HAC Risk Stratification & Care Management Analytics Flashcards
6 cards from real HAC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 HAC Risk Stratification & Care Management Analytics flashcards as text
What is 'hot spotting' in community health analytics?
Answer: Identifying geographic zones or patient subgroups with disproportionately high healthcare costs and utilization to focus intervention resources
Hot spotting, popularized by Dr. Jeffrey Brenner, uses claims data to identify the small percentage of patients or neighborhoods driving the largest share of costs.
When building a readmission prediction model, which feature is typically the strongest single predictor of 30-day readmission?
Answer: Number of prior hospitalizations in the past 12 months
Prior hospitalization frequency is consistently the strongest predictor of readmission across multiple studies because it reflects underlying disease severity and care gaps.
In the context of accountable care organizations (ACOs), what is the role of attribution in analytics?
Answer: Determining which patients are assigned to a specific provider or ACO for cost and quality accountability
Attribution rules define which patients are 'attributed' to an ACO or provider, establishing the denominator population against which cost and quality metrics are measured.
Which care management analytic stratifies patients into tiers (e.g., Tier 1–3) based on clinical complexity and expected resource needs?
Answer: Risk-tiered population segmentation
Risk-tiered segmentation divides populations into levels (e.g., catastrophic, high, moderate, low) so that care management intensity—from intensive case management to self-care support—can be matched to each tier.
What is the primary limitation of using claims data alone for risk stratification in healthcare analytics?
Answer: Claims data reflect only what was billed, missing undiagnosed conditions, behavioral health nuances, and SDOH factors
Claims capture documented diagnoses and procedures but miss newly developing conditions, underdiagnosed issues, and non-clinical factors that significantly affect risk.
An ACO analytics team wants to measure whether their diabetes care management program improved glycemic control across the attributed population. Which metric BEST evaluates this at the population level?
Answer: Percentage of attributed diabetic patients with HbA1c tested and controlled (< 8%) within the measurement year
HbA1c testing and control rate is the standard HEDIS measure for diabetes population management, directly measuring whether patients' glucose is being monitored and managed to goal.