AHIP Exam AHM-530 Topic 4 Question 94 Discussion

Actual exam question for AHIP's AHM-530 exam

Question #: 94
Topic #: 4

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon will compensate her under a typical discounted fee-for-service (DFFS) payment system.

During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan determine how well she met Canyon's standards. The report included cumulative performance data for Dr. Enberg and encompassed all measurable aspects of her performance. This report included such information as the number of hospital admissions Dr. Enberg had and the number of referrals she made outside of Canyon's provider network during a specified period. Canyon also used process measures, structural measures, and outcomes measures to evaluate Dr. Enberg's performance.

Canyon used a process measure to evaluate the performance of Dr. Enberg when it evaluated whether:

ADr. Enberg's young patients receive appropriate immunizations at the right ages

BDr. Enberg's young patients receive appropriate immunizations at the right ages

CThe condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg

DDr. Enberg's procedures are adequate for ensuring patients' access to medical care

Show Suggested Answer

Suggested Answer: A

by Edelmira at Aug 04, 2024, 04:05 AM

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Lynelle

2 months ago

I bet Canyon's report on Dr. Enberg was longer than War and Peace. With all those 'measurable aspects of her performance,' they must have needed a forklift to deliver it to her office.

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Val

2 months ago

Ah, the joys of provider performance evaluation. I wonder if Canyon also checked how many times Dr. Enberg made her patients laugh during their visits. That's a metric they should consider!

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Flo

2 months ago

I agree, it's important to consider all aspects of a provider's performance, including patient satisfaction.

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Roselle

2 months ago

That would definitely be a unique metric to include in the evaluation process!

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Luke

2 months ago

Hmm, I'm going with B) Dr. Enberg's young patients receive appropriate immunizations at the right ages. It's a standard process measure, and the question specifically mentions that Canyon used process measures to evaluate Dr. Enberg's performance.

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Micaela

2 months ago

Wait, wait, wait. Isn't the answer supposed to be D) Dr. Enberg's procedures are adequate for ensuring patients' access to medical care? I mean, that's the only one that actually mentions 'access to medical care.'

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Mattie

3 months ago

Hah! This is a piece of cake. The answer is clearly B) Dr. Enberg's young patients receive appropriate immunizations at the right ages. Checking on immunization rates is a classic process measure.

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Fletcher

2 months ago

It's important to make sure young patients are receiving their immunizations on time.

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Nobuko

2 months ago

I agree, checking on immunization rates is definitely a process measure.

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Felix

3 months ago

I think the answer is A) Dr. Enberg's young patients receive appropriate immunizations at the right ages. It's a straightforward process measure that aligns with the information provided in the question.

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Jarvis

2 months ago

It's good to see that Canyon health plan takes into account various measures to assess providers like Dr. Enberg.

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Trinidad

2 months ago

Process measures are important for evaluating performance, and ensuring patients receive necessary care is crucial.

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Wilburn

2 months ago

I agree, A) Dr. Enberg's young patients receive appropriate immunizations at the right ages seems like the correct answer.

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Sharen

3 months ago

The correct answer is B) Dr. Enberg's young patients receive appropriate immunizations at the right ages. This is a process measure that evaluates the performance of a provider based on the care they deliver.

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