Industry Trends & Emerging Technologies Flashcards
7 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Industry Trends & Emerging Technologies flashcards as text
Which value-based care model holds provider organizations financially accountable for the total cost and quality of care for a defined population over a set time period?
Answer: Accountable Care Organization (ACO) shared savings
ACO shared savings models hold provider groups accountable for total cost and quality for attributed patient populations, rewarding cost reductions below benchmarks.
A care manager wants to use predictive analytics to identify patients at risk of hospital readmission. Which data source would MOST directly improve model accuracy?
Answer: Social determinants of health (SDOH) data
SDOH data such as housing instability, food insecurity, and transportation barriers are strong predictors of readmission that clinical data alone may miss.
Which emerging technology allows patients to securely share their health records across different provider systems without re-entering data, as mandated by the 21st Century Cures Act?
Answer: FHIR-based application programming interfaces (APIs)
The 21st Century Cures Act mandates FHIR-based APIs to enable patient-directed data sharing and prevent information blocking.
A care management organization is piloting a chatbot to triage member inquiries. The PRIMARY ethical concern the CCM should raise is:
Answer: Potential for the chatbot to provide inaccurate clinical guidance
AI-driven chatbots risk delivering inaccurate or inappropriate clinical guidance, making clinical oversight and clear escalation pathways essential.
Which payment innovation bundles a single prospective payment to cover all services related to a defined clinical episode, such as a hip replacement?
Answer: Episode-of-care or bundled payment
Bundled or episode-of-care payments cover all provider and facility services within a defined clinical episode under a single prospective amount.
Remote patient monitoring (RPM) programs have demonstrated the greatest impact in managing which condition type?
Answer: Chronic conditions such as heart failure and hypertension
RPM has the strongest evidence base for chronic disease management, particularly heart failure and hypertension, where continuous biometric data enables early intervention.
Under CMS's Interoperability and Patient Access final rule, health plans are required to implement which standard to give members access to their claims and clinical data?
Answer: HL7 FHIR Patient Access API
CMS's Interoperability and Patient Access rule requires payers to implement HL7 FHIR-based Patient Access APIs so members can retrieve their own data.