to evaluate the quality of its diabetes disease management program.
Measure A: Incidence of foot ulcers among long-term diabetes patients Measure B: Ability of long-term diabetes patients to m

1. A. Measure A clinical status Measure B patient perception
2. B. Measure A clinical status Measure B functional status
3. C. Measure A functional status Measure B patient perception
4. D. Measure A functional status Measure B clinical status

Correct Answer: B

- (Topic 1)
A common physician-only integrated model is a group practice without walls (GPWW). One characteristic of a typical GPWW is that the

1. A. GPWW combines multiple independent physician practices under one umbrella organization
2. B. GPWW generally has a lesser degree of integration than does an IPA
3. C. member physicians cannot own the GPWW
4. D. GPWW's member physicians must perform their own business operations

Correct Answer: A

- (Topic 2)
The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

1. A. Has ever participated in any quality improvement activities.
2. B. Is a participating provider in a health plan that will compete with Ark in its new service area.
3. C. Meets the requirements of the Ethics in Patient Referrals Act.
4. D. Has had a medical malpractice claim filed or other disciplinary actions taken against her.

Correct Answer: D

- (Topic 3)
The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

1. A. Under the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency
2. B. The Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review
3. C. According to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria
4. D. The Quality Assessment and Improvement Model Act exempts closed plans from
5. E. implementing a quality improvement program.

Correct Answer: A