AHIP AHM-520 Exam - Topic 6 Question 71 Discussion

Actual exam question for AHIP's AHM-520 exam

Question #: 71
Topic #: 6

The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:

Preferred provider organization (PPO)

Group model HMO

Staff model health maintenance organization (HMO)

Traditional health insurance

Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:

Apreferred provider organization (PPO)

Bgroup model HMO

Cstaff model health maintenance organization (HMO)

Dtraditional health insurance

Show Suggested Answer

Suggested Answer: C

by Deandrea at Jul 08, 2023, 03:37 AM

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Shay

4 months ago

Group model HMOs have their own risks, but I see the point about PPOs.

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Craig

4 months ago

Wait, really? I thought HMOs were more risky overall.

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Tomoko

4 months ago

I think traditional health insurance could be riskier too.

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Leota

5 months ago

Totally agree, PPOs are more flexible but risky!

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Serita

5 months ago

PPOs usually have higher costs and risks.

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Dorian

5 months ago

I feel like PPOs could be the answer, but I also recall that staff model HMOs have a more direct relationship with providers, which might reduce risk.

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Maryann

5 months ago

I practiced a question similar to this, and I think the group model HMO has a more controlled risk environment compared to PPOs.

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Maryann

5 months ago

I'm not entirely sure, but I think traditional health insurance might expose the plan to more risk because it doesn't have the same managed care controls as HMOs.

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Malcom

6 months ago

I remember studying that PPOs allow more flexibility in choosing providers, which could lead to higher costs and risks for the health plan.

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Holley

6 months ago

Hmm, this looks like a tricky one. I'll need to carefully read through each option and think about which ones are provided by Secure Connect.

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Remona

6 months ago

This looks like a straightforward file reading exercise. I'll need to read each line, check if it's blank, and print the line if it's not. Shouldn't be too difficult.

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Oliva

6 months ago

This is a tricky one, but I think the key is to focus on the core elements of the system that could be impacted. I'd analyze the technical infrastructure and the business processes.

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Meghan

6 months ago

I'm feeling confident about this one. The establishment of an advisory committee is not actually a step in the IFRS development, so that's got to be the answer.

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Ilona

6 months ago

Hmm, I'm a bit unsure about this one. I know Synergy is a composable infrastructure, but I'm not sure which tool would be used to manage the 3PAR storage specifically.

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Jarod

11 months ago

I'm going with the group model HMO. The health plan has more influence over the provider network, but not as much overhead as the staff model. Seems like the sweet spot for risk management.

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Raylene

9 months ago

I see your point, but I still think the group model HMO is the best choice for managing risk.

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Cristy

9 months ago

I would go with the staff model HMO. It may have more overhead, but it also offers more control over providers.

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Ailene

9 months ago

I agree, the group model HMO seems like a balanced option for risk management.

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Louisa

9 months ago

I think the group model HMO is a good choice. It offers some control over providers without too much risk.

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Stevie

9 months ago

C) staff model health maintenance organization (HMO)

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Ira

9 months ago

B) group model HMO

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Ressie

10 months ago

A) preferred provider organization (PPO)

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Norah

10 months ago

C) staff model health maintenance organization (HMO)

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Man

10 months ago

B) group model HMO

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Helene

10 months ago

A) preferred provider organization (PPO)

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Paz

11 months ago

Haha, traditional health insurance? That's like the health plan just sitting back and hoping for the best. Might as well roll the dice in Vegas!

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Rene

11 months ago

Why do you think that? Can you explain your rationale?

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Chaya

11 months ago

I disagree, I believe the answer is A) preferred provider organization (PPO).

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Billi

11 months ago

I'm not so sure. The staff model HMO seems riskier to me. Directly employing all the providers means the health plan has to manage a larger workforce and infrastructure.

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Keva

10 months ago

I agree, the staff model HMO does seem riskier. Managing a larger workforce and infrastructure can be challenging.

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Aracelis

10 months ago

D) traditional health insurance

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Jacob

10 months ago

C) staff model health maintenance organization (HMO)

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Tula

10 months ago

B) group model HMO

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Denny

10 months ago

A) preferred provider organization (PPO)

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Rene

11 months ago

I think the answer is C) staff model health maintenance organization (HMO).

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Gearldine

11 months ago

The PPO definitely exposes the health plan to the highest risk. With less control over providers, there's more potential for cost overruns and quality issues.

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