Page 24 - FPGEE Management Q&A Book

www.pharmacyexam.com Krisman

service area. Medicare Advantage provides the 7. (b) A recent review of the research related to
following options: medication adherence reported that adherence
rates for blood-glucose lowering therapy ranged
1. HMO plans, otherwise known as Health from 65% to 85%, with lower rates (36% to 54%)
Maintenance Organization plans, emphasize reported for certain populations (e.g. Medicaid
preventive care but without coverage for providers recipients) and regimens requiring more frequent
or facilities outside the HMO network. They almost dosing.
always require a network primary care physician
referral to access a network specialist; they usually There were a number of reasons cited in these
offer drug benefits. studies for lower adherence rates, including
patients’ inadequate understanding of the regimen,
2. POS plans, otherwise known as Point of Service medication side effects, lack of perceived regimen
Plans, offer a network of preferred providers, like benefits, medication costs, and regimen complexity.
HMO plans, but also provide reduced benefits for
providers or facilities outside the HMO network. 8. (a) Open-ended questions are questions that
They typically require a referral from a network encourage people to talk about whatever is
primary care physician to access a network important to them. They help to establish rapport,
specialist; they sometimes offer drug benefits. gather information, and increase understanding.
They are the opposite of closed ended questions,
3. Regionally Expanded Preferred Provider which typically require a simple brief response such
Organization (PPO) plans are similar to POS plans “yes” or “no”. Open-ended questions invite others
but have broader geographic access to network to “tell their story” in their own words. They do not
providers in a larger service area, and with reduced lead people in a specific direction.
benefits outside the PPO network. They do not
typically require a referral from a network primary Open-ended questions should be used frequently,
care physician to access network specialists. They though not exclusively, in conversation. When
may or may not offer drug benefits. asking open-ended questions, one must be ready
and willing to listen to the response.
4. PSO plans, otherwise known as Provider-
Sponsored Organizations, are similar to the POS To illustrate closed-ended vs. open-ended
plans but are usually organized with physicians that questions, consider the following examples. The
practice in a regional or community hospital. There topic is the same in both questions, but the
may or may not be coverage for providers or responses likely will be very different.
facilities outside the PSO network, depending upon
the plan designs offered. Did you have a good relationship with your parents?
(closed-ended)
They may require a referral from a network primary
care physician to access network specialists. They Tell me about your relationship with your parents.
typically offer drug benefits. (open-ended).

6. (d) The Medicare Part D prescription drug benefit 9. (c) According to WHO, health is defined as a state
program was enacted as part of the Medicare of complete physical, mental and social well-being
Prescription Drug, Improvement and Modernization and not merely the absence of disease or infirmity.
Act, which has become better known as simply the
Medicare Modernization Act (MMA) of 2003. 10. (a) The U.S. Department of Health and Human
Services (HHS) announced a final rule that will
facilitate the United States’ ongoing transition to an
electronic health care environment through the

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