AHIP Exam AHM-520 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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Jarod

1 days 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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Paz

2 days 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

8 days ago

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

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Chaya

9 days ago

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

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Billi

9 days 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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Rene

10 days ago

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

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Gearldine

13 days 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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