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Question 1: 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's young patients receive appropriate immunizations at the right ages
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
Correct Answer: A
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