CCM Strategic Planning & Decision Making 2 — Questions and Answers
Question 1: A care manager is evaluating two post-acute placement options for a patient. One facility has lower readmission rates but longer wait times. Which decision-making framework best supports this trade-off analysis?
- Cost-benefit analysis
- SWOT analysis
- Multi-criteria decision analysis (Correct answer)
- Root cause analysis
Correct answer: Multi-criteria decision analysis
Multi-criteria decision analysis allows simultaneous weighting of multiple competing factors such as quality metrics and access timing.
Question 2: In strategic planning for a care management program, a 'gap analysis' is primarily used to:
- Identify differences between current performance and desired goals (Correct answer)
- Assess competitor programs in the same market
- Determine patient satisfaction scores
- Calculate the cost per care management episode
Correct answer: Identify differences between current performance and desired goals
Gap analysis compares current state to desired future state, highlighting areas requiring strategic action.
Question 3: When a care management organization adopts a population health stratification model, the PRIMARY strategic purpose is to:
- Reduce administrative overhead costs
- Allocate care management resources to highest-need patients (Correct answer)
- Standardize documentation across care settings
- Improve payer contract negotiations
Correct answer: Allocate care management resources to highest-need patients
Stratification enables targeted resource allocation so that intensive care management reaches the patients who will benefit most.
Question 4: A care manager notices that readmission rates have risen 12% over two quarters despite a new transition-of-care protocol. The BEST next strategic step is to:
- Discontinue the protocol immediately
- Conduct a variance analysis to identify protocol adherence gaps (Correct answer)
- Increase staffing without further investigation
- Report the findings to regulators
Correct answer: Conduct a variance analysis to identify protocol adherence gaps
Variance analysis investigates whether the protocol is being followed as intended before drawing conclusions about its effectiveness.
Question 5: The PDSA (Plan-Do-Study-Act) cycle is most appropriately applied in care management strategic planning when:
- Conducting annual budget reviews
- Testing small-scale changes before full program implementation (Correct answer)
- Credentialing new care management staff
- Negotiating value-based contracts with payers
Correct answer: Testing small-scale changes before full program implementation
PDSA is a rapid-cycle improvement method designed to pilot changes on a small scale and learn before broader rollout.
Question 6: In evidence-based decision making for care management, the HIGHEST level of evidence for changing a clinical care pathway is derived from:
- Expert consensus opinion
- Single observational studies
- Systematic reviews and meta-analyses (Correct answer)
- Case reports
Correct answer: Systematic reviews and meta-analyses
Systematic reviews and meta-analyses synthesize data from multiple studies, providing the strongest evidence base for practice changes.
Question 7: A care management program is implementing a new chronic disease management strategy. Establishing measurable key performance indicators (KPIs) at the outset is critical because:
- KPIs satisfy accreditation documentation requirements only
- KPIs allow objective evaluation of whether the strategy is achieving intended outcomes (Correct answer)
- KPIs reduce the need for staff training
- KPIs are required by all commercial payers
Correct answer: KPIs allow objective evaluation of whether the strategy is achieving intended outcomes
KPIs provide objective benchmarks that determine program success and guide ongoing strategic adjustments.
CCM Strategic Planning & Decision Making 2
A care manager is evaluating two post-acute placement options for a patient.
One facility has lower readmission rates but longer wait times.
Which decision-making framework best supports this trade-off analysis?