CCM Industry Trends & Emerging Technologies 2 — Questions and Answers
Question 1: Which value-based care model holds provider organizations financially accountable for the total cost and quality of care for a defined population over a set time period?
- Fee-for-service reimbursement
- Global capitation payment
- Accountable Care Organization (ACO) shared savings (Correct answer)
- Bundled payment arrangement
Correct answer: Accountable Care Organization (ACO) shared savings
ACO shared savings models hold provider groups accountable for total cost and quality for attributed patient populations, rewarding cost reductions below benchmarks.
Question 2: A care manager wants to use predictive analytics to identify patients at risk of hospital readmission. Which data source would MOST directly improve model accuracy?
- Patient satisfaction survey results
- Social determinants of health (SDOH) data (Correct answer)
- Physician credentialing records
- Facility accreditation status
Correct answer: Social determinants of health (SDOH) data
SDOH data such as housing instability, food insecurity, and transportation barriers are strong predictors of readmission that clinical data alone may miss.
Question 3: Which emerging technology allows patients to securely share their health records across different provider systems without re-entering data, as mandated by the 21st Century Cures Act?
- Health Information Exchange via Direct messaging
- FHIR-based application programming interfaces (APIs) (Correct answer)
- HL7 v2 batch file transfers
- Proprietary EHR portal sharing
Correct answer: FHIR-based application programming interfaces (APIs)
The 21st Century Cures Act mandates FHIR-based APIs to enable patient-directed data sharing and prevent information blocking.
Question 4: A care management organization is piloting a chatbot to triage member inquiries. The PRIMARY ethical concern the CCM should raise is:
- Increased staffing costs for chatbot maintenance
- Potential for the chatbot to provide inaccurate clinical guidance (Correct answer)
- Reduction in call center volume metrics
- Slower response time compared to email
Correct answer: Potential for the chatbot to provide inaccurate clinical guidance
AI-driven chatbots risk delivering inaccurate or inappropriate clinical guidance, making clinical oversight and clear escalation pathways essential.
Question 5: Which payment innovation bundles a single prospective payment to cover all services related to a defined clinical episode, such as a hip replacement?
- Per member per month capitation
- Diagnosis-related group (DRG) inpatient payment
- Episode-of-care or bundled payment (Correct answer)
- Pay-for-performance bonus
Correct answer: Episode-of-care or bundled payment
Bundled or episode-of-care payments cover all provider and facility services within a defined clinical episode under a single prospective amount.
Question 6: Remote patient monitoring (RPM) programs have demonstrated the greatest impact in managing which condition type?
- Acute surgical recovery only
- Chronic conditions such as heart failure and hypertension (Correct answer)
- Psychiatric inpatient care
- Pediatric immunization compliance
Correct answer: Chronic conditions such as heart failure and hypertension
RPM has the strongest evidence base for chronic disease management, particularly heart failure and hypertension, where continuous biometric data enables early intervention.
Question 7: Under CMS's Interoperability and Patient Access final rule, health plans are required to implement which standard to give members access to their claims and clinical data?
- NCPDP SCRIPT standard
- HL7 FHIR Patient Access API (Correct answer)
- X12 EDI 837 transaction
- CCD-A document exchange
Correct answer: HL7 FHIR Patient Access API
CMS's Interoperability and Patient Access rule requires payers to implement HL7 FHIR-based Patient Access APIs so members can retrieve their own data.
CCM Industry Trends & Emerging Technologies 2
Which value-based care model holds provider organizations financially accountable for the total cost and quality of care for a defined population over a set time period?