CCM Industry Trends & Emerging Technologies 2

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?

Accepted Answer

Accountable Care Organization (ACO) shared savings

Answer

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?

Accepted Answer

Social determinants of health (SDOH) data

Answer

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?

Accepted Answer

FHIR-based application programming interfaces (APIs)

Answer

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:

Accepted Answer

Potential for the chatbot to provide inaccurate clinical guidance

Answer

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?

Accepted Answer

Episode-of-care or bundled payment

Answer

Bundled or episode-of-care payments cover all provider and facility services within a defined clinical episode under a single prospective amount.

(CCM) Certified Care Management Professional Practice Test

(CCM) Certified Care Management Professional Practice Test

CCM Industry Trends & Emerging Technologies 2