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AHM-540 Exam Dumps : Medical Management

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Medical Management Questions and Answers

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Question 1

The following statements are about the use of provider profiling for pharmacy benefits. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

Options:

A.

Health plans typically use provider profiles to improve the quality of care associated with the use of prescription drugs.

B.

Provider profiles identify prescribing patterns that fall outside normal ranges.

C.

Health plans can motivate providers to change their prescribing patterns by sharing profile information with plan members and the general public.

D.

Provider profiles are effective in modifying individual prescribing patterns, but they have little effect on group prescribing patterns.

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Question 2

PBMs are accredited by the same organizations that accredit health plans.

Options:

A.

True

B.

False

Question 3

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

Options:

A.

concurrent and formative

B.

concurrent and summative

C.

retrospective and formative

D.

retrospective and summative

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