HAC HAC Risk Stratification & Care Management Analytics

Question 1

What is the primary goal of risk stratification in population health management?

Accepted Answer

To identify and prioritize patients by their likelihood of future adverse health events or high utilization

Answer

Risk stratification segments a patient population by predicted risk level so that care management resources can be targeted toward those most likely to benefit.

Question 2

Which data elements are MOST commonly used in predictive risk scoring models for healthcare analytics?

Accepted Answer

Prior utilization patterns, chronic condition burden, and demographic factors

Answer

Predictive risk models rely on historical claims, diagnosis codes, prior ED/inpatient visits, and demographics because these variables are strongly associated with future utilization.

Question 3

A care manager receives a list of 500 high-risk patients. Which intervention strategy aligns BEST with an analytics-driven care management model?

Accepted Answer

Triaging patients by acuity and deploying targeted interventions matched to each patient's specific risk drivers

Answer

Analytics-driven care management matches intervention intensity and type to each patient's specific risk profile, maximizing impact per resource invested.

Question 4

The Hierarchical Condition Category (HCC) model is primarily used in healthcare analytics to:

Accepted Answer

Predict future healthcare costs for Medicare Advantage enrollees based on diagnosis data

Answer

CMS uses HCC risk scores to adjust capitated payments to Medicare Advantage plans based on the expected cost of each enrollee's chronic condition burden.

Question 5

Which metric is most useful for evaluating the effectiveness of a care management program targeting high-risk patients?

Accepted Answer

30-day all-cause readmission rate among enrolled high-risk patients

Answer

The 30-day readmission rate among enrolled high-risk patients directly measures whether the program is preventing the acute events it is designed to avoid.

(HAC) Healthcare Analytics Certification Practice Test

(HAC) Healthcare Analytics Certification Practice Test

HAC HAC Risk Stratification & Care Management Analytics