,HLTH 4980 Final Exam QUESTIONS AND
ANSWERS 100% CORRECT!
**What are the two landmark pieces of health legislation responsible for the most
sig**What are the two landmark pieces of health legislation responsible for the most
significant payment reforms seen in recent decades? - ANSWER 1. The Patient
Protection and Affordable Care Act of 2010 (ACA)
2. Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA)
**What is the CMMI and how has it influence payment patterns? - ANSWER The Center
for Medicare and Medicaid Innovation (CMMI) has unprecedented funding and the
authority to pilot new payment and delivery models, including coordination with the
private sector
What are the two voluntary tracks in the new Quality Payment Program under MACRA ?
- ANSWER 1. under the Merit-based Incentive Payment System (MIPS), physician
groups are scored
in four domains: quality, cost efficiency, technology adoption, and clinical practice
improvement activities aligned with population health care models.
2. MACRA drives physician participation in one of an increasing number of Alternative
Payment Models (APMs), in particular those that require providers to bear substantial
downside financial risk, or "advanced" APMs.
**What are the four domains of quality scored in the MIPS? - ANSWER 1. quality
2. cost efficiency
3. technology adoption
4. clinical practice improvement activities
aligned with population health care models.
What are the characteristics and requirements of the APMs employed in the second
track of MACRA? - ANSWER APMs are built upon coordinated care models in which
incentives are linked to broader
outcomes, especially the total cost of care for people with specific conditions or entire
populations. Accountability for the total cost of care requires providers to shift their
frame of reference 180
,degrees, from one that is centered around individual healthcare delivery services, to
one that is longitudinal regardless of whether, where, and when services are provided
for the target population.
**What type of practitioner must be included in an ACO? - ANSWER PCP
**What is the "thorn in the side" of ACO managers and clinicians? Why? - ANSWER
The detailed and complex methods for patient attribution to ACOs since patients very
often do not seek care exclusively with a single provider unless their insurance requires
it (which is rare).
What are the guidelines to optimize correct attribution and drive more effective care? -
ANSWER -provide the best possible access and a seamless high-quality care
experience so
that it is easy for patients to want to stay within the system (also known as the
"stickiness" strategy—a
win under both volume and value).
-Ensure that all patients (especially Medicare beneficiaries) see their PCP at least once
per
calendar year, preferably including a preventive care visit. This is not only good practice
but also a
fully covered benefit without copay (under ACA rules).
-Ensure all physicians are listed under the correct specialty in the payer's systems,
especially
CMS where physicians may have been initially credentialed before they completed
specialty training.
This issue is irrelevant under fee-for-service but critical in population health/coordinated
care models.
**What are the characteristics of the comprehensive primary care programs (CPC)? -
ANSWER -builds upon the principles of the patient centered medical home
-provides education and technical support
-Primary care physicians are central and work to make team-based care
-all members of team have defined roles and functions in patient care at micro and
macro levels
-paid in fee for service but can elect to be paid partially in captivated monthly fee
-incentives for quality and efficiency
-required to invest some funs in new resources to improve care coordination
What determines the amount of savings shard with an ACO? - ANSWER The amount of
savings shared with the ACO is often determined by the quality score achieved
, in multiple domains, including prevention, chronic disease management, care
coordination, and patient
experience.
**What is the purpose of a care model? - ANSWER -Use of evidence-based guidelines
and data to manage, track, and improve outcomes of
specific conditions
-Appropriate access to care
-Patient navigation/coordination/ education
-Collaboration and communication with primary care as a virtual team
**What is the role of the office supervisor? - ANSWER -oversee patient flow
-triage patients
-facilitate access
-supervise medical assistants (MAs).
The supervisor organizes the daily huddle, which is designed to keep team members
informed and anticipating the day's work.
**What is the purpose of the "daily huddle"? - ANSWER To keep team members
informed and anticipating the day's work
**What is the role of the MA in the care team? - ANSWER -support patient flow by
rooming patients
-often considered the right hand of the
physician
-take vital signs
-administer injections
-collect information, such as confirming
reason for visit, medication changes, and information outlined on patient health
questionnaires
What is a basic regulatory requirement of Chronic Care Management (CCM)? -
ANSWER A care plan, created with the patient and signed off
by the physician, followed by 20 minutes of (documented) coaching in a 30-day period,
resulting in a billable encounter
**What is involved in care model transformation? - ANSWER Care model transformation
addresses people, process, and technology:
ANSWERS 100% CORRECT!
**What are the two landmark pieces of health legislation responsible for the most
sig**What are the two landmark pieces of health legislation responsible for the most
significant payment reforms seen in recent decades? - ANSWER 1. The Patient
Protection and Affordable Care Act of 2010 (ACA)
2. Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA)
**What is the CMMI and how has it influence payment patterns? - ANSWER The Center
for Medicare and Medicaid Innovation (CMMI) has unprecedented funding and the
authority to pilot new payment and delivery models, including coordination with the
private sector
What are the two voluntary tracks in the new Quality Payment Program under MACRA ?
- ANSWER 1. under the Merit-based Incentive Payment System (MIPS), physician
groups are scored
in four domains: quality, cost efficiency, technology adoption, and clinical practice
improvement activities aligned with population health care models.
2. MACRA drives physician participation in one of an increasing number of Alternative
Payment Models (APMs), in particular those that require providers to bear substantial
downside financial risk, or "advanced" APMs.
**What are the four domains of quality scored in the MIPS? - ANSWER 1. quality
2. cost efficiency
3. technology adoption
4. clinical practice improvement activities
aligned with population health care models.
What are the characteristics and requirements of the APMs employed in the second
track of MACRA? - ANSWER APMs are built upon coordinated care models in which
incentives are linked to broader
outcomes, especially the total cost of care for people with specific conditions or entire
populations. Accountability for the total cost of care requires providers to shift their
frame of reference 180
,degrees, from one that is centered around individual healthcare delivery services, to
one that is longitudinal regardless of whether, where, and when services are provided
for the target population.
**What type of practitioner must be included in an ACO? - ANSWER PCP
**What is the "thorn in the side" of ACO managers and clinicians? Why? - ANSWER
The detailed and complex methods for patient attribution to ACOs since patients very
often do not seek care exclusively with a single provider unless their insurance requires
it (which is rare).
What are the guidelines to optimize correct attribution and drive more effective care? -
ANSWER -provide the best possible access and a seamless high-quality care
experience so
that it is easy for patients to want to stay within the system (also known as the
"stickiness" strategy—a
win under both volume and value).
-Ensure that all patients (especially Medicare beneficiaries) see their PCP at least once
per
calendar year, preferably including a preventive care visit. This is not only good practice
but also a
fully covered benefit without copay (under ACA rules).
-Ensure all physicians are listed under the correct specialty in the payer's systems,
especially
CMS where physicians may have been initially credentialed before they completed
specialty training.
This issue is irrelevant under fee-for-service but critical in population health/coordinated
care models.
**What are the characteristics of the comprehensive primary care programs (CPC)? -
ANSWER -builds upon the principles of the patient centered medical home
-provides education and technical support
-Primary care physicians are central and work to make team-based care
-all members of team have defined roles and functions in patient care at micro and
macro levels
-paid in fee for service but can elect to be paid partially in captivated monthly fee
-incentives for quality and efficiency
-required to invest some funs in new resources to improve care coordination
What determines the amount of savings shard with an ACO? - ANSWER The amount of
savings shared with the ACO is often determined by the quality score achieved
, in multiple domains, including prevention, chronic disease management, care
coordination, and patient
experience.
**What is the purpose of a care model? - ANSWER -Use of evidence-based guidelines
and data to manage, track, and improve outcomes of
specific conditions
-Appropriate access to care
-Patient navigation/coordination/ education
-Collaboration and communication with primary care as a virtual team
**What is the role of the office supervisor? - ANSWER -oversee patient flow
-triage patients
-facilitate access
-supervise medical assistants (MAs).
The supervisor organizes the daily huddle, which is designed to keep team members
informed and anticipating the day's work.
**What is the purpose of the "daily huddle"? - ANSWER To keep team members
informed and anticipating the day's work
**What is the role of the MA in the care team? - ANSWER -support patient flow by
rooming patients
-often considered the right hand of the
physician
-take vital signs
-administer injections
-collect information, such as confirming
reason for visit, medication changes, and information outlined on patient health
questionnaires
What is a basic regulatory requirement of Chronic Care Management (CCM)? -
ANSWER A care plan, created with the patient and signed off
by the physician, followed by 20 minutes of (documented) coaching in a 30-day period,
resulting in a billable encounter
**What is involved in care model transformation? - ANSWER Care model transformation
addresses people, process, and technology:
