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:
A) Dr. Enberg's young patients receive appropriate immunizations at the right ages
B) Dr. Enberg conforms to standards for prescribing controlled substances 87
C) The condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg
D) Dr. Enberg's procedures are adequate for ensuring patients' access to medical care

Question

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:
A) Dr. Enberg's young patients receive appropriate immunizations at the right ages
B) Dr. Enberg conforms to standards for prescribing controlled substances  87
C) The condition of one of Dr. Enberg's patients improved after the patient received medical treatment from Dr. Enberg
D) Dr. Enberg's procedures are adequate for ensuring patients' access to medical care

Quizplus · Accepted Answer

A process measure evaluates whether a healthcare provider is following established protocols and delivering services correctly. Therefore, evaluating whether Dr. Enberg's young patients receive appropriate immunizations at the right ages is an example of a process measure. B is incorrect because it refers to a prescribing standard, not a process standard. C is incorrect because it refers to an outcome measure, not a process measure. D is incorrect because it refers to a structural measure, not a process measure.

The Provider Contract That the Canyon Health Plan Has with Dr