How to Answer Large Case Management Questions (Complete Guide)

This question tests key academic concepts commonly covered in coursework.

What This Question Is About

This question relates to large case management and requires a structured academic response.

How to Approach This Question

Start by identifying the main issue, then apply relevant academic frameworks.

Key Explanation

This topic involves large case management. A strong answer should include explanation, application, and examples.

Original Question

d large case management are types of utilization management activity which both create customized treatment plans for selected plan enrollees, and actively coordinate the activities of the team of clinical providers implementing that treatment plan. True False QUESTION 16 Patient-centered Medical Homes: a. Are expected to provide better coordination of patient care across different clinical services, clinical settings, and clinical providers b. Are expected to increase and improve physician/patient communication c. Are expected to limit the use of diagnostic imaging and specialist consultations d. Are heavily reliant on data from electronic health records e. All the above QUESTION 17 Since 2000 utilization management is increasingly focused on identifying and changing the behavior of the small percentage of very high utilizers of health care services. These efforts have especially focused on which of the following sets of patients / plan enrollees: a. Long term care patients. b. Patients / enrollees using Emergency Room Services c. Ambulatory Surgery patients d. Orthopedic Surgery patients QUESTION 18 “__________________” is a set of standardized performance measures / indicators that look at plan and clinical provider performance across a variety of important dimensions, such as delivery of preventive health services, provider credentialing, and the effectiveness of medical treatment for various illnesses. a. CVO b. UM c. CAHPS d. HEDIS e. HOS QUESTION 19 For Traditional Medicare enrollees, which one of the following statements is False? a. The network of individual, group, and institutional providers available in a geographic area is very broad, covering most of the providers in that area. b. Members are NOT allowed to sign up for “wrap around” private insurance plans to help reduce their out-of-pocket expenditures for Medicare Part A and Part B deductibles and coinsurance. c. Plan members do NOT need to choose a Primary Care Practitioner. d. Members must take responsibility for signing up for Medicare D pharmaceutical benefits, and for managing that relationship. QUESTION 20 For enrollees in a Medicare Part C/Advantage Plan, their chosen Part C plan does not take responsibility for managing all Medicare service benefits (Part A, Part B, and Part D). True False QUESTION 21 For enrollees in a Medicare Part C/Advantage plan, which one of the following statements is False? a. These plans often provide benefits not covered by Traditional Medicare, such as dental and vision services. b. These plans have very broad, extensive and easy to access networks of health services providers. c. Most of these plans are HMOs and require a member to choose a Primary Care Practitioner. d. These plans set annual and lifetime limits on out-of-pocket expenditures paid by plan enrollees for Part A and Part B as well as Part D services. QUESTION 22 For Medicare Part C/Advantage plans and plan members – the Federal CMS (Centers for Medicare and Medicaid Services) actively monitors patient satisfaction, management of patients with chronic conditions like asthma and diabetes, and promotion of healthy living and prevention for plan members through the CMS STAR Quality Rating program. True False QUESTION 23 Which of the following concerns about the quality and price of care offered to Medicare Part C/Advantage plan members are increasingly of concern to the Federal government, and to Part C plan members? (The answer may be one or more than one of the items listed below.) a. Excessively high monthly premium payments made by the Federal government to cover plan member health care needs. b. Misleading advertising by the plans concerning what the plans offer, and what members will need to pay out of pocket if they are in one of these plans. c. Overly narrow and geographically inaccessible provider networks which inconvenience members and may lead some members to go out of network for care. d. Misleading statements to the Federal government made by the plans in assessing how sick and therefore expensive their members are to treat and manage. e. All the above. QUESTION 24 To reduce the cost per member of treating and managing State Medicaid enrollees, many State Medicaid programs have experimented with supporting the growth and extended influence of Patient Centered Medical Homes (PCMH’s). States do this to improve the management and coordination of medical services for the sickest Medicaid enrollees. True False QUESTION 25 The Medicaid Coverage Gap refers to working poor people in States which chose not to implement the Medicaid Expansion under the Affordable Care Act of 2010. These people are potential Medicaid enrollees whose incomes are too high for them to successfully apply for Medicaid, but too low for them to be eligible for the ACA State Marketplaces. True False

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