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 the primary goal of risk stratification in population health management?
Answer: To identify and prioritize patients by their likelihood of future adverse health events or high utilization
Risk stratification segments a patient population by predicted risk level so that care management resources can be targeted toward those most likely to benefit.
Which data elements are MOST commonly used in predictive risk scoring models for healthcare analytics?
Answer: Prior utilization patterns, chronic condition burden, and demographic factors
Predictive risk models rely on historical claims, diagnosis codes, prior ED/inpatient visits, and demographics because these variables are strongly associated with future utilization.
A care manager receives a list of 500 high-risk patients. Which intervention strategy aligns BEST with an analytics-driven care management model?
Answer: Triaging patients by acuity and deploying targeted interventions matched to each patient's specific risk drivers
Analytics-driven care management matches intervention intensity and type to each patient's specific risk profile, maximizing impact per resource invested.
The Hierarchical Condition Category (HCC) model is primarily used in healthcare analytics to:
Answer: Predict future healthcare costs for Medicare Advantage enrollees based on diagnosis data
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.
Which metric is most useful for evaluating the effectiveness of a care management program targeting high-risk patients?
Answer: 30-day all-cause readmission rate among enrolled high-risk patients
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.
In care management analytics, what does 'gap in care' identification refer to?
Answer: Detecting patients who are overdue for evidence-based preventive or chronic disease management services
Gaps in care are evidence-based services (e.g., HbA1c testing for diabetics, mammograms) that a patient is due for but has not received, identified by comparing claims to clinical guidelines.