Page 41 - FPGEE Management Q&A Book

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Set) is the gold standard in health care performance 68.(d) Telephone discussions are a common type of
measurement, used by more than 90 percent (NOT one-to-one interaction between pharmacists and
45%) of the nation’s health plans and many leading prescribers. Pharmacists successfully influence or
employers and regulators. change prescribing in a large majority (80% or
more) of interactions.
HEDIS is a set of standardized measures that
specifies how organizations collect, audit and report 69. (c) The National Committee for Quality
performance information across the most pressing Assurance (NCQA), the Joint Commission on
clinical areas, as well as important dimensions of Accreditation of Healthcare Organization (Joint
customer satisfaction and patient experience. Commission), the American Accreditation
Healthcare Commission, the Foundation for
HEDIS is the most widely used set of inpatient and Accountability (FACCT), and the Agency for Health
ambulatory performance measures in the health Care Policy and Research (AHCPR) are entities
care industry. It is a registered trademark of the involved with measurements and advancement of
National Committee for Quality Assurance (NCQA). quality in managed care.

65. (b) Oxycodone is the nation’s number one 70.(a) The purchasers must fill all the three copies
prescribed narcotic medication for treating chronic of the DEA 222 form. They submit copy I and II of
severe and moderate pain. the DEA 222 form to the supplier and keep copy III
for their own records.
66.(d) All. Medicaid is Title XIX of the Social Security
Act of 1935. It provides health coverage to 71.(b) The Health behavior is any action taken by a
medically indigent persons such as the blind, healthy person for the purpose of remaining
disabled, and aged. healthy or of remaining in an asymptomatic state.
Examples of such behavior would be brushing teeth,
67.(d) The knowledge needed to make informed exercising regularly, wearing a seat belt, etc.
decisions about daily diabetes self-management
falls into two main domains. 72.(d) All. A drug formulary is defined as a list of
preferred medications. Health plans develop drug
The first domain is expertise about diabetes. This formularies to guide physicians’ prescribing and
expertise is generally provided by DSME (Diabetes pharmacies’ dispensing. They have been used to
Self-Management Education) either during one-to- promote the use of the most cost-effective drugs
one visits or group programs. and products. It is usually prepared by physicians
and pharmacists on health plans or by a PBM
The second and equally important domain is self- pharmacy and therapeutic committee.
awareness and psychosocial skills. Because diabetes
and its treatment affect the physical, emotional, 73.(b) The Medicare HMO plan in which Medicare
mental, and spiritual domains of a patient’s life, pays a predetermined per member per month
DSME needs to address the impact of diabetes on amount based on the total estimated budget to the
the totality of that person’s life. contracted HMO is known as Cost contract HMO.
The difference between the monthly payments and
The empowerment philosophy is based on the the actual costs are reconciled at the end of the
assumption that to live with and care for diabetes year. Under these plans, enrolled members can
successfully, patients need to have the psychosocial receive services outside the plan without
skills necessary to recognize the need for and bring restriction.
about changes in their personal behavior, their
social situations, and the institutions that influence
their lives.

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