08 January, 2025

The Update Guide To AHM-540 Free Draindumps

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Total 163 questions Full Exam Access

Question 1

Accreditation is intended to help purchasers and consumers make decisions about healthcare coverage.
The following statements are about accreditation. Select the answer choice containing the correct statement.

At the request of health plans, accrediting agencies gather the data needed for accreditation.

Most purchasers and consumers review accreditation results when making decisions to purchase or enroll in a specific health plan.

Accreditation is typically conducted by independent, not-for-profit organizations.

All health plans are required to participate in the accreditation process.

Question 2

The Noble Health Plan conducted a cost/benefit analysis of the following four prescription drugs:
BenefitCost Drug A$525$350 Drug B$450$250
Drug C$400$200 Drug D$350$100
According to this analysis, the drug that represents the most efficient use of resources is

Drug A

Drug B

Drug C

Drug D

Question 3

In order for a health plan’s performance-based quality improvement programs to be effective, the desired outcomes must be

achievable within a specified timeframe

defined in terms of multiple results

expressed in subjective, qualitative terms

all of the above

Question 4

Determine whether the following statement is true or false:
Immunization programs are a direct means of reducing health plan members’ needs for healthcare services and are typically cost-effective.

True

False

Question 5

Occasionally, employers combine workers’ compensation, group healthcare, and disability programs into an integrated product known as 24-hour coverage. One true statement about 24-hour coverage is that it typically

increases administrative costs

requires plans to maintain separate databases of patient care information

exempts plans from complying with state workers’ compensation regulations

allows plans to apply disability management and return-to-work techniques to nonoccupational conditions

Question 6

The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.

A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.

Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.

In order to serve as a hospitalist, a physician must have a background in critical care medicine.

Hospitalists typically spend at least one-quarter of their time in a hospital setting.

Question 7

Health plan performance measures include structure measures, process measures, and outcome measures. The following statements are about the characteristics of these three types ofperformance measures. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

The most widely used structure measures relate to physician education and training.

One advantage of structure measures over process measures is that structures are often linked directly to healthcare outcomes.

Process measures are useful in identifying underuse, overuse, and inappropriate use of services.

One disadvantage of outcome measures is that they can be influenced by factors outside the control of the health plan.

Question 8

Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

The proportion of adult members who are screened for hypertension will increase by ten percent.

Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.

The QM program director will evaluate the level of provider compliance with clinicalpractice guidelines (CPGs).

The disease management program director will increase participation by asthmatic children in the health plan’s pediatric asthma disease management program.

Question 9

The Quality Assessment Performance Improvement (QAPI) is a quality initiative designed to strengthen health plans’ efforts to protect and improve the health and satisfaction of Medicare and Medicaid health plan enrollees. The Centers for Medicare and Medicaid Services (CMS) requires compliance with QAPI from

both Medicare+Choice plans and Medicaid health plans

Medicare+Choice plans only

Medicaid health plans only

neither Medicare+Choice plans nor Medicaid health plans

Question 10

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.

This questionnaire was designed specifically for use by health plans.

Each health plan must use the same form of the questionnaire, with no additions or modifications.

This questionnaire monitors the prevalence of the major behavioral risks associated with illness and injury among adults.

All of the above statements are correct.

Question 11

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

All of the above

1 and 2 only

2 and 3 only

3 only

Question 12

Home healthcare encompasses a wide variety of medical, social, and support services delivered at the homes of patients who are disabled, chronically ill, or terminally ill. The time period(s) when health plans typically use home healthcare include
* 1. The period prior to a hospital admission
* 2. The period following discharge from a hospital

Both 1 and 2

1 only

2 only

Neither 1 nor 2

Question 13

Determine whether the following statement is true or false:
The utilization review (UR) process produces the greatest number of case management referrals.

True

False

Question 14

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

National Committee for Quality Assurance (NCQA)

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

American Accreditation HealthCare Commission/URAC (URAC)

Foundation for Accountability (FACCT)

Question 15

One difference between outcomes research and clinical research is that outcomes research

provides an absolute measure of treatment results, whereas clinical research provides a relative measure of results

focuses on treatment effectiveness, whereas clinical research focuses on treatmentefficacy

examines diseases and treatments in isolation, whereas clinical research considers the effects of changes in health status and quality of life

gathers outcomes data from controlled clinical trials, whereas clinical research collects and analyzes clinical, financial, and administrative data

Question 16

In order to be effective, a clinical pathway must improve quality and decrease costs.

True

False

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Total 163 questions Full Exam Access