AHM-540 AHIP Exam Questions and Free Practice Test

Question 19

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

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

B. 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.

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

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

Correct Answer:B

Question 20

With respect to the activities of MCO medical directors, it is correct to say that medical directors typically perform all of the following activities EXCEPT

A. maintaining clinical practices

B. delivering performance feedback to providers

C. participating in utilization management (UM) activities

D. educating other MCO staff about new clinical developments or provider innovations that might impact clinical practice management

Correct Answer:A

Question 21

The following statements are about disease management programs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

A. The focus of disease management is on responding to the needs of individual members for extensive, customized healthcare supervision.

B. Disease management programs serve to improve both clinical and financial outcomes for healthcare services related to chronic conditions.

C. Tools such as preventive care, self-care, and decision support programs are used to support both case management and disease management.

D. Disease management programs apply to both diseases and medical conditions that are not diseases, such as high-risk pregnancy, severe burns, and trauma.

Correct Answer:A

Question 22

The following statement(s) can correctly be made about performance measurement systems:
* 1.The most difficult purpose for a performance measurement system to address is to measure changes in outcomes caused by modifications in administrative or clinical treatment processes
* 2.A health plan needs different performance measurement systems to evaluate its administrative services and the clinical performance of its providers

A. Both 1 and 2

B. 1 only

C. 2 only

D. Neither 1 nor 2

Correct Answer:C

Question 23

This agency’s accreditation decisions are based on the results of an on-site survey of clinical and administrative systems and processes, as well as the health plan’s performance on selected effectiveness of care and member satisfaction measures.

A. American Accreditation HealthCare Commission/URAC (URAC)

B. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

C. Community Health Accreditation Program (CHAP)

D. National Committee for Quality Assurance (NCQA)

Correct Answer:D

Question 24

As a follow-up to a performance improvement plan for member services, the Stellar Health Plan conducted an evaluation of the success of the plan. Stellar conducted its evaluation as the plan was being carried out. The evaluation focused on specific activities and assessed the relative importance of those activities to the plan as a whole. This information indicates that Stellar’s evaluation of the plan was both

A. concurrent and formative

B. concurrent and summative

C. retrospective and formative

D. retrospective and summative

Correct Answer:A

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