PAM FINAL EXAM WITH ALL CORRECT & 100%
VERIFIED ANSWERS (UPDATED TO PASS)
What is "primary care" and its key components? Correct answer-- Primary care: care provided by
clinicians trained and skilled in first contact and continuing care for people with undiagnosed signs,
symptoms, or concernts. Not limited by problem origin, organ system, or diagnosis
- Performed by clinicians collaborating with other health professionals, providing advocact in the
health care system to accomplish cost-effective care
- Promotes effective communication
- Patient as partner
True or false: No matter how you slice the data, higher quality of care is more expensive care.
Correct answer-False
In 2010, prescription drugs were responsible for the greatest share of healthcare spending in the US.
Correct answer-- False, it was hospital, physicians, then prescription drugs.
True or False: In the US, strong clinical care is the #1 driver of the wellbeing of individuals and
communities. Correct answer-True
What are the three main components of the IHI "triple aim"? Correct answer-- Population Health
- Experience of Care
- Per Capita Cost
What fourth component does Cornell Health incorporate to produce a "quadruple aim"? Correct
answer-Readiness
Population Health Management Correct answer-- accountability and management of the health of
an entire community, regardless of system membership or insurance status.
- Combines interventions that focus on patients with specific chronic conditions (disease
management) or very high cost irrespective of the cause (case management) with wellness
components aimed at using health risk assessments to identify and improve unhealthy behaviors
key attributes of PHM Correct answer-o approaches developed to foster health and quality of care
improvements while managing costs
o Addresses the preventive and chronic care needs of every patient
o organized systems of care
o coordinated care teams
o focus on upstream social determinants of health
o holistic patient centered primary care by interdisciplinary care teams
o analysis of data to identify and target high-risk/high cost patients for chronic care management
o accountability
care coordination pyramid Correct answer-- organizes patients into strata of who needs more
attention
5/50 rule Correct answer-small percent of people in any given population who account for 50% of
the cost
,why is 5/50 rule so important to triple aim? Correct answer-- this is important because as health
care costs rise, providers are trying to find these patients and get to the root of their problem in
order to decrease cost, increase quality of care, and increase health of population overall
What is a healthcare "super utilizer?" Correct answer-- high need, high cost patients who require
complex care management
- complex physical, behavioral, and social needs are not well met through the current fragmented
health care system
- often bounce from ED to ED, inpatient admission to readmission, etc. which is costly and ineffective
How did the Camden Coalition develop their strategy for improving outcomes and reducing costs
among super utilizers Correct answer-- A doctor mapped out crime rates in relation to health
outcomes in the city and found that the most expensive patients were concentrated in the same
area.
-By focusing on this specific population that had the highest costs, they were able to focus on getting
community health workers.
camden coalition Correct answer-- the strategic use of data to reallocate resources to a small
subset of high-needs, high-cost patients.
- Actively identifying sick patients and responding proactively in real time to improve health and
reduce costs.
chronic care management (CCM) Correct answer-- Primary-care integrated complex care
management
- specially trained, multidisciplinary teams that coordinate closely with primary care teams to meet
the needs of medically complex patients.
how does CCM target high-need/high-cost patients to improve their health, wellbeing, functional
status, and costs? Correct answer-- They use predictive modelling (acute events, ED visits,
hospitalizations, etc.) to identify patients at highest risk for poor outcomes and who would benefit
from CCM.
- They try to address more than medical issues by increasing patients capacity to self-manage
condition; eliminate unnecessary clinical testing, and reduce need for acute care services
What role does trust play in CCM? Correct answer-- It helps to address social factors and isolation
by visiting patients at a time of need, having culturally and linguistically concordant and
approachable stave, and motivational interviewing to encourage patient activation and self
management.
warm hand off Correct answer-- handing off patient from one provider to another without
consistently having the patient start over
Why take an incremental approach in CCM? Correct answer-o It helps to build trust.
o It also helps to find tangible ways to help improve patients' lives
o Build social connections
o Help steer patients toward long term health goals
incremental approach in CCM Correct answer-- starting small and engaging with patients to
explore what the patient is willing to change/do to decrease risk.
, What are community health workers? Correct answer-- Trusted community members trained to
serve as liaisons between health/social services and community to facilitate access and improve
quality/cultural competence of service deliver.
what roles do community health workers play in CCM and why does the research tend to show they
are effective at improving the health of medically complex patients? Correct answer-- They build
individual and community capacity by increasing health knowledge and self-sufficiency through
range of activities such as outreach, community education, informal counseling, social support, and
advocacy
patient navigators Correct answer-- trained, culturally sensitive health care workers who provide
support and guidance throughout the care continuum.
- Help people "navigate" through the maze of doctors, offices, clinics, hospitals, outpatient center,
insurance and payment systems
How can Camden Coalition's Housing First program improve the care/costs/outcomes of high cost
high needs homeless patients? Correct answer-- Identifies frequently-hospitalized and housing-
unstable individuals and gives them affordable permanent affordable housing vouchers.
Camden Coalition's Housing First Correct answer-- widely-used evidence based housing model that
ends homelessness for individuals facing long-term housing challenges
how can community paramedicine improve the care/costs/outcomes of high cost high needs
patients? Correct answer-- Community paramedics operate under expanded scope to provide
comprehensive, person-centered services in the patient's home (rather than just "stabilize and
transport")
- These individuals are always available, are trusted and accepted, are trained to make health status
assessments, recognize and manage life-threatening conditions outside of the hospital
community paramedicine Correct answer-- taking care into the home of complex patients.
- Employment of licensed paramedics who have received specialized training in addition to general
paramedicine training and work within a designated community pramedicine program under local
medical control.
patient centered medical home (PCMH) Correct answer-- holistic primary care based on ongoing,
stable relationships between patients and their personal physicians.
- Personal physician (PCP) is initial point of contact and provides continuous and comprehensive care.
5 key attributes of PCMH Correct answer-- person centered
- comprehensive
- accessible
- coordinated
- committed to quality and safety
patient centeredness Correct answer-- health care that establishes a partnership among
practitioners, patients, and their families to ensure that decisions respect the patients' wants, needs,
and preferences and that patients have the education and support they need to make decisions and
participate in their own care
VERIFIED ANSWERS (UPDATED TO PASS)
What is "primary care" and its key components? Correct answer-- Primary care: care provided by
clinicians trained and skilled in first contact and continuing care for people with undiagnosed signs,
symptoms, or concernts. Not limited by problem origin, organ system, or diagnosis
- Performed by clinicians collaborating with other health professionals, providing advocact in the
health care system to accomplish cost-effective care
- Promotes effective communication
- Patient as partner
True or false: No matter how you slice the data, higher quality of care is more expensive care.
Correct answer-False
In 2010, prescription drugs were responsible for the greatest share of healthcare spending in the US.
Correct answer-- False, it was hospital, physicians, then prescription drugs.
True or False: In the US, strong clinical care is the #1 driver of the wellbeing of individuals and
communities. Correct answer-True
What are the three main components of the IHI "triple aim"? Correct answer-- Population Health
- Experience of Care
- Per Capita Cost
What fourth component does Cornell Health incorporate to produce a "quadruple aim"? Correct
answer-Readiness
Population Health Management Correct answer-- accountability and management of the health of
an entire community, regardless of system membership or insurance status.
- Combines interventions that focus on patients with specific chronic conditions (disease
management) or very high cost irrespective of the cause (case management) with wellness
components aimed at using health risk assessments to identify and improve unhealthy behaviors
key attributes of PHM Correct answer-o approaches developed to foster health and quality of care
improvements while managing costs
o Addresses the preventive and chronic care needs of every patient
o organized systems of care
o coordinated care teams
o focus on upstream social determinants of health
o holistic patient centered primary care by interdisciplinary care teams
o analysis of data to identify and target high-risk/high cost patients for chronic care management
o accountability
care coordination pyramid Correct answer-- organizes patients into strata of who needs more
attention
5/50 rule Correct answer-small percent of people in any given population who account for 50% of
the cost
,why is 5/50 rule so important to triple aim? Correct answer-- this is important because as health
care costs rise, providers are trying to find these patients and get to the root of their problem in
order to decrease cost, increase quality of care, and increase health of population overall
What is a healthcare "super utilizer?" Correct answer-- high need, high cost patients who require
complex care management
- complex physical, behavioral, and social needs are not well met through the current fragmented
health care system
- often bounce from ED to ED, inpatient admission to readmission, etc. which is costly and ineffective
How did the Camden Coalition develop their strategy for improving outcomes and reducing costs
among super utilizers Correct answer-- A doctor mapped out crime rates in relation to health
outcomes in the city and found that the most expensive patients were concentrated in the same
area.
-By focusing on this specific population that had the highest costs, they were able to focus on getting
community health workers.
camden coalition Correct answer-- the strategic use of data to reallocate resources to a small
subset of high-needs, high-cost patients.
- Actively identifying sick patients and responding proactively in real time to improve health and
reduce costs.
chronic care management (CCM) Correct answer-- Primary-care integrated complex care
management
- specially trained, multidisciplinary teams that coordinate closely with primary care teams to meet
the needs of medically complex patients.
how does CCM target high-need/high-cost patients to improve their health, wellbeing, functional
status, and costs? Correct answer-- They use predictive modelling (acute events, ED visits,
hospitalizations, etc.) to identify patients at highest risk for poor outcomes and who would benefit
from CCM.
- They try to address more than medical issues by increasing patients capacity to self-manage
condition; eliminate unnecessary clinical testing, and reduce need for acute care services
What role does trust play in CCM? Correct answer-- It helps to address social factors and isolation
by visiting patients at a time of need, having culturally and linguistically concordant and
approachable stave, and motivational interviewing to encourage patient activation and self
management.
warm hand off Correct answer-- handing off patient from one provider to another without
consistently having the patient start over
Why take an incremental approach in CCM? Correct answer-o It helps to build trust.
o It also helps to find tangible ways to help improve patients' lives
o Build social connections
o Help steer patients toward long term health goals
incremental approach in CCM Correct answer-- starting small and engaging with patients to
explore what the patient is willing to change/do to decrease risk.
, What are community health workers? Correct answer-- Trusted community members trained to
serve as liaisons between health/social services and community to facilitate access and improve
quality/cultural competence of service deliver.
what roles do community health workers play in CCM and why does the research tend to show they
are effective at improving the health of medically complex patients? Correct answer-- They build
individual and community capacity by increasing health knowledge and self-sufficiency through
range of activities such as outreach, community education, informal counseling, social support, and
advocacy
patient navigators Correct answer-- trained, culturally sensitive health care workers who provide
support and guidance throughout the care continuum.
- Help people "navigate" through the maze of doctors, offices, clinics, hospitals, outpatient center,
insurance and payment systems
How can Camden Coalition's Housing First program improve the care/costs/outcomes of high cost
high needs homeless patients? Correct answer-- Identifies frequently-hospitalized and housing-
unstable individuals and gives them affordable permanent affordable housing vouchers.
Camden Coalition's Housing First Correct answer-- widely-used evidence based housing model that
ends homelessness for individuals facing long-term housing challenges
how can community paramedicine improve the care/costs/outcomes of high cost high needs
patients? Correct answer-- Community paramedics operate under expanded scope to provide
comprehensive, person-centered services in the patient's home (rather than just "stabilize and
transport")
- These individuals are always available, are trusted and accepted, are trained to make health status
assessments, recognize and manage life-threatening conditions outside of the hospital
community paramedicine Correct answer-- taking care into the home of complex patients.
- Employment of licensed paramedics who have received specialized training in addition to general
paramedicine training and work within a designated community pramedicine program under local
medical control.
patient centered medical home (PCMH) Correct answer-- holistic primary care based on ongoing,
stable relationships between patients and their personal physicians.
- Personal physician (PCP) is initial point of contact and provides continuous and comprehensive care.
5 key attributes of PCMH Correct answer-- person centered
- comprehensive
- accessible
- coordinated
- committed to quality and safety
patient centeredness Correct answer-- health care that establishes a partnership among
practitioners, patients, and their families to ensure that decisions respect the patients' wants, needs,
and preferences and that patients have the education and support they need to make decisions and
participate in their own care
