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D391 Healthcare Ecosystems Exam
with A+ Answers.
What is the first step regarding shared decision-making in healthcare? - <<<<<>>>>>>The first step is to identify the problem to be discussed.
What is the significance of moving from the Triple Aim to the Quadruple Aim? - <<<<<>>>>>>improving the work life of clinicians and staff.The four aims of the Quadruple Aim framework help to increase productivity.
What is the purpose of the Quadruple Aim framework? - <<<<<>>>>>>To improve efficiency. The main goal of the Quadruple Aim framework is to improve efficiency by reducing costs and improving population health, patient experience, and healthcare team well- being.
What does the health information exchange (HIE) allow? -
<<<<<>>>>>>HIE contributed to the faster delivery of services to clients in the community.
Which medical facilities were created under the Protecting Access to Medicare Act of 2014 to expand mental health and addiction treatment services for populations negatively affected by deinstitutionalization? - <<<<<>>>>>>Certified Community Behavioral Health Clinics. Certified Community Behavioral Health Clinics were created in response to the opioid crisis, allowing states to apply for federal grants and set up partnerships with other healthcare providers and local law enforcement.
How can the Quadruple Aim framework improve client outcomes? -
<<<<<>>>>>>The Quadruple Aim framework focuses on providing a good experience for the client and good quality of service.
Quantitative is? - <<<<<>>>>>>Creating records and reports are quantitative methods.
How does telemedicine improve the delivery of care to clients? -
<<<<<>>>>>>Clients can access medical services from anywhere in the world
How does telemedicine improve efficiency? - <<<<<>>>>>>Telemedicine provides less expensive and faster services.
healthcare ecosystem: - <<<<<>>>>>>a system composed of elements that create a community
healthcare system: - <<<<<>>>>>>an organization of individuals, institutions, and resources that deliver services to clients
What are the fundamental components of a healthcare system? - <<<<<>>>>>>Organization, funding, and delivery.When integrated and streamlined, these components can help produce quality health outcomes at a reasonable cost.
A client has health problems related to being overweight. This client has received nutritional counseling but is on a fixed income and shops at a food pantry with limited food selection.Which type of disparity is this client experiencing? - <<<<<>>>>>>Access to social needs.Financial
Which healthcare specialist serves as a client's main point of contact throughout a stay in an inpatient facility? - <<<<<>>>>>>Hospitalists stay in close contact with clients throughout their stay in addition to performing medical procedures, designing treatment plans, and coordinating with the client's entire medical team.
A newly retired 45-year-old union worker has a history of diabetes, and their health insurance fully covers the cost of their medication but not their medical appointments. - <<<<<>>>>>>Apply for group health insurance
correct.This individual is eligible for gap coverage if they can afford it.
Which type of insurance covers more than half of the U.S. population under 65 years old? - <<<<<>>>>>>Employer-sponsored insurance plans cover more Americans under 65 than any other type of coverage.
Which federal healthcare insurance will be a better fit for a 30-year-old client who is currently receiving dialysis for permanent kidney failure? - <<<<<>>>>>>Medicare is available for people aged 65 or older, younger people with disabilities, and people with end-stage renal disease.
A 69-year-old retired machinist who is widowed has one child that lives out of state. The retiree has a history of congestive heart failure and is currently unable to care for themselves. Their physician's office helped enroll them in a long-term service and support program through Medicaid. While the original assessment qualified the retiree to receive support from a home health aide for 30 hours per week, a six-month reassessment reduced the support qualification to 15 hours per week. According to the physician, the retiree's declining health necessitates 30 hours of support from a home health aide per week; however, Medicaid denied the appeal.Which agency can the retiree make a complaint to? - <<<<<>>>>>>State
Department of Health.This agency monitors and responds to complaints presented by individuals that need assistance in ensuring they can receive necessary assistance that is needed based on their situation.
Which organization accredits health insurance companies? - <<<<<>>>>>>National Commission on Quality and Assurance,This commission is a nonprofit accreditation agency for payer groups.
A small rural community is facing a public health crisis during a particularly virulent flu season. A Health and Human Services (HHS) professional is assigned to work directly with the community to reinforce the importance of preventative care and to ensure the members of the community have the resources and knowledge they need to prevent the spread of flu.
Which HHS role is appropriate to serve this need? - <<<<<>>>>>>Public health educators
work directly with the public to spread awareness of preventative health measures.
Which component of the U.S. healthcare ecosystem is classified as a provider? - <<<<<>>>>>>An urgent care facility
is a place that offers healthcare services, so it is classified as a provider in the healthcare ecosystem.
A single mother of two young children who relies on public assistance is having difficulty seeing due to an outdated eyeglass lens prescription. However, she has no vision coverage and can't afford to pay out of pocket for an optometrist appointment and new lenses and frames.Where should this client go to get an eye exam and new glasses? - <<<<<>>>>>>A free medical clinic (FMC)
Which medical field contains the largest percentage of U.S. physicians by specialty as of 2019? - <<<<<>>>>>>General practice/Family medicine
As of 2019, general practice physicians represent 16% of all physicians in the U.S., more than any other medical field.
What is one of the five main funding models of the U.S. healthcare system? -
<<<<<>>>>>>The national health insurance model is one of the five main funding models of the U.S. healthcare system.
What is The equity model - <<<<<>>>>>>The equity model is a component of the ACA, not a payer model.
Which model is a social health insurance model? -
<<<<<>>>>>>The Bismarck Model reimburses for social needs in the plan of care.
Three defining features of the Beveridge model. - <<<<<>>>>>>(1) Universal, single-payer insurance - no enrollment necessary, all financed through taxes. (2) Public health care provision - government runs hospitals and clinics + decides all supply. (3) Free care - care is provided for free at government hospitals.
Which ins model is a hybrid and of what? - <<<<<>>>>>>The National Health Insurance model is a hybrid of the Beveridge and Bismarck models in which the government is the single-payer for healthcare (Beveridge) and the providers are private (Bismarck)
What is The Beveridge Model? - <<<<<>>>>>>Is a single- payer national health service that is provided and financed by the
government s everyone has access. Taxpayer money provided by health staff who are considered government employees
What is The Bismarck Model - <<<<<>>>>>>Social insurance model.
healthcare is jointly funded by 'sickness funds" employers and employees through payroll taxes deducted directly from employee paychecks
Government regulates closely, and must include all citizens.
Functions like ins, but not -for -profit.
Relies on an insurance system known as sickness funds
Providers are mostly private!
Which is an example of fraud by a provider? - <<<<<>>>>>>Kickbacks.Providers are not allowed to take funds from vendors for referrals.
Which health plan is regulated under the Employee Retirement Income Security Act (ERISA)? - <<<<<>>>>>>Self-insured.Self-insured plans are governed by state regulations under ERISA.
Identify insurance regulations and reimbursement procedures for affordable
quality care. - <<<<<>>>>>>look it up
Identify fundamental federal- and state-level government insurance regulations and reimbursement procedures to ensure compliance. - <<<<<>>>>>>look it up
What is the role of the Food and Drug Administration in healthcare? -
<<<<<>>>>>>The FDA keeps the public safe from injury by approving medications and products.
Children Health Insurance Program (CHIP) - <<<<<>>>>>>insurance for families with children that do not qualify for Medicaid
Under the Patient Protection and Affordable Care Act, what was the major change to Medicaid? - <<<<<>>>>>>The expansion of Medicaid coverage.
There was an increase in coverage for Americans with the ACA.
Which government program allows clients to qualify for dual-eligibility to pay for additional services beyond those covered by the program? -
<<<<<>>>>>>Medicare.
Medicaid can be used as supplemental coverage for qualified Medicare clients, covering costs that Medicare does not.
Cost sharing - <<<<<>>>>>>is the cost your health plan covers out-of-pocket.These payments include deductibles, coinsurance, and copayments.
What is an example of an employer group plan? - <<<<<>>>>>>The three group plans are HMO, PPO, and self- insured.
Which term describes group insurance? - <<<<<>>>>>>Employer insurance
Group plans are employer benefits.
Which organizations are part of the healthcare ecosystem? - <<<<<>>>>>>Laboratories
A client needs medical services from different specialists. Who should be in charge of organizing the services provided to the patient? -
<<<<<>>>>>>A care coordinator
A client has been unable to stop taking opioid medication months after being discharged from their medical treatment. Which facility should the client visit? - <<<<<>>>>>>A specialist clinic
Which type of insurance will cover a 40-year-old client who is an uninsured,
disabled non-veteran? - <<<<<>>>>>>Medicare
Which is a goal of the Affordable Care Act? - <<<<<>>>>>>Make affordable health insurance available to more people
Which organizations are responsible for providing health education campaigns and activities to prevent diseases in the community? - <<<<<>>>>>>State health departments
What is the purpose of the American Medical Association (AMA)? - <<<<<>>>>>>To promote public health and science
A high-income 20-year-old client with pre-existing conditions is looking for a new healthcare plan. Which healthcare plan will fit the needs of the client? - <<<<<>>>>>>A high-risk plan (HRP)
Which Medicare part pays for prescriptions? -
<<<<<>>>>>>Medicare Part D is the prescription plan.
Why is antitrust law important to health insurance? - <<<<<>>>>>>Regulates economic power.The antitrust law is to control costs among competitors.
What did the Affordable Care Act of 2010 provide to individuals? -
<<<<<>>>>>>The Triple Aim
What are the components of the PDSA cycle? - <<<<<>>>>>>Plan, do, study, and act.
The PDSA model is used when carrying out a change in healthcare. Each part of the cycle allows stakeholders to provide feedback on what is working in the change process and what is not. The process helps to ensure change goals or stop the change if it is not working. The PDSA also reduces costs.
What are the six dimensions of quality in healthcare supporting efficiency and quality? - <<<<<>>>>>>Safe, timely, effective, efficient, equitable, and patient-centered (STEEEP) are the six domains that guide performance improvement projects in healthcare.
Lean - <<<<<>>>>>>The lean process uses resources effectively and reduces waste in performance improvement projects.
In the Agency for Healthcare Research and Quality SHARE Approach, which strategy is best - <<<<<>>>>>>Ask open-ended questions.Correct:
Open-ended questions provide the opportunity to gain the most information from the discussion.
Miss Smith is a 60-year-old woman with a newly diagnosed lung mass. She meets with the healthcare team to see the next steps in the diagnosis process.
Which is a part of the shared decision-making process? Choose two answers.
- <<<<<>>>>>>he team explores all options available to Miss Smith.
The team assesses the patient's values and preference of treatment options.A shared discussion includes all the treatments available to Miss Smith to bring her to the optimal health possible.
In a shared decision-making process, the team assesses patients' needs and values.
Which approach helps test a change that is implemented? - <<<<<>>>>>>Plan-Do-Study-Act (PDSA)
How many alternatives must be considered before choosing the best approach when using the Define, Establish, Consider, Identify, Develop, Evaluate (DECIDE) approach? - <<<<<>>>>>>As many as possible
To address the issue of long wait times causing clients to forgo vaccination, Health and Human Services (HHS) workers in the vaccine clinic have increased staff to improve processing time and made improvements to the waiting area such as adding comfortable seating and reading material. In the two weeks since the change has been implemented, they have been collecting feedback from clients and gathering data on average wait times.Which stage of the DECIDE decision-making process are HHS workers using? - <<<<<>>>>>>Evaluate and monitor the solution
The DECIDE model helps healthcare staff to improve their decision-making skills, which leads to better patient outcomes. Direct questions to determine
