CSBI HFMA FINAL EXAM QUESTIONS WITH ANSWERS
2025/2026
Types of Health Services - Refer to locations, care settings or providers of care.
Examples are: preventive, primary care, acute, specialty, subacute, chronic, long term,
rehabilitative, end of life care
Providers & Locations - Adds complexity to the healthcare delivery service that patients
must navigate. Patients must have contacts with these touch points are required for
care.
CPP Constrained Payment Providers - Method in which payments for services paid are
defined in advance of care. Examples are Accountable Care Organizations (ACO),
Patient Centered Medical Homes (PCMHs), Medicare Advantage Plans, and service
specific bundled payments
Bundled Payments - service programs where payment is made on the basis of expected
costs for clinically defined episodes of care. Also known as global payments, case rate,
episodic payment.
Provider Organization Ownership Status - Refers to Not For Profit or For Profit.
Historically, physician entities were largely for profit, but now many are changing to not
for profit status. Tax issues are affecting this area where efforts must be taken to ensure
community service requirements are maintained for tax-exemptions.
Supplier and supply chain - Comprised of all for-profit entities, manufacturers of all kind,
distributions organizations, purchasing entities. Examples are - pharmaceuticals,
biomedical, life sciences, comsumables
Government - Key system component at the federal level. Has vast influence -
Medicare, ACA implementation, FDA, Public health service, and general health
regulations. examples are - public insurance financing, health regulations/policy,
research funding, public health
Economic Factors - general economy, consumer sentiments and demand elasticity,
economic development, demand elasticity by service, labor market/union strength,
employer strength, demand elasticity, market liquidity
Social Values - Diversity, social cohesion, established precedents, religious preferences
Global Influences - Immigration, vacation travel, tourism, epidemics, terrorism, demands
for equity in medication distribution
Population Characteristics - demographics - education level, age; socio-economics
morbidity related to ethnic and gender gaps, social morbidity, social determinants of
health
, Political Climate - elected officials, current party dominance, social healthcare policy,
interest groups
Technology development - engineering science, information science, applied
mathematics, IoT coverage and access
Physical Environment - Pollution, sanitation, workplaces, neighborhoods
What are the challenging areas of healthcare continuum of care? - 1-Lack of
Coordination
2-Healthcare Users on their own
3-Service Coordination
What are the types of service on health continuum? - 1-Well - preventative care, primary
care
2-At Risk - acute care
3-At risk mild - specialty care
4-Early Chronic - chronic care
5-Late Chronic - long-term care
6-Terminal - end of life care
Supply Sensitive Care - a driver of utilization - Care decisions are strongly influenced by
capacity, rather than medical evidence or severity of illness. Decisions depend on the
number of available hospital beds, clinics, CT scanners, doctors.. Also based on
competition, supplier promotional efforts and influences in supply variations impacting
cost of care delivered.
Preference Sensitive Care - a driver of utilization - Care selection and selection
frequency driven in large measure by the physician opinion.
What are misalignment with healthcare user and hospitals? - 1-focus on cost
2-drivers of service utilization
3-financing mechanism
What are the Foundational Ideas for Change? - 1 - Triple Aim
2 - Transparency in cost - gave way to Meaningful Use and now Promoting
Interoperability
3 - Understand Production Cost - gave way to Activity Based Costing (ABC type
analysis)
4- Community Based Services
Disruptive Innovation - disrupts and replaces existing markets with ways of working or
products previously not thought of as possible, now are possible due to new technology
or other catalysts.
2025/2026
Types of Health Services - Refer to locations, care settings or providers of care.
Examples are: preventive, primary care, acute, specialty, subacute, chronic, long term,
rehabilitative, end of life care
Providers & Locations - Adds complexity to the healthcare delivery service that patients
must navigate. Patients must have contacts with these touch points are required for
care.
CPP Constrained Payment Providers - Method in which payments for services paid are
defined in advance of care. Examples are Accountable Care Organizations (ACO),
Patient Centered Medical Homes (PCMHs), Medicare Advantage Plans, and service
specific bundled payments
Bundled Payments - service programs where payment is made on the basis of expected
costs for clinically defined episodes of care. Also known as global payments, case rate,
episodic payment.
Provider Organization Ownership Status - Refers to Not For Profit or For Profit.
Historically, physician entities were largely for profit, but now many are changing to not
for profit status. Tax issues are affecting this area where efforts must be taken to ensure
community service requirements are maintained for tax-exemptions.
Supplier and supply chain - Comprised of all for-profit entities, manufacturers of all kind,
distributions organizations, purchasing entities. Examples are - pharmaceuticals,
biomedical, life sciences, comsumables
Government - Key system component at the federal level. Has vast influence -
Medicare, ACA implementation, FDA, Public health service, and general health
regulations. examples are - public insurance financing, health regulations/policy,
research funding, public health
Economic Factors - general economy, consumer sentiments and demand elasticity,
economic development, demand elasticity by service, labor market/union strength,
employer strength, demand elasticity, market liquidity
Social Values - Diversity, social cohesion, established precedents, religious preferences
Global Influences - Immigration, vacation travel, tourism, epidemics, terrorism, demands
for equity in medication distribution
Population Characteristics - demographics - education level, age; socio-economics
morbidity related to ethnic and gender gaps, social morbidity, social determinants of
health
, Political Climate - elected officials, current party dominance, social healthcare policy,
interest groups
Technology development - engineering science, information science, applied
mathematics, IoT coverage and access
Physical Environment - Pollution, sanitation, workplaces, neighborhoods
What are the challenging areas of healthcare continuum of care? - 1-Lack of
Coordination
2-Healthcare Users on their own
3-Service Coordination
What are the types of service on health continuum? - 1-Well - preventative care, primary
care
2-At Risk - acute care
3-At risk mild - specialty care
4-Early Chronic - chronic care
5-Late Chronic - long-term care
6-Terminal - end of life care
Supply Sensitive Care - a driver of utilization - Care decisions are strongly influenced by
capacity, rather than medical evidence or severity of illness. Decisions depend on the
number of available hospital beds, clinics, CT scanners, doctors.. Also based on
competition, supplier promotional efforts and influences in supply variations impacting
cost of care delivered.
Preference Sensitive Care - a driver of utilization - Care selection and selection
frequency driven in large measure by the physician opinion.
What are misalignment with healthcare user and hospitals? - 1-focus on cost
2-drivers of service utilization
3-financing mechanism
What are the Foundational Ideas for Change? - 1 - Triple Aim
2 - Transparency in cost - gave way to Meaningful Use and now Promoting
Interoperability
3 - Understand Production Cost - gave way to Activity Based Costing (ABC type
analysis)
4- Community Based Services
Disruptive Innovation - disrupts and replaces existing markets with ways of working or
products previously not thought of as possible, now are possible due to new technology
or other catalysts.
