Comorbidity can have a significant impact on the effective implementation of disease management programs. Comorbidity can correctly be defined as the

• A. prevalence or rate of a sickness or injury within a given population
• B. degree to which the progression of a disease or condition is understood
• C. degree of severity of a particular disease or condition
• D. presence of a chronic condition or added complication other than the condition that requires medical treatment

Federal laws, such as the Employee Retirement Income Security Act (ERISA), the Balanced Budget Act (BBA) of 1997, and the Health Insurance Portability and Accountability Act (HIPAA), have affected medical management activities by health plans. Consider the following provisions of federal regulations:
Provision 1-Limits damage awards in lawsuits related to noncoverage of benefits based on medical necessity decisions to the cost of noncovered treatment and does not allow health plan members to obtain compensatory or punitive damages
Provision 2-Establishes electronic data security standards, which define the security measures that healthcare organizations must take to protect the confidentiality of electronically stored and transmitted patient information From the answer choices below, select the response that correctly identifies the federal laws that include Provision 1 and Provision 2, respectively.

• A. Provision 1- ERISA Provision 2- HIPAA
• B. Provision 1- BBA of 1997 Provision 2- HIPAA
• C. Provision 1- ERISA Provision 2- BBA of 1997
• D. Provision 1- HIPAA Provision 2- ERISA

In most health plans, the formulary system is developed and managed by a P&T committee. The P&T committee is responsible for

• A. evaluating and selecting drugs for inclusion in the formulary
• B. overseeing the manufacture, distribution, and marketing of prescription drugs
• C. certifying the medical necessity of expensive, potentially toxic, or nonformulary drugs
• D. all of the above

A health plan's preventive care initiatives may be classified into three main categories: primary prevention, secondary prevention, and tertiary prevention. Secondary prevention refers to activities designed to

• A. detect a medical condition in its early stages and prevent or at least delay disease progression and complications
• B. develop an appropriate treatment strategy for patients whose conditions require extensive, complex healthcare
• C. educate and motivate members to prevent illness through their lifestyle choices
• D. prevent the occurrence of illness or injury

One way that health plans evaluate their UR programs is by monitoring utilization rates. By definition, utilization rates typically

• A. indicate changes in the total amount of medical expenses or claim dollars paid for particular procedures
• B. report the number of times that a particular provider performs or recommends a service excluded from the benefit plan
• C. measure the number of services provided per 1,000 members per year
• D. indicate standard approaches to care for many common, uncomplicated healthcare services