Certified Rehabilitation Registered Nurse (CRRN) Practice Exam

How do health plans primarily manage financial risk to ensure cost control?

1. By setting premium rates

2. By cost-sharing with beneficiaries

3. By employing managed care techniques

4. By implementing fee-for-service models

The correct answer is: By employing managed care techniques

Managed care techniques are the primary method through which health plans manage financial risk and ensure cost control. These techniques involve coordinated care, which includes strategies such as provider networks, utilization review, and care management. The goal of managed care is to provide quality care while limiting unnecessary expenditures, thereby controlling costs more effectively. By using managed care approaches, health plans can negotiate rates with providers, encourage preventive care to reduce expensive interventions later, and promote the use of evidence-based practices to enhance efficiency. These strategies not only help in controlling the overall healthcare costs but also manage the risk associated with unpredictable expenses, contributing significantly to the financial health of the insurance plans and the sustainability of the healthcare system overall. While setting premium rates, cost-sharing with beneficiaries, and implementing fee-for-service models are all strategies that play a role in healthcare financing, they do not primarily focus on the management of financial risk in the same comprehensive manner as managed care techniques do.