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Operational Excellence & Efficiency 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 Operational Excellence & Efficiency flashcards as text

  1. A care management organization is experiencing high rates of care plan non-adherence. Which operational strategy most directly addresses this issue?

    Answer: Implement motivational interviewing training for care managers

    Motivational interviewing is an evidence-based communication technique that helps care managers address patient ambivalence and improve adherence to care plans.

  2. Which key performance indicator (KPI) best measures the operational efficiency of a care transitions program?

    Answer: 30-day hospital readmission rate

    The 30-day readmission rate is the primary outcome metric for care transitions programs, reflecting how effectively patients are supported after discharge.

  3. A care management team notices that referral-to-enrollment time averages 14 days. To improve operational efficiency, the FIRST step should be:

    Answer: Map the current referral workflow to identify bottlenecks

    Process mapping the current workflow is the essential first step to identify where delays occur before implementing any solution.

  4. Under NCQA Case Management Accreditation, organizations must demonstrate which operational capability?

    Answer: A systematic process for identifying and stratifying high-risk members

    NCQA accreditation requires a standardized, documented process for identifying members who need case management and stratifying them by risk level.

  5. Which lean management tool is MOST appropriate for eliminating redundant steps in a care management documentation workflow?

    Answer: Value stream mapping

    Value stream mapping visually identifies all steps in a workflow, distinguishing value-added from non-value-added (waste) activities to streamline the process.

  6. A care management program serving a Medicare Advantage population should prioritize outreach to members who:

    Answer: Have two or more chronic conditions with recent acute utilization

    Members with multiple chronic conditions and recent acute care utilization represent the highest-risk, highest-cost population most likely to benefit from care management intervention.

  7. When evaluating a care management program's return on investment (ROI), which calculation approach is considered the gold standard?

    Answer: Using a matched control group to compare utilization between managed and unmanaged members

    Using a matched control group isolates the program's impact on utilization by comparing similar populations, providing the most valid ROI estimate.