CCM Quality Control & Process Improvement 3

Question 1

A care management team wants to reduce avoidable ER visits by streamlining the nurse triage process. Which Lean concept involves eliminating non-value-added steps?

Accepted Answer

Waste reduction (Muda)

Answer

Lean's concept of Muda identifies and eliminates eight types of waste that add no value to the patient or process.

Question 2

Which accreditation body sets quality and performance standards specifically for managed care organizations?

Accepted Answer

NCQA (National Committee for Quality Assurance)

Answer

NCQA accredits health plans and managed care organizations and administers the HEDIS quality measurement set.

Question 3

HEDIS measures are primarily used to:

Accepted Answer

Assess and compare health plan performance on clinical and service quality

Answer

HEDIS (Healthcare Effectiveness Data and Information Set) provides standardized measures to compare health plan quality.

Question 4

A care manager is reviewing a scatter plot showing the relationship between care management contact frequency and hospital admissions. What does a strong negative correlation indicate?

Accepted Answer

More contacts are associated with fewer admissions

Answer

A strong negative correlation means as one variable increases, the other decreases — suggesting more contacts may reduce admissions.

Question 5

Which of the following best describes a 'sentinel event' in healthcare quality management?

Accepted Answer

An unexpected occurrence involving death or serious physical harm

Answer

A sentinel event is an unexpected incident resulting in death or serious harm that signals the need for immediate investigation.

(CCM) Certified Care Management Professional Practice Test

(CCM) Certified Care Management Professional Practice Test

CCM Quality Control & Process Improvement 3