C O U R S E E X A M I N AT I O N · A N S W E R K E Y & R AT I O N A L E S
NUR 621: Value-Based
Arrangements in
Healthcare
A comprehensive 75-question examination aligned with
NUR 621 course objectives — spanning value-based care
fundamentals, alternative payment models, quality
measurement, accountable care organizations, financial
risk sharing, and implementation directions for 2026-2027.
Nursing Leadership and Healthcare Finance
Graduate Program in Nursing
Academic Year 2026-2027 · 75 Questions · Six Sections
,NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
NUR 621: Value-Based Arrangements in Healthcare
Course Examination · Academic Year 2026-2027
EXAMINATION OVERVIEW
Course NUR 621 — Nursing Leadership and Healthcare Finance
Examination Value-Based Arrangements in Healthcare
Academic Year 2026-2027
75 questions — six sections — multiple choice (A-D), one correct response
Total Questions
per item
Cognitive Levels 25% recall — 50% application — 25% analysis
Question Style 70% scenario-based — 30% direct recall and model identification
The correct option is marked inline with [CORRECT]; the keyed answer and a
Answer Format
detailed rationale follow each question
This examination evaluates mastery of value-based arrangements in healthcare as specified in the NUR 621
Nursing Leadership and Healthcare Finance course objectives. Items progress across six sections, moving
from value-based care fundamentals to payment models, quality measurement, accountable care
organizations, financial risk sharing, and implementation and future directions, with current CMS models for
2026-2027 integrated throughout. Each item carries a single best response, and the accompanying rationale
explains why the keyed answer is correct while identifying the payment-model, quality-measurement, or
risk-arrangement reasoning that invalidates each distractor.
1
,NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
Section 1: Value-Based Care Fundamentals
Definition, Principles, & Evolution of Value-Based Care · Questions 1-10
Q1: Which statement most accurately defines value-based care (VBC) as presented in NUR
621?
A. A reimbursement method in which providers are paid for each individual service, test,
or encounter delivered
B. A care delivery and payment model in which providers are reimbursed and held
accountable for health outcomes, quality, patient experience, and total cost of care rather
than the volume of services delivered [CORRECT]
C. A fixed monthly payment made to a provider for each enrolled patient regardless of
whether the patient seeks care
D. A federal mandate requiring hospitals to reduce operating costs by a set percentage
each year
Correct Answer: B
Rationale: Value-based care is defined by accountability for outcomes, quality, patient experience,
and cost rather than service volume; option A describes fee-for-service, the very model VBC replaces.
Option C describes capitation, which is one payment mechanism that can operate within VBC but does
not define the model. Option D is a fabricated mandate with no basis in CMS policy or value-based
program design.
Q2: The Quadruple Aim framework that guides value-based transformation includes
improving patient experience, improving population health, and reducing per capita cost, along
with which fourth component?
A. Expanding inpatient surgical volume
B. Maximizing payer contract rates
C. Improving care team well-being [CORRECT]
D. Increasing annual technology spending
Correct Answer: C
Rationale: Bodenheimer and Sinsky (2014) expanded IHI's Triple Aim to the Quadruple Aim by
adding care team well-being, recognizing that clinician and staff burnout undermines quality,
experience, and cost goals. Options A and B reflect fee-for-service volume and revenue priorities
rather than system-level aims. Technology spending (D) is an operational input, not an aim of value
transformation.
2
, NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
Q3: A medical-surgical nurse manager learns that her hospital's largest commercial payer has
replaced volume-based reimbursement with a value-based arrangement rewarding 30-day
readmission reduction and patient experience scores. Which nursing action best aligns the unit
with this shift?
A. Implementing structured discharge education, 48-72 hour follow-up telephone calls,
and pharmacist-led medication reconciliation to prevent avoidable readmissions
[CORRECT]
B. Encouraging early discharge regardless of patient readiness in order to increase bed
turnover
C. Recruiting additional elective surgical admissions to grow service-line revenue
D. Adding secondary diagnoses to claims to increase reimbursement per case
Correct Answer: A
Rationale: The payer now rewards outcomes and experience, so evidence-based transitions of care
directly improve the metrics that drive payment under this value-based arrangement. Early discharge
without readiness (B) raises readmission risk and undermines the contract. Recruiting volume (C) is a
fee-for-service growth strategy, and adding unsupported diagnoses (D) constitutes fraudulent coding
rather than genuine value improvement.
Q4: Which legislation authorized the creation of the CMS Innovation Center (CMMI) to
design and test alternative payment models?
A. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015
B. The Patient Protection and Affordable Care Act of 2010 [CORRECT]
C. The Social Security Amendments of 1965
D. The American Rescue Plan Act of 2021
Correct Answer: B
Rationale: Section 1115A of the Affordable Care Act (2010) created CMMI with authority to test
innovative payment and delivery models such as ACOs, bundled payments, and primary care models.
MACRA (A) later built on this work by creating the Quality Payment Program. The Social Security
Amendments (C) established Medicare and Medicaid in 1965, and the American Rescue Plan (D)
addressed pandemic relief, not payment reform.
3
NUR 621: Value-Based
Arrangements in
Healthcare
A comprehensive 75-question examination aligned with
NUR 621 course objectives — spanning value-based care
fundamentals, alternative payment models, quality
measurement, accountable care organizations, financial
risk sharing, and implementation directions for 2026-2027.
Nursing Leadership and Healthcare Finance
Graduate Program in Nursing
Academic Year 2026-2027 · 75 Questions · Six Sections
,NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
NUR 621: Value-Based Arrangements in Healthcare
Course Examination · Academic Year 2026-2027
EXAMINATION OVERVIEW
Course NUR 621 — Nursing Leadership and Healthcare Finance
Examination Value-Based Arrangements in Healthcare
Academic Year 2026-2027
75 questions — six sections — multiple choice (A-D), one correct response
Total Questions
per item
Cognitive Levels 25% recall — 50% application — 25% analysis
Question Style 70% scenario-based — 30% direct recall and model identification
The correct option is marked inline with [CORRECT]; the keyed answer and a
Answer Format
detailed rationale follow each question
This examination evaluates mastery of value-based arrangements in healthcare as specified in the NUR 621
Nursing Leadership and Healthcare Finance course objectives. Items progress across six sections, moving
from value-based care fundamentals to payment models, quality measurement, accountable care
organizations, financial risk sharing, and implementation and future directions, with current CMS models for
2026-2027 integrated throughout. Each item carries a single best response, and the accompanying rationale
explains why the keyed answer is correct while identifying the payment-model, quality-measurement, or
risk-arrangement reasoning that invalidates each distractor.
1
,NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
Section 1: Value-Based Care Fundamentals
Definition, Principles, & Evolution of Value-Based Care · Questions 1-10
Q1: Which statement most accurately defines value-based care (VBC) as presented in NUR
621?
A. A reimbursement method in which providers are paid for each individual service, test,
or encounter delivered
B. A care delivery and payment model in which providers are reimbursed and held
accountable for health outcomes, quality, patient experience, and total cost of care rather
than the volume of services delivered [CORRECT]
C. A fixed monthly payment made to a provider for each enrolled patient regardless of
whether the patient seeks care
D. A federal mandate requiring hospitals to reduce operating costs by a set percentage
each year
Correct Answer: B
Rationale: Value-based care is defined by accountability for outcomes, quality, patient experience,
and cost rather than service volume; option A describes fee-for-service, the very model VBC replaces.
Option C describes capitation, which is one payment mechanism that can operate within VBC but does
not define the model. Option D is a fabricated mandate with no basis in CMS policy or value-based
program design.
Q2: The Quadruple Aim framework that guides value-based transformation includes
improving patient experience, improving population health, and reducing per capita cost, along
with which fourth component?
A. Expanding inpatient surgical volume
B. Maximizing payer contract rates
C. Improving care team well-being [CORRECT]
D. Increasing annual technology spending
Correct Answer: C
Rationale: Bodenheimer and Sinsky (2014) expanded IHI's Triple Aim to the Quadruple Aim by
adding care team well-being, recognizing that clinician and staff burnout undermines quality,
experience, and cost goals. Options A and B reflect fee-for-service volume and revenue priorities
rather than system-level aims. Technology spending (D) is an operational input, not an aim of value
transformation.
2
, NUR 621 · Value-Based Arrangements in Healthcare — Course Examination 2026-2027
Q3: A medical-surgical nurse manager learns that her hospital's largest commercial payer has
replaced volume-based reimbursement with a value-based arrangement rewarding 30-day
readmission reduction and patient experience scores. Which nursing action best aligns the unit
with this shift?
A. Implementing structured discharge education, 48-72 hour follow-up telephone calls,
and pharmacist-led medication reconciliation to prevent avoidable readmissions
[CORRECT]
B. Encouraging early discharge regardless of patient readiness in order to increase bed
turnover
C. Recruiting additional elective surgical admissions to grow service-line revenue
D. Adding secondary diagnoses to claims to increase reimbursement per case
Correct Answer: A
Rationale: The payer now rewards outcomes and experience, so evidence-based transitions of care
directly improve the metrics that drive payment under this value-based arrangement. Early discharge
without readiness (B) raises readmission risk and undermines the contract. Recruiting volume (C) is a
fee-for-service growth strategy, and adding unsupported diagnoses (D) constitutes fraudulent coding
rather than genuine value improvement.
Q4: Which legislation authorized the creation of the CMS Innovation Center (CMMI) to
design and test alternative payment models?
A. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015
B. The Patient Protection and Affordable Care Act of 2010 [CORRECT]
C. The Social Security Amendments of 1965
D. The American Rescue Plan Act of 2021
Correct Answer: B
Rationale: Section 1115A of the Affordable Care Act (2010) created CMMI with authority to test
innovative payment and delivery models such as ACOs, bundled payments, and primary care models.
MACRA (A) later built on this work by creating the Quality Payment Program. The Social Security
Amendments (C) established Medicare and Medicaid in 1965, and the American Rescue Plan (D)
addressed pandemic relief, not payment reform.
3
