CCM Operational Excellence & Efficiency 2

Question 1

A care management organization is experiencing high rates of care plan non-adherence. Which operational strategy most directly addresses this issue?

Accepted Answer

Implement motivational interviewing training for care managers

Answer

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?

Accepted Answer

30-day hospital readmission rate

Answer

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:

Accepted Answer

Map the current referral workflow to identify bottlenecks

Answer

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?

Accepted Answer

A systematic process for identifying and stratifying high-risk members

Answer

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?

Accepted Answer

Value stream mapping

Answer

Value stream mapping visually identifies all steps in a workflow, distinguishing value-added from non-value-added (waste) activities to streamline the process.

(CCM) Certified Care Management Professional Practice Test

(CCM) Certified Care Management Professional Practice Test

CCM Operational Excellence & Efficiency 2