CPE Population Health Management 3 — Questions and Answers
Question 1: A physician executive reviews data showing high 30-day readmission rates for heart failure patients. Which intervention has the STRONGEST evidence for reducing readmissions?
- Requiring patients to call a hotline after discharge
- Structured transitional care programs with follow-up calls and early clinic visits (Correct answer)
- Extending inpatient length of stay by one additional day
- Restricting discharge to only patients with family support
Correct answer: Structured transitional care programs with follow-up calls and early clinic visits
Structured transitional care programs combining post-discharge calls, medication reconciliation, and timely follow-up visits have the strongest evidence base for reducing heart failure readmissions.
Question 2: In population health management, 'hot spotting' refers to:
- Identifying geographic areas or patients with disproportionately high healthcare utilization and costs (Correct answer)
- Monitoring for infectious disease outbreaks in real time
- Flagging physicians with the highest prescribing rates
- Tracking hospital-acquired infections across units
Correct answer: Identifying geographic areas or patients with disproportionately high healthcare utilization and costs
Hot spotting identifies geographic clusters or individual patients with disproportionately high utilization and costs to target intensive interventions where they will have the greatest impact.
Question 3: Which indicator is the BEST measure of health equity within a population health program?
- Overall population mortality rate
- Variation in health outcomes stratified by race, income, and geography (Correct answer)
- Average patient satisfaction scores
- Total program enrollment numbers
Correct answer: Variation in health outcomes stratified by race, income, and geography
Stratifying outcomes by race, income, and geography reveals disparities and allows targeted interventions to reduce inequities within the population.
Question 4: A health system is moving toward a total cost of care model. Which population health strategy MOST directly reduces total costs?
- Increasing specialist visit rates
- Optimizing high-value preventive care and reducing avoidable acute care utilization (Correct answer)
- Expanding the number of inpatient beds
- Prioritizing fee-for-service billing optimization
Correct answer: Optimizing high-value preventive care and reducing avoidable acute care utilization
Optimizing preventive care and reducing avoidable hospitalizations and ED visits directly lowers total cost of care while improving population health outcomes.
Question 5: Which concept describes the idea that health systems should take responsibility for the health of a defined geographic or attributed population?
- Accountable Care (Correct answer)
- Managed Competition
- Selective Contracting
- Capitation Only
Correct answer: Accountable Care
Accountable Care Organizations (ACOs) are built on the principle that health systems are accountable for the quality and cost outcomes of a defined attributed patient population.
Question 6: A physician executive wants to address food insecurity as part of a population health initiative. Which action is MOST appropriate at the health system level?
- Prescribing vitamins to malnourished patients
- Integrating SDOH screening into clinical workflows and connecting patients to community food resources (Correct answer)
- Referring all food-insecure patients to the ED for nutritional support
- Eliminating cafeteria food options to reduce costs
Correct answer: Integrating SDOH screening into clinical workflows and connecting patients to community food resources
Integrating SDOH screening into clinical workflows and establishing referral pathways to community resources addresses food insecurity systematically at scale.
Question 7: Which payment model MOST aligns provider incentives with population health management goals?
- Fee-for-service with no quality metrics
- Global capitation with shared savings and quality performance requirements (Correct answer)
- Per-diem inpatient reimbursement
- Bundled payments for acute episodes only
Correct answer: Global capitation with shared savings and quality performance requirements
Global capitation with shared savings and quality requirements incentivizes providers to manage the total health of a population efficiently rather than maximizing volume.
CPE Population Health Management 3
A physician executive reviews data showing high 30-day readmission rates for heart failure patients.
Which intervention has the STRONGEST evidence for reducing readmissions?