Bcacp Practice Management Exam Questions And Answers

What is the triple aim of Institute for Health Improvement? 1. improve patients' experience of care 2. reduce cost of care 3. improve population health Complex adaptive systems (CAS) Group of diverse individuals who learn together Interdependent connections that vary in intensity and may be inconsistent Which group is involved in health care interoperability? Office of the National Coordinator (ONC) per the Cures Act of 2016 What is SNOMED CT? SNOMED CT or SNOMED Clinical Terms is a systematically organized computer processable collection of medical terms providing codes, terms, synonyms, and definitions used in clinical documentation and reporting. *creates alphanumeric coding of clinical documentation which allows for electronic sharing of a clinical note between two EHRs What is RxNorm? -Normalized naming system for generic and brand name drugs and relationships -Produced by the National Library of Medicine (NLM) - attaches medications to a set of codes, creating an electronic vocabulary of medications (combines NDC numbers) What is LOINC? Logical Observation Identifiers Names and Codes database and universal code standard for identifying medical laboratory tests, measurements, observations What is C-CDA Consolidated clinical documentation architecture standard electronic structures for clinical documents (i.e. discharge summaries, progress notes) - Pharmacist e-Care Plan is an example What are value sets? group of specific values or codes derived from single or multiple standard code sets -often presented as pull down prompts What is an ACO? Accountable Care Organizations - Type of alternative payment model - Voluntary group of physicians, hospitals, long term care providers, and other HCP who assume responsibility for care of defined population of beneficiaries assigned to them by a payer such as Medicare - IF TRIPLE AIM IS MET (better care and health are redced cost): shared savings between ACO and the payer What is a PCMH? - Model of primary care that emphasizes quality - Comprehensive team based care - includes physician, nurse or NP and coach as core members - whole person oriented; very good access to care What are examples of value based payment models (VBP)? 1. Pay for performance 2. Global payment 3. Bundled payment 4. Risk sharing 5. Value based insurance design What is pay for performance? Payment for health care services based on quality measures and performance of providers - often paired with fee for service What is global payment? Set fee per patient paid to provider for certain amount of time for all of their care - requirement to meet quality benchmarks What is bundled payment? A set price meant to cover every element of clinical care and support for a specific procedure or condition (i.e. set payment for hip replacement) - must meet certain quality measures What is risk sharing? Full risk: providers at full financial risk for negative events that increase costs; receive financial rewards for increased quality associated with cost savings Partial risk/risk sharing: organization and payer share financial risk for negative events that increase cost and results that reduce cost What is a value-based insurance design? Payers incentivize pts by reducing cost for services that are evidence based and disincentive patients by increasing cost for services with minimal evidence What are the Donabedian domains of quality? Structure - how resources and systems affect pt care Process - provider-patient interactions Outcome - what happens to the patients (economic, clinical, humanistic) What are the 5 key principles of the lean process used to evaluate quality? 1. Achieving value outcomes with least amount of work possible 2. Eliminate waste, remove activity that does not add value 3. Jidoka (just in time) - automatically detect and stop the process when problem occurs 4. Identify value streams (steps most critical and valuable) 5. Every worker is a problem solver What is six sigma? Method focused on reducing variation and defects within processes to consistently create the desired outcome 1. Identify and define what needs to be improved 2. Measure what is currently occurring (collect data) 3. Use creative solutions to improve the process with policies, guidelines, and strategies What are the 4 areas to focus on to have a "balanced scorecard" for a quality program? 1. Structure (i.e. train staff, communication systems effective) 2. Process (i.e. error rates, timeliness) 3. Patient Outcomes (clinical markers, patient satisfaction) 4. Financial outcomes What does the Agency for Healthcare Research and Quality do? Sets national strategy for quality improvement in healthcare (set goals for readmissions, diabetes control, blood pressure control, immunizations) What is the Universal Data System? Established by Health Resources and Services Administration for Health Center Program grantees (Federally Qualified Health Centers, Migrant Health Centers, Health Care for the Homeless, Public Housing Primary Care Program) What is the National Academy of Medicine (formerly IOM) Independent nonprofit organization that works outside of government to provide advice to decision makers and the public Almost 200 reports on health care quality What is the Pharmacy Quality Alliance (PQA)? Mission is to optimize health by advancing quality of med use -Public-private partnership to assist CMS to ensure quality provided to Medicare beneficiaries - Develop measure concepts that are tested, voted on and moved forward for public use What is the Alliance for Integrated Medication Management Collaborative (AIMM)? Initiated by HRSA to address med errors in underserved patients - Uses PDSA process to integrate clinical pharmacy services into patient care to improve patient safety What is the National Quality Forum (NQF)? Created in 1999 by Presidential Commission to review healthcare quality and consumer protection *Endorses quality measures Criteria for approval: