Quality outcome measurement and cost containment strategy concepts for case management practice tested on the CCM certification exam.
30 cards · basic cards · AI-written, checked twice. Edit anything.
- What is the triple aim framework used in healthcare quality improvement?
- Improving population health, improving patient experience of care, and reducing per capita cost of care
- What was added to the triple aim to create the quadruple aim?
- Improving the work life and well-being of healthcare providers
- What does a hospital readmission rate measure?
- The percentage of patients readmitted to a hospital within a defined period, often 30 days, after discharge
- Why is 30-day readmission rate a common case management quality metric?
- High readmission rates often reflect gaps in discharge planning or care transitions that case management aims to reduce
- What is a return on investment (ROI) calculation used for in case management programs?
- To demonstrate the financial value of case management interventions relative to their cost
- What is cost avoidance in case management?
- Savings achieved by preventing an unnecessary or avoidable healthcare expense, such as an emergency visit or readmission
- What is a care gap?
- A discrepancy between recommended care and the care a patient actually received
- What is HEDIS?
- Healthcare Effectiveness Data and Information Set, a widely used set of standardized performance measures for health plans
- What survey is commonly used in the United States to measure hospital patient care experience?
- HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
- What is value-based care?
- A payment and care delivery model that rewards providers for patient health outcomes rather than volume of services
- What is fee-for-service reimbursement?
- A payment model in which providers are paid for each individual service performed
- What is a bundled payment model?
- A single payment covering all services related to a treatment or condition over a defined episode of care
- What is capitation?
- A payment model where a provider or organization receives a fixed amount per patient per period, regardless of services rendered
- What is an accountable care organization (ACO)?
- A group of providers who share responsibility for the cost and quality of care for a defined patient population
- What is the purpose of tracking length of stay (LOS) as a quality and cost metric?
- To identify opportunities to reduce unnecessary hospital days while maintaining quality of care
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