Which of the following tasks are practice management programs used for quizlet?

1. Restricting patients' choice of providers: After enrolling in an HMO, members MUST receive services from the NETWORK of Physicians, Hospitals, and other providers who are EMPLOYED BY or UNDER CONTRACT to the HMOs. Visits t o OUT-OF-NETWORK providers are NOT COVERED except for EMERGENCY CARE or URGENT HEALTH PROBLEMS that arise when the member is temporarily away from the geographical service area.
2. Requiring pre-authorization for services: HMOs often REQUIRE pre-authorization (also called Pre-Certification or Prior Authorization) BEFORE the patient receives many types of services.
3. Controlling the use of services: HMOs develop medical necessity guidelines for the use of medical services. The HMO holds the provider ACCOUNTABLE for ANY questionable service and may deny a patient's or provider's request for pre-authorization.
4. Controlling Drug Costs: Providers MUST prescribe drugs for patients ONLY from the HMO's list of selected pharmaceuticals and approved dosages, called a FORMULARY. Drugs that are NOT on the list require the patient to have pre-authorization, which is OFTEN DENIED.
5. Cost-Sharing: At the time an HMO member sees a provider, he or she pays a SPECIFIED CHARGE, called a COPAYMENT (or COPAY). A LOWER copayment may be charged for an office visit to the Primary Care Physician (PCP), and a HIGHER copayment may be required for a visit to the office of a specialist OR for the use of EMERGENCY SERVICES.
6. Requiring Referalls: HMOs may require a patient to select a Primary Care Physician (PCP) - also called a "Gatekeeper" - from the HMO's list of GENERAL or FAMILY practitioners, internists, and pediatricians. A PCP coordinates patients' overall care to ensure that ALL services are, in a PCP's judgement, necessary. In gatekeeper's plans, an HMO member needs a medical REFERALL from the PCP BEFORE seeing a specialist or a consultant and for hospital admission. (Members who visit providers WITHOUT A REFERALL are DIRECTLY RESPONSIBLE for the TOTAL COST OF THE SERVICE).

1. Disease/Case Management: Some patients face difficult treatments, such as for high-risk pregnancies, and others need CHRONIC CARE for conditions such as Congestive Heart Failure, Diabetes, and Asthma. HMOs often assign CASE MANAGERS to work with these patients.
2. Preventive Care: Preventive care, which seeks to PREVENT THE OCCURRENCE OF CONDITIONS through EARLY DETECTION OF DISEASE, is emphasized through PROVISIONS for ANNUAL CHECKUPS, SCREENING PROCEDURES, and INOCULATIONS.
3. Pay-For-Performance (P4P): HMOs collect and analyze large amounts of data about patients' clinical treatments and their responses to treatment. In this way, HMOs can establish the "most effective protocols" - detailed, precise treatment regimens that work best. HMOs use FINANCIAL INCENTIVES to ENCOURAGE THEIR PROVIDERS to FOLLOW THESE PROTOCOLS.

1. Medicare is a 100% FEDERALLY-FUNDED Health Plan that covers people who are 65 and OVER and those who, regardless of age, are DISABLED or have PERMANENT-KIDNEY FAILURE (end-stage renal disease, or ESRD).
2. Medicaid,a FEDERAL PROGRAM that is JOINTLY-FUNDED by FEDERAL and STATE governments, covers LOW-INCOME people who CANNOT afford medical care. Each state administers its OWN Medicaid program, determining the program's qualifications and benefits under BROAD FEDERAL GUIDELINES.
3. TRICARE, a Department of Defense program, covers medical expenses for ACTIVE-DUTY MEMBERS of the "Uniformed Services" and their spouses, children, and other dependents; retired military personnel and their dependents; and family members of deceased active-duty personnel. (This program replaced CHAMPUS, the Civilian Health and Medical Care Program of the Uniformed Services, in 1998.)
4. CHAMPVA, the Civilian Health and Medical Program of the Departments of Veterans Affairs, covers the spouses and dependents of veterans with PERMANENT SERVICE-RELATED DISABILITIES. It ALSO COVERS surviving spouses and dependent children of veterans who died from service-related disabilities.

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