AHIP AHM-530 Exam - Topic 3 Question 79 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 79
Topic #: 3

The Gardenia Health Plan has a national reputation for quality care. When Gardenia entered a new market, it established a preferred provider organization (PPO), a health maintenance organization (HMO), and a point-of-service product (POS) to serve the plan members in this market. All of the providers included in the HMO or the POS are included in the broader provider panel of the PPO. The POS will be a typical two-level POS that offers a cost-based incentive plans for PCPs, and the HMO is a typical staff model HMO.

The network strategy that Gardenia is using to establish its range of healthcare plans is known as the

Anetwork-within-a-network approach

Bgatekeeper approach

Ctiered network approach

Dpreferred tier approach

Show Suggested Answer

Suggested Answer: B

by Benton at Dec 22, 2023, 08:09 PM

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Laticia

5 months ago

I agree with the tiered network idea, but I'm not sure about the details.

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Yolande

5 months ago

Wait, how can they manage all those plans effectively?

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Rosendo

6 months ago

Definitely a gatekeeper approach, right?

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Curt

6 months ago

I think it's more of a tiered network approach.

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Marva

6 months ago

Sounds like a network-within-a-network approach to me.

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Skye

6 months ago

I feel like the preferred tier approach could be relevant here, but I need to double-check how it differs from the others we discussed in class.

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Tamesha

7 months ago

The tiered network approach seems like a possibility too, especially with the cost-based incentives for PCPs. I just can't recall the specifics.

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Josphine

7 months ago

I think this might relate to the gatekeeper approach since they have a PCP involved, but I could be mixing it up with another question we practiced.

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Nathan

7 months ago

I remember studying different network strategies, but I'm not entirely sure which one fits here. The term "network-within-a-network" sounds familiar.

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Deonna

7 months ago

I'm pretty sure this is the network-within-a-network approach, since the HMO and POS providers are a subset of the PPO network. That makes the most sense given the information provided.

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Kayleigh

7 months ago

Okay, I see. The PPO is the broader network, and the HMO and POS are more limited networks within that. So this is definitely the network-within-a-network approach.

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Freeman

7 months ago

The key details seem to be that the HMO and POS are subsets of the broader PPO network. That sounds like a network-within-a-network strategy to me.

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Stefania

7 months ago

Hmm, I'm a bit confused here. Is this a tiered network approach or a gatekeeper approach? I'll need to think this through carefully.

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Luisa

7 months ago

I think this is a network-within-a-network approach, since the HMO and POS providers are a subset of the broader PPO network.

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Ezekiel

7 months ago

Wait, what exactly is the "assessment process" they're referring to? I need to make sure I understand the full scope before I can decide if it's true or false.

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Ricki

7 months ago

Hmm, I'm a bit unsure about this one. I know VRRPv3 has some additional features, but I can't quite recall which ones off the top of my head. I'll have to think it through or maybe even make an educated guess.

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Oneida

7 months ago

Based on the question, I think option B, Term Grades with Contact, is the way to go. The dean is specifically looking for students who did well in the Intro to Civil Engineering class, so that's the information we need to provide.

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