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
In care management operations, a 'warm handoff' refers to:
Answer: A direct introduction between a patient and their new care manager or provider
A warm handoff is a real-time, personal introduction that facilitates relationship transfer between care team members to reduce gaps in care.
A care management director wants to reduce care manager burnout. Which operational change has the strongest evidence for sustainability?
Answer: Implementing defined caseload caps based on acuity-adjusted ratios
Acuity-adjusted caseload caps ensure workload is distributed equitably and sustainably, addressing a primary structural cause of burnout.
Which element is MOST critical to include in a care management program's operational dashboard for weekly team review?
Answer: Caseload size, contact attempt rates, and enrollment conversion rates
Operational dashboards should track activity metrics (caseload, contact attempts) and conversion rates that reflect the program's ability to engage and enroll members.
The Plan-Do-Study-Act (PDSA) cycle is used in care management to:
Answer: Test small-scale changes and evaluate their impact before full implementation
The PDSA cycle is a rapid-cycle improvement methodology that tests changes on a small scale, studies results, and acts on learnings before broader rollout.
A health plan's care management program has an opt-out enrollment model. The primary operational advantage of this approach is:
Answer: It maximizes program enrollment rates, particularly among high-risk members
Opt-out enrollment (where members are automatically enrolled unless they decline) consistently achieves higher participation rates, especially among members who would benefit most.
Which federal regulation most directly governs the operational privacy practices of a care management program that shares member health information with community-based organizations?
Answer: HIPAA Privacy Rule (45 CFR Parts 160 and 164)
The HIPAA Privacy Rule governs all uses and disclosures of protected health information, including sharing with community partners, requiring appropriate authorizations or BAAs.
A care management team is implementing a new electronic care plan template. To ensure adoption and operational efficiency, which approach is BEST?
Answer: Pilot the template with a small team, gather feedback, and refine before full rollout
Piloting with a small group allows identification of workflow problems and user barriers before organization-wide implementation, improving adoption rates.