CCM Operational Excellence & Efficiency 2 — Questions and Answers
Question 1: A care management organization is experiencing high rates of care plan non-adherence. Which operational strategy most directly addresses this issue?
- Increase the frequency of administrative audits
- Implement motivational interviewing training for care managers (Correct answer)
- Expand the number of care managers on staff
- Reduce the complexity of documentation requirements
Correct answer: Implement motivational interviewing training for care managers
Motivational interviewing is an evidence-based communication technique that helps care managers address patient ambivalence and improve adherence to care plans.
Question 2: Which key performance indicator (KPI) best measures the operational efficiency of a care transitions program?
- Number of care managers hired per quarter
- 30-day hospital readmission rate (Correct answer)
- Average length of initial assessment
- Total number of care plans created monthly
Correct answer: 30-day hospital readmission rate
The 30-day readmission rate is the primary outcome metric for care transitions programs, reflecting how effectively patients are supported after discharge.
Question 3: A care management team notices that referral-to-enrollment time averages 14 days. To improve operational efficiency, the FIRST step should be:
- Hire additional intake staff immediately
- Map the current referral workflow to identify bottlenecks (Correct answer)
- Implement an automated referral tracking system
- Reduce eligibility criteria to accept more referrals
Correct answer: Map the current referral workflow to identify bottlenecks
Process mapping the current workflow is the essential first step to identify where delays occur before implementing any solution.
Question 4: Under NCQA Case Management Accreditation, organizations must demonstrate which operational capability?
- Real-time electronic health record integration with all payers
- A systematic process for identifying and stratifying high-risk members (Correct answer)
- Guaranteed 24/7 telephonic access for all enrolled members
- Monthly case conferences with hospital medical staff
Correct answer: A systematic process for identifying and stratifying high-risk members
NCQA accreditation requires a standardized, documented process for identifying members who need case management and stratifying them by risk level.
Question 5: Which lean management tool is MOST appropriate for eliminating redundant steps in a care management documentation workflow?
- Root cause analysis (RCA)
- Value stream mapping (Correct answer)
- Statistical process control (SPC)
- Failure mode and effects analysis (FMEA)
Correct answer: Value stream mapping
Value stream mapping visually identifies all steps in a workflow, distinguishing value-added from non-value-added (waste) activities to streamline the process.
Question 6: A care management program serving a Medicare Advantage population should prioritize outreach to members who:
- Have not contacted the health plan in over 12 months
- Have two or more chronic conditions with recent acute utilization (Correct answer)
- Are newly enrolled in the Medicare Advantage plan
- Have expressed dissatisfaction on member satisfaction surveys
Correct answer: Have two or more chronic conditions with recent acute utilization
Members with multiple chronic conditions and recent acute care utilization represent the highest-risk, highest-cost population most likely to benefit from care management intervention.
Question 7: When evaluating a care management program's return on investment (ROI), which calculation approach is considered the gold standard?
- Comparing program costs to the number of members enrolled
- Using a matched control group to compare utilization between managed and unmanaged members (Correct answer)
- Tracking the number of care plans completed versus initiated
- Measuring member satisfaction scores before and after enrollment
Correct answer: Using a matched control group to compare utilization between managed and unmanaged members
Using a matched control group isolates the program's impact on utilization by comparing similar populations, providing the most valid ROI estimate.
CCM Operational Excellence & Efficiency 2
A care management organization is experiencing high rates of care plan non-adherence.
Which operational strategy most directly addresses this issue?