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
A care manager is reviewing a patient's wearable device data showing elevated resting heart rate trends over two weeks. The BEST immediate action is to:
Answer: Alert the treating clinician for clinical interpretation and possible follow-up
Wearable-generated data that may indicate clinical deterioration should be escalated to the treating clinician for interpretation rather than acted on unilaterally by the care manager.
Precision medicine in care management primarily refers to:
Answer: Tailoring prevention and treatment strategies based on genetic, environmental, and lifestyle factors
Precision medicine individualizes care by integrating genomic, clinical, environmental, and lifestyle data to target interventions to specific patient subgroups.
Which of the following BEST describes the role of a 'care navigator' in a complex care model?
Answer: A trained individual who helps patients overcome barriers and coordinate across the care system
Care navigators help patients understand their diagnoses, coordinate appointments, connect to community resources, and overcome social and systemic barriers to care.
Under the No Surprises Act, which protects patients from unexpected out-of-network medical bills, care managers should be aware that the law primarily applies to:
Answer: Emergency services and non-emergency services at in-network facilities where patients receive surprise bills from out-of-network providers
The No Surprises Act limits out-of-network cost-sharing for emergency care and for scheduled services at in-network facilities involving out-of-network providers without patient consent.
Artificial intelligence applications in prior authorization processes are primarily intended to:
Answer: Automate routine approvals and flag complex cases for human review, reducing administrative burden
AI-assisted prior authorization automates approvals for routine requests against established criteria, freeing reviewers to focus on complex or borderline cases.
Which concept describes healthcare organizations that provide services across the full continuum of care—from prevention through post-acute—under aligned financial incentives?
Answer: Integrated delivery network (IDN) or integrated health system
Integrated delivery networks combine hospitals, physician groups, and post-acute providers under shared governance and financial structures to coordinate full-spectrum care.
A CCM is advising on the implementation of a closed-loop referral system. The PRIMARY benefit of this technology is:
Answer: Tracking whether patients actually complete specialist referrals and notifying referring providers of outcomes
Closed-loop referral systems notify referring providers when patients schedule, attend, or miss specialist appointments, enabling timely follow-up and preventing care gaps.