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HLTH 4980 Final Exam Questions And Answers
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HLTH 4980 Final Exam Questions AndAnswers
**What are the two landmark pieces of health legislation responsible
for the most significant payment reforms seen in recent decades? -
correct answer ✅1. The Patient Protection and Affordable Care Act of
2010 (ACA)
2. Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA)
**What is the CMMI and how has it influence payment patterns? -
correct answer ✅The Center for Medicare and Medicaid Innovation
(CMMI) has unprecedented funding and the authority to pilot new
payment and delivery models, including coordination with the private
sector
What are the two voluntary tracks in the new Quality Payment Program
under MACRA ? - correct answer ✅1. under the Merit-based Incentive
Payment System (MIPS), physician groups are scored
in four domains: quality, cost efficiency, technology adoption, and
clinical practice improvement activities aligned with population health
care models.
2. MACRA drives physician participation in one of an increasing number
of Alternative Payment Models (APMs), in particular those that require
providers to bear substantial
downside financial risk, or "advanced" APMs.
,HLTH 4980 Final Exam Questions And
Answers
**What are the four domains of quality scored in the MIPS? - correct
answer ✅1. quality
2. cost efficiency
3. technology adoption
4. clinical practice improvement activities
aligned with population health care models.
What are the characteristics and requirements of the APMs employed
in the second track of MACRA? - correct answer ✅APMs are built upon
coordinated care models in which incentives are linked to broader
outcomes, especially the total cost of care for people with specific
conditions or entire populations. Accountability for the total cost of care
requires providers to shift their frame of reference 180
degrees, from one that is centered around individual healthcare
delivery services, to one that is longitudinal regardless of whether,
where, and when services are provided for the target population.
**What type of practitioner must be included in an ACO? - correct
answer ✅PCP
What determines the amount of savings shard with an ACO? - correct
answer ✅The amount of savings shared with the ACO is often
determined by the quality score achieved
,HLTH 4980 Final Exam Questions And
Answers
in multiple domains, including prevention, chronic disease
management, care coordination, and patient
experience.
**What is the "thorn in the side" of ACO managers and clinicians?
Why? - correct answer ✅The detailed and complex methods for
patient attribution to ACOs since patients very often do not seek care
exclusively with a single provider unless their insurance requires it
(which is rare).
What are the guidelines to optimize correct attribution and drive more
effective care? - correct answer ✅-provide the best possible access and
a seamless high-quality care experience so
that it is easy for patients to want to stay within the system (also known
as the "stickiness" strategy—a
win under both volume and value).
-Ensure that all patients (especially Medicare beneficiaries) see their
PCP at least once per
calendar year, preferably including a preventive care visit. This is not
only good practice but also a
fully covered benefit without copay (under ACA rules).
-Ensure all physicians are listed under the correct specialty in the
payer's systems, especially
, HLTH 4980 Final Exam Questions And
Answers
CMS where physicians may have been initially credentialed before they
completed specialty training.
This issue is irrelevant under fee-for-service but critical in population
health/coordinated care models.
**What are the characteristics of the comprehensive primary care
programs (CPC)? - correct answer ✅-builds upon the principles of the
patient centered medical home
-provides education and technical support
-Primary care physicians are central and work to make team-based care
-all members of team have defined roles and functions in patient care at
micro and macro levels
-paid in fee for service but can elect to be paid partially in captivated
monthly fee
-incentives for quality and efficiency
-required to invest some funs in new resources to improve care
coordination
**What is the purpose of a care model? - correct answer ✅-Use of
evidence-based guidelines and data to manage, track, and improve
outcomes of
specific conditions
-Appropriate access to care
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