Match the term with the appropriate definition or description.

Question

A. System of health care delivery that monitors the cost, quality, and access to health care
B. The health insurance company has the highest HMO enrollment in the United States.
C. A hybrid form of HMO, which allows physicians to provide services in their solo offices and bill the organization
D. Provided grants and loans for the establishment of HMOs
E. Usually a primary care physician (PCP), who must authorize specialty care before any is rendered
F. A managed care plan that contracts with physicians and other primary care clinicians on an exclusive basis for services
G. A managed care plan that contracts with private clinicians to deliver care; however, the clinicians may see other patients not in the plan
H. An organization that provides a wide range of comprehensive health care services for a specified group of subscribers for a fixed, prenegotiated, periodic rate, normally a PMPM capitation rate
I. A common capitation measure
J. Portion of a claim or medical expense that a member must pay out-of-pocket at the time of treatment; usually a fixed amount
K. Employs providers to deliver care to enrollees at their facilities
L. Some of the care members receive is subject to preapproval
M. An organized system of health care providers that spans a broad range of health care services by using vertical integration to contract with a variety of clinicians and health plans
N. A set amount of money paid per enrollee for a predetermined set of benefits to be rendered if medically necessary
O. Contracts with multiple physician groups to deliver health care to members
P. A system that bonds clinicians and hospitals together to form an IDS
Q. Contracts with an established medical group for the provision of health care services, instead of individual clinicians.

Answer 1

A. managed care
B. Kaiser Permanente
C. independent practice association (IPA)
D. HMO Act of 1973
E. gatekeeper
F. closed panel
G. open panel
H. HMO
I. per member per month (PMPM)
J. copayment
K. staff model HMO
L. managed indemnity plans
M. integrated delivery system (IDS)
N. capitation
O. network model HMO
P. physician hospital organization (PHO)
Q. group model HMO