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HLTH 4980 Final Exam questions with 100% Correct Answers | Latest Version (2024/2025) Expert Verified
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  • HLTH 4980
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  • HLTH 4980

HLTH 4980 Final Exam questions with 100% Correct Answers | Latest Version (2024/2025) Expert Verified

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  • October 15, 2024
  • 56
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • hlth 4980 final exam
  • what are the two landmark pieces of health legisla
  • what is the cmmi and how has it influe
  • what are the two voluntary tracks in the new quali

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  • HLTH 4980
  • HLTH 4980

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HLTH 4980 Final Exam questions with
100% Correct Answers | Latest Version
(2024/2025) Expert Verified

**Whatiareitheitwoilandmarkipiecesiofihealthilegislationiresponsibleifor
itheimostisignificantipaymentireformsiseeniinirecentidecades?i-

iCorrectiAnswer-

1.iTheiPatientiProtectioniandiAffordableiCareiActiofi2010i(ACA)
2.iMedicare
AccessiandiCHIPiReauthorizationiActiofi2015i(MACRA)


**WhatiisitheiCMMIiandihowihasiitiinfluenceipaymentipatterns?i-
iCorrectiAnswer-

TheiCenteriforiMedicareiandiMedicaidiInnovationi(CMMI)ihasiunpreced
entedifundingianditheiauthorityitoipilotinewipaymentiandideliveryimod
els,iincludingicoordinationiwithitheiprivateisector


WhatiareitheitwoivoluntaryitracksiinitheinewiQualityiPaymentiProgrami
underiMACRAi?i-iCorrectiAnswer-1.iunderitheiMerit-
basediIncentiveiPaymentiSystemi(MIPS),iphysicianigroupsiareiscored
inifouridomains:iquality,icostiefficiency,itechnologyiadoption,iandiclinic
alipracticeiimprovementiactivitiesialignediwithipopulationihealthicarei
models.

,2.iMACRAidrivesiphysicianiparticipationiinioneiofianiincreasinginumberi
ofiAlternativeiPaymentiModelsi(APMs),iiniparticularithoseithatirequirei
providersitoibearisubstantial
downsideifinancialirisk,iori"advanced"iAPMs.


**WhatiareitheifouridomainsiofiqualityiscorediinitheiMIPS?i-
iCorrectiAnswer-1.iquality


2.icostiefficiency
3.itechnologyiadoption
4.iclinicalipracticeiimprovementiactivities
alignediwithipopulationihealthicareimodels.


WhatiareitheicharacteristicsiandirequirementsiofitheiAPMsiemployediini
theiseconditrackiofiMACRA?i-iCorrectiAnswer-
APMsiareibuiltiuponicoordinatedicareimodelsiiniwhichiincentivesiareilin
keditoibroader
outcomes,iespeciallyitheitotalicostioficareiforipeopleiwithispecificicondit
ionsiorientireipopulations.iAccountabilityiforitheitotalicostioficareirequir
esiprovidersitoishiftitheiriframeiofireferencei180
degrees,ifromioneithatiisicenterediaroundiindividualihealthcareidelivery
iservices,itoioneithatiisilongitudinaliregardlessiofiwhether,iwhere,iandiw

heniservicesiareiprovidediforitheitargetipopulation.


**WhatitypeiofipractitionerimustibeiincludediinianiACO?i-
iCorrectiAnswer-PCP

,WhatideterminesitheiamountiofisavingsishardiwithianiACO?i-
iCorrectiAnswer-

TheiamountiofisavingsisharediwithitheiACOiisioftenideterminedibyitheiq
ualityiscoreiachieved
inimultipleidomains,iincludingiprevention,ichronicidiseaseimanagement
,icareicoordination,iandipatient
experience.


**Whatiisithei"thorniinitheiside"iofiACOimanagersiandiclinicians?iWhy?i-
iCorrectiAnswer-

TheidetailediandicompleximethodsiforipatientiattributionitoiACOsisincei
patientsiveryioftenidoinotiseekicareiexclusivelyiwithiaisingleiprovideriunl
essitheiriinsuranceirequiresiiti(whichiisirare).


Whatiareitheiguidelinesitoioptimizeicorrectiattributioniandidriveimoreie
ffectiveicare?i-iCorrectiAnswer--
provideitheibestipossibleiaccessiandiaiseamlessihigh-
qualityicareiexperienceiso
thatiitiisieasyiforipatientsitoiwantitoistayiwithinitheisystemi(alsoiknownia
sithei"stickiness"istrategy—a
winiunderibothivolumeiandivalue).
-
Ensureithatiallipatientsi(especiallyiMedicareibeneficiaries)iseeitheiriPCPi
atileastionceiper

, calendariyear,ipreferablyiincludingiaipreventiveicareivisit.iThisiisinotionl
yigoodipracticeibutialsoia
fullyicoveredibenefitiwithouticopayi(underiACAirules).
-
Ensureialliphysiciansiareilistediunderitheicorrectispecialtyiinitheipayer'sis
ystems,iespecially
CMSiwhereiphysiciansimayihaveibeeniinitiallyicredentialedibeforeitheyic
ompletedispecialtyitraining.
Thisiissueiisiirrelevantiunderifee-for-
serviceibuticriticaliinipopulationihealth/coordinatedicareimodels.


**Whatiareitheicharacteristicsiofitheicomprehensiveiprimaryicareiprogr
amsi(CPC)?i-iCorrectiAnswer--
buildsiuponitheiprinciplesiofitheipatienticenteredimedicalihome
-providesieducationianditechnicalisupport
-Primaryicareiphysiciansiareicentraliandiworkitoimakeiteam-basedicare
-
allimembersiofiteamihaveidefinedirolesiandifunctionsiinipatienticareiati
microiandimacroilevelsi
-
paidiinifeeiforiserviceibuticanielectitoibeipaidipartiallyiinicaptivatedimont
hlyifeei
-incentivesiforiqualityiandiefficiencyi
-
requireditoiinvestisomeifunsiininewiresourcesitoiimproveicareicoordinat
ion

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