WGU-D046 Intro to Care Coordination Exam with Complete Solutions

A patient arrives at your organization and needs specific care. Recently, your organization signed an agreement with a university health system to allow for telehealth assessment and identification of potential treatment ...

A patient arrives at your organization and needs specific care. Recently, your organization signed an agreement with a university health system to allow for telehealth assessment and identification of potential treatment options. As the coordinator for this patient, what would be the next step to determine if this is a good solution? - ANSWER Contact the leadership team and the telehealth informatics specialist to identify whether everything is in place for this patient to receive care through this association. Telehealth initiatives have associated a lot of organizations with university and other larger health systems to facilitate a collaborative practice for care delivery. A patient is ready to go home, and the family has expressed concern about the patient being on her own during the day. The patient is unable to complete full activities of daily living due to a recent injury. Is there something that the coordination team can recommend for provision of lunch or dinner? - ANSWER Recommend that the family contact the local Meals on Wheels program, so they can ensure the patient has access to food and drink during the day. The patient has some activities for daily living but is not able to complete all activities. Since the concern is around food during the day, the coordinator identified a service that provides free or reduced delivery of hot meals one time a day. Use of this service also provides reassurance for the family that someone has checked on the patient that day. The care team has determined that to reverse behaviors of smoking, a patient and family should seek ongoing support. What recommendations would the care coordinator make? - ANSWER The care coordinator recommends current community outreach programs available and assists the patient and family in deciding which option will meet their needs. The care coordinator should have a list of partners in the community who can assist patients and families, encouraging compliance and promoting health wellness. Provide an example of the clinic-clinician patient relationship. - ANSWER Examples of the clinic-clinician patient relationship include trust between the clinician and patient, shared decision-making, and mechanisms for mutual support of patient self-management. Provide an example of the clinic-clinician-community resource relationship. - ANSWER Examples of the clinic-clinician-community resource relationship include the level of interrelationship along Himmelman's continuum for collaborative processes, formal mechanisms for referrals, and effective mechanisms for feedback from community resource to clinic. Provide an example of the patient-community resource relationship. - ANSWER Examples of the patient-community resource relationship include patients' perception and trust of the community resource, formal mechanisms for referrals, and effective communication between patient and community resource. Using health technology to gather patient-specific data in their electronic health record, how could the care coordination team focus care on an individual patient? - ANSWER Using the data collected provides a collection of problems and diagnosis-related groups (DRGs) that can help the care team determine discharge needs. Review of demographic data can provide information after validation that the information is correct during the assessment phase of contact with the patient and family. The electronic health record is a tool used by the coordination team and others to gather information on what is going on with the patient, by providing information on both the current situation and the medical history. It can also include advance directive information for the future. Where should the documentation of the care plan be recorded? - ANSWER In the care planning module of the electronic health record The electronic health record is where all the care team members have access to the record of the patient, and it is the official health record for that patient. A pregnant client is living in the wilds of Alaska. She is not considered to be high risk and there is no reason for her to stay close to town since a frontier midwife is available to travel to her home every month. What would the care coordinator recommend for the client? - ANSWER Satellite telecommunications device A satellite phone is recommended to ensure that if any questions arise when the midwife is not available, the client can call for help. Which statement describes how a healthcare coordinator improves the quality of care delivered in the community? - ANSWER Serves as a bridge between patients, families, and other health care providers. Care coordinators organize care provided by multiple providers that may not have the ability or means to communicate with each other. Coordinating care improves disease management and patient compliance, offers resources, and removes barriers. A care coordinator collaborates with health care providers to ensure that a patient with a chronic health problem receives appropriate care, avoids hospitalization, and attends follow-up visits as scheduled. For which reason should the healthcare coordinator use health information technology (HIT) to improve a patient's care? - ANSWER It improves communication between clinicians and inpatient and outpatient healthcare settings. HIT improves communication between multiple clinicians and clinical sites by improving access to the patient's medical and medication history, plan of care, referral history, and support services. A care coordinator is scheduled to meet with adolescents and adult patients in a community clinic. Which action could a healthcare coordinator take to demonstrates how care coordination improves in disease management? - ANSWER Meet with the school nurse to review the action plans for students with asthma. Care coordination interventions for patients with chronic diseases effectively link outreach, support services, education and guidance. Meeting with the school nurse to review the action plans for students with asthma ensures compliance with medication use and administration in a location convenient for the patient and care providers. What are the outcome goals of the Ambulatory Integration of Medical and Social (AIMS) model? - ANSWER To obtain patient engagement, identify a best practice care model, manage cases as a team, and identify the potential ongoing needs of the patient and family to maintain optimal health The AIMS model goals are patient engagement, care plan development, case management, and ongoing care as needed. What occurs during the patient engagement and assessment phases of the AIMS model? - ANSWER The patient engagement and assessment phases occur during the initial introduction and detailed interview. This allows for the care coordinator and patient to build a trusting relationship and identify the goals and outcomes for care delivery, identify what part each team member will play in the ongoing care team, and identify any concerns that need to be addressed to improve the potential for meetings the goals of care delivery. The introduction of the care coordinator to the care planning process, review of the aims of the team to facilitate optimal health, and incorporation of whatever considerations need to be addressed are vital to a quality outcome. The client and family should be actively engaged in the process. What is the goal for the case management phase in the AIMS model? - ANSWER The goals are about managing the care plan and ensuring that the goals of the plan are considered and modified as needed, and to offer support to the team, the patient, and the family for the success of the care delivery. The care management phase is to evaluate the goals, modify the plan as needed, and to support the care team, patient, and family as needed to meet the goals of the AIMS model. Under which step are there guidelines for the system navigator? - ANSWER Step 3 Step 3 is where the Systems Navigator has specific guidelines for care planning. Under which step are there care conference guidelines? - ANSWER Step 2 Step 2 is where the client goals and needs are assessed and the care team members are identified. Under which step is the Patient Post Card? - ANSWER Step 1 Step 1 is when the identification and referral information is completed and tracked. Under which step is the Coordinated Care Plan located? - ANSWER Step 2 Step 2 is where the client goals and needs are assessed and the care team members are identified. On which form could a patient sign and acknowledge his or her right to withdraw consent to sharing personal health information? - ANSWER Participant Consent Form The Participant Consent Form is used to received a patient consent to have his/her personal health information shared with HealthLink and providers of HealthLink. On which form would the care coordinator document the pharmacies that a patient uses? - ANSWER Coordinated Care Plan The Coordinated Care Plan provides detailed patient information to create a higher user profile for HealthLink. Which document explains to the patient what the patient will receive after the care plan meeting? - ANSWER Patient Post Card The Patient Post Card provides essential information to the patient regarding what is a Coordinated Care Plan and the type of consent needed for HealthLink. Which form would be used to document criteria that validate the patient as a high user of the health system? - ANSWER Coordinated Care Plan The Coordinated Care Plan provides detailed patient information to create a higher user profile for HealthLink. Which action should a healthcare coordinator complete when establishing a plan of care for the patient? - ANSWER Identify the needs, access to resources, and support services. .The case manager should identify the patient's strengths and barriers. This will assist with managing the appropriate plan of care for the patient. Which action should the healthcare coordinator perform when coordinating a patient's care plan? - ANSWER Facilitates services to provide ongoing supportive care. Case management provides ongoing support and coordination of services to improve the patient's quality of life. Which action will the healthcare coordinator take when coordinating care in a clinical setting? - ANSWER Identifies strengths, barriers, and plans care. The case manager assesses the patient's strengths and barriers, creates a plan of care, identifies and arranges the appropriate support services, and monitors for reevaluation or lack of compliance. What is the term identified in the lesson for gathering information, engaging the patient and family, and building a trusting relationship? - ANSWER Motivational interviewing During the interviewing process, it is vital for the care coordinator to build a trusting relationship with the patient and family for collection of medical history and other pertinent information and to encourage the patient and family to engage in the planning of care coordination as members of the team. What are the five key steps that should take place in communication skills needed for care coordination? - ANSWER Setting the stage, eliciting information, providing information to the patient and family, understanding the patient and family's perspective, and ending the encounter These five steps are a guide to completing a quality interview with the patient and family: setting the stage, eliciting the information, providing information to the patient and family, understanding the patient's perspective, and ending the encounter. During the motivational interviewing session, what are some of the behaviors that demonstrate active listening? - ANSWER Undivided attention, appropriate body language, acknowledgement of patient, nonjudgmental attitude, and respectful responses Demonstrations of active listening are behaviors that convey attention and respect. Here are five that are recommended from the reading: undivided attention, appropriate body language, acknowledgement of patient, nonjudgmental attitude, and respectful responses. Culturally competent care coordination teams tend to demonstrate the following key behaviors or approaches: - ANSWER Collaborative relationship, effective communications, respectful care incorporating culture into care, holistic perspective, individualized care, interprofessional coordination, empowerment, and cultural skills These practices are key descriptors of culturally competent care, including collaborative relationship, effective communications, respectful care incorporating culture into care, holistic perspective, individualized care, interprofessional coordination, empowerment, and cultural skills. What are some of the factors that should be included for a patient's culturally competent care? - ANSWER Age, ethnicity, geographical background, languages spoken, socioeconomic status, health literacy, and other factors Culturally competent care accounts for the dimensions of a patient's background (e.g., age, ethnicity, geographical background, languages spoken, socioeconomic status, health literacy, etc.) in determining the approach to both care and healthcare plan coordination. While working with an older individual, you ask that the family leave the room. After they leave, you notice the patient is anxious and not engaged in the conversation or responding verbally. What are some considerations to evaluate for communicating with this patient? - ANSWER Consider bringing the family back into the room. Cultural sensitivity involves discussing with the patient and family who needs to be present during all discussions. Some cultures use a social system to identify the best treatment for older members of their society. In which way should a healthcare coordinator collaborate with a patient's interdisciplinary team? - ANSWER Share patient responses to care and treatment during the meeting. An interdisciplinary team consists of all healthcare providers involved in the patient's care. It is a joint effort with all team members having the same common goal to meet the patient's needs. All members' assessments, treatments, and outcomes are taken into consideration and discussed during the meeting. A healthcare coordinator is using motivational interviewing to counsel an adolescent with obesity. In which way should they facilitate behavior change? - ANSWER Encourages goals to change lifestyle and eating habits. Motivational interviewing is a communication technique used to help identify therapeutic interventions that strengthening the patient's personal motivation and commitment to newly established treatment goals. A healthcare coordinator is preparing to assess a patient from a non-English speaking culture. In which way will they provide culturally appropriate care to this patient? - ANSWER Honors the patient's choices and beliefs When providing culturally appropriate care, the patient's personal and cultural preferences are identified and taken into consideration. All of the data that were collected at the starting point for Charles's care coordination would have been initiated at what phase in the care coordination process? - ANSWER Issue identification and collection of patient data begin after the completion of the case selection and intake into case management and occur intermittently, as needed, throughout the case. The face-to-face meetings with the IEHP team represent which phase of the care coordination process? - ANSWER This phase puts the case management plan into action, and these meetings with the care team allow members of the team to implement treatment interventions and track the patient's progress. Identification of a plan to manage Charles's mental health issues and keep him from seeking hospitalization are part of which phase of the care coordination process? - ANSWER During the development of the care plan, the care team establishes goals of the intervention and prioritizes the needs of the patient, support system, and family or caregiver, as well as determines the types of services and resources that are available in order to address the established goals or desired outcomes. The "Health Building" aspects of Charles's care represent which phase of the care coordination process? - ANSWER As the patient has progressed through the plan and is making progress on goals, new goals can be determined for monitoring. The "Achieving Goals" outcomes of Charles's care represent which phase of the care coordination process? - ANSWER Once a patient has established new patterns of behavior and has achieved treatment intervention goals, he or she may be eventually exited from the plan (while the care manager would still conduct periodic checks on the patient's ongoing progress). As the care coordinator, a unique client case has you thinking about options for the family of a client with Alzheimer disease. The client is in an early stage and needs to be around others for safety reasons. The family is with the client most of the evening and at night but is not able to cover the daytime hours of 9 am to 5 pm. What is a cost-effective consideration that will meet the needs of the client and family? - ANSWER Look at community services for seniors. The option of a senior center will allow the client to be engaged in activities outside of the family, yet allow the patient to have others close by without the cost of a personal sitter or healthcare worker. Most senior centers have staff available. The center should be made aware of the client's condition so that they can plan for safety concerns. The client has some special needs that should be set up prior to discharge. Your organizations do not offer these types of services. How will you facilitate getting the services established for the client? - ANSWER Contact multiple community organizations that offer the services and seek information on the options and prices related to the services. Consider adding these services to your organization's partnership list for future utilization. No organization can provide every service that may be needed. Partnerships with community organizations that are focused on providing specialized services to clients are vital to the success of both this client and other clients. A special needs child and his family are ready to consider transitioning back to a home setting, but the care needed in the home would be too extensive for the family alone. What would be the best option for this situation? - ANSWER Review the admission assessment and interview to identify whether a home care situation was already in place. If not, work with the family to see if they would like to have you contact the hospital's home health department to arrange this service through the organization. Collaboration with the client and family is vital to success. If they do not already have a service established or want to change services, the coordinator can contact the organization's services to attempt to cover it. Also have other services that are offered within the community available, so the family has multiple options. Which step in evidence-based practice (EBP) determines if a revised protocol is a success? - ANSWER Evaluate. Evaluating determines whether the revised protocol is a success and whether there is a need to modify the revised protocol or intervene again. A healthcare coordinator assesses an adolescent patient in the behavior health clinic. Which action should they take when prioritizing problems and goals that reduce anxiety and encourage compliance? - ANSWER Plan the details for each task. Planning the details for each task reduces misconceptions and fears that may keep the patient from accomplishing the tasks. A healthcare coordinator is reviewing the treatment plans created by multiple providers to manage a patient's chronic illness. Which action should the healthcare coordinator take to ensure healthcare was appropriately delivered between the providers? - ANSWER Review the plans for intervention alignment. A patient with a chronic illness may receive care from multiple providers, often causing confusion and creating barriers. Care coordination prevents fragmentation of care and aligns interventions. What is utilization management? - ANSWER Continuous process improvement to encourage quality improvement in care and utilization of resources Care utilization management (UM) is a continuous quality improvement measure whereby care plan implementation is evaluated against established criteria to verify the effective use of healthcare resources; it serves as a means to profile providers' adherence to clinical guidelines and helps to identify additional patient psychosocial needs that may not be addressed but may affect the appropriate utilization of resources (Tahan & Treiger, 2017). Which type of review can occur if concerns over not following the guidelines are identified? - ANSWER Peer review process A peer review process will evaluate whether the criteria for meeting the guidelines for care delivery have been met or the process needs to move toward formal reprimand. After determining the plan of care for a client, it is discovered that the condition is worse than expected: the case is terminal. How does the care coordinator approach the client and family with this news? - ANSWER Collaborate with the provider/physician to be present when the client and family are told so that you are included in the discussion and can help facilitate the grieving process and determine the new needs of the client and family. The care coordinator is not responsible for delivery of the news of a terminal condition. Inclusion in the release of information to the client and family is important to help with the grieving process and to coordinate the new needs of the client and family. What are the factors data collection that the care coordinator or case manager need to consider? - ANSWER Assessments and other pertinent information that will allow for the creation of interventions to meet the needs of the client and family Gathering all the information from assessments and other pertinent information will allow for the creation of interventions to meet the needs of the client and family. What are the key data sets needed for case management? - ANSWER Data gathering, developmental strategies, patient acuity determinates, and verification of appropriate utilization of resources Factors that influence care management are data gathering, developmental strategies, patient acuity determinates and verification of appropriate utilization of resources. A client arrives from a poor socioeconomic area with a diagnosis of renal failure needing dialysis. There are several components to her care that need to be addressed. What is the most important factor for this patient? - ANSWER Dialysis treatment needs to be set up and mobility to the center established to encourage compliance. Which phase of intervention occurs following identification of potential services? - ANSWER Planning Planning occurs after the identification of the potential services are needed. Creation of the care team and identification of the care coordination plan will begin. A healthcare services professional is coordinating services for a Muslim female patient that who does not want a male caregiver to complete an assessment. Which intervention is appropriate at this stage based on individualization? - ANSWER The male caregiver should leave the room and ask if a female caregiver is available. This is an appropriate response and is part of the individualization phase of intervention. A patient who is Muslim may not be comfortable being examined by a member of the opposite gender. A female caregiver should complete the assessment. A patient with a history of liver cirrhosis has documentation that indicates 6 months of abstinence from alcohol. Which stage of change is the patient demonstrating? - ANSWER Maintenance The patient has abstained from alcohol and has proof that the change has been maintained for 6 months. A client needs services related to a change in health status. The client has been seeing a general practice doctor for hypertension and hypercholesterolemia. After being seen in the emergency department, the client learns that he has diabetes mellitus and will need to start taking medications for this. The client is not working and does not have health insurance, and finding a good resource to manage his conditions is vital to the success of his quality outcomes. What steps would you as the coordinator recommend for this client? - ANSWER Refer the client to a specialist in endocrinology, to the diabetic clinic for education and medication management training, to a nutritionist for consultation, and to the financial team for identification of eligibility for insurance coverage. Collaborate with the client and other identified partners for ongoing care. This is the right choice since, as the coordinator, it is your responsibility to refer the client to a service specialist for endocrinology, the resources of the diabetic clinic for education and ongoing DM management, a nutritionist for diet management, and the financial team for all matters related to finance and insurance coverage options. In a collaborative setting, identification of the right professional is important to ensure successful outcomes for the client. Who would be the right resource for a client needing terminal care with a life expectancy of six months or less? - ANSWER Hospice care Hospice care is the right resource for a client needing terminal care, as they have less than six months' life expectancy. A client is seeking assistance in escaping a domestic situation, and the client and children need a secret place to go. What type of resource is needed for this client? - ANSWER A police notification is needed to ensure that a restraining order is in place and to validate the information, then placement in a halfway house for domestic clients with children will need to be established. Police notification is required to ensure that the safety of the client and family are dealt with legally. Placement in a halfway house for families is needed with limited information available for sharing to other individuals or agencies. Which type of therapy helps a patient understand the thoughts and feelings that influence behavior? - ANSWER Cognitive behavioral Cognitive behavioral therapy helps a patient understand the thoughts and feelings that influence behavior and focuses on challenging and changing unhelpful cognitive distortions and behavior. Which techniques are used for motivational interviewing? - ANSWER Open questions, affirmation, reflective listening, and summary reflections These techniques can be used to provide client-centered counseling and promote behavior change. Which statement shows a correct usage of cognitive reframing? - ANSWER "Your husband is in Heaven now and is no longer in pain." Cognitive reframing is a method of turning negative events into positive ones and is commonly used in therapy. The SBIRT tool has identified that a client meets the criteria for substance abuse. The client expresses interest in recovery. What solution would be the best for this client? - ANSWER An inpatient recovery unit During the initial phases of recovery, it may require inpatient therapy to ensure that the client is closely monitored for potential severe withdrawal symptoms as well as to ensure success of the outcome. During your assessment of a client in the mental health clinic, you have discovered that she has a medical condition that is not currently being treated along with schizophrenia that is currently controlled. What would your next step be to include all aspects of care in the coordination care plan? - ANSWER Establish an appointment with an internist to care for this client. This is the best option as it will allow for sharing of information related to the schizophrenia history to ensure that the provider is aware of the mental condition as well as establish a relationship with one provider, improving coordination communication and quality of care. As the coordinator seeking to ensure that your client receives the best care, how would you handle a situation where there is no mental health specialist within the community and the patient does not have the ability to travel to see the specialist? - ANSWER Explore setting up a telehealth system that will allow the client to come to the clinic to be able to meet with the provider via the internet. This will allow the coordinating team to be available for any questions and to touch base with both the provider and the client to ensure that this care delivery method is working. After a patient has heart surgery, a surgeon changes the patient's medications and asks to have the patient's blood pressure and heart rate monitored weekly. Which strategic partner should take on this task? - ANSWER Home health nurse A home health nurse provides clinical assessment, education, or treatment as ordered by a physician in the patient's home. The physician orders for assessing blood pressure and heart rate are within the scope of practice for a home health nurse. What is the distinguishing characteristic of the brokerage case management model? - ANSWER It links the client with available community resources and contacts. Brokerage is a form of case management that assists clients in identification of their specific needs and available resources or contacts. In the brokerage model, the case manager serves as a link between the client and needed resources. A patient with a smoking history is newly diagnosed with lung disease and is being discharged to home in the care of her spouse. Which action demonstrates support for patient autonomy? - ANSWER Asking the patient about her preferences Autonomy is the ability to make independent decisions. Asking the patient about her preferences brings understanding of her perspective and supports her ability to make decisions. What does the M stand for in the SMART model of goal setting? - ANSWER Measurable Measurable stands for the M in the SMART model. This means that the goal has objective criteria that can be met or demonstrated. The healthcare coordinator of a substance abuse center is responsible for obtaining intake information. What is an effective interview technique? - ANSWER Beginning with less personal questions to establish trust Beginning with less personal questions allows for the patient to interact with the coordinator in a nonthreatening way that helps establish trust. Using this technique can ease concerns of the patient and allow for exploration into more personal questions necessary to treat a patient dealing with substance abuse. Which step in the case management process is defined as executing activities or interventions that lead to the patient accomplishing the goals of the plan? - ANSWER Implementation Implementation is the process of executing activities or interventions that assist the patient in accomplishing mutually established goals. This step involves coordinating care by organizing, securing, integrating, and modifying resources so that the patient can achieve the goals set. Which SBIRT intervention is in use when a care team associate teaches a low-risk patient about moderate drinking limits? - ANSWER Brief intervention Brief intervention is the process of engaging the patient in a conversation where feedback and advice are offered. Teaching about moderate drinking limits would be a brief intervention. What is the first step in determining which safeguards should be put in place to protect electronic medical records? - ANSWER Conduct a risk assessment for the organization The first step is completing a risk assessment for the organization and departments to analyze what objectives are needed to meet the current and future needs of the organization. In an effort to comply with the health information portability accountability act (HIPPA), the implementation of which strategy can help mitigate the risk of EMR data breaches? - ANSWER Assigning different levels of access based upon employee role. The implementation of administrative, physical and technical safeguards will help to mitigate risk. Which action should be taken to ensure patient assessments are documented timely and accurately into the electronic medical record (EMR)? - ANSWER Document the assessment as it is being completed. Documenting in real time is the best way to ensure that the information is correct and allows other members of the healthcare team to view the current status of the patient. What is the best method to gain clients' approval to share information with partner organizations? - ANSWER Written consent Written consent is obtained at the point of initial contact, although a client or family member (medical power of attorney) may rescind this at any time. HIPAA security requires that all information is secure and not shared with anyone outside of the team members assigned to the client. What measures can the coordinator put into place to ensure the right individuals have access? - ANSWER Assign and keep the record updated in the system. Assign and keep the record updated in the system to ensure that the right individuals are assigned to the client. All care team members should be assigned to the client, so they have access. Without these assignments, limited information sharing can prevent the efficiency of the team. What does the term PHI mean? - ANSWER Personal health information Which activities can open the EMR to breaches? - ANSWER Sharing passwords Sharing passwords is one of the easiest methods of breaching the HIPAA protections that organizations put into place to secure data. This can lead to termination from the organization and other legal problems. What are some of the threats that coordinators need to be prepared for in securing client data? - ANSWER Natural, environment and human threats There are three threats that the coordinators need to be aware of and prepared for in the event of problems. These are natural/environmental events, human or technology threats. Consideration of these type of threats can allow for development of disaster preparations in the event something occurs. What are some of the practices that care coordinators can use to protect and secure patient information on portable devices? - ANSWER Securing access to information on the device It is important to follow all the protection requirements of an organization to prevent the breach of information. Securing mobile devices with a password or bio print is a good method of securing them. A continuing education program is being designed that focuses on the Health Insurance Portability and Accountability Act (HIPAA). Which is an example of inappropriate use of personal health information (PHI)? - ANSWER Advertising a service related to a patient's illness. Using a patient's health information to target advertising is an inappropriate use of PHI. A family member calls a medical-surgical care area and asks for the results of a patient's tests. Which action should be taken? - ANSWER Check to see if the patient has set up a password for the medical record. In order to receive patient information over the phone, the family member would need to give the password set up by the patient. If the patient did not set up a password, the information cannot be shared. While riding in the elevator with a colleague, the care coordinator is asked about a specific patient. What should the care coordinator do? - ANSWER Refuse to discuss the patient if the colleague is not involved in the patient's care. Healthcare professionals should not share patient information with colleagues who are not involved in a patient's direct care. What is an ACO as it related to healthcare? - ANSWER Affordable Care Organization What does DRGs stand for in healthcare? - ANSWER Diagnostic Related Groups What is the purpose for utilization management in healthcare? - ANSWER Ensure that proper documentation for conditions are included in the chart to capture the DRGs for payment Ensure that proper documentation for conditions are included in the chart to capture the DRGs for payment. Utilization managment also works on reviewing why claims are refused or denied. A group of physicians, hospitals, and ancillary healthcare providers are collaborating to provide care to patients enrolled in Medicare. Which term best describes this structure of care providers? - ANSWER Accountable Care Organizations (ACOs) ACOs are groups of healthcare providers that voluntarily join to provide coordinated care to patients with a goal to keep patients healthier, reduce medical errors, save time, and save money. The care coordinator is researching the provisions of the Patient Protection and Affordable Care Act (ACA) for a patient. Which should be identified as a practice of this legislation? - ANSWER Prohibits health insurance to be cancelled for a new illness The ACA was created to make health insurance affordable and available to more people. This is one of the protections of the Act. A patient's insurance company is evaluating the appropriateness of required emergency surgery before paying the insurance claim. Which process is the insurance company using for this review? - ANSWER Retrospective review This method of utilization management (UM) involves the review of medical records after treatment is provided. The insurance company will use the results to approve or deny coverage for treatments that usually require pre-authorization, but were done without approval, such as for emergency surgery. What is an advantage of using computerized provider order entry (CPOE)? - ANSWER It reduces the number of prescription errors. Prescription errors are reduced when using CPOE. This is due to the use of mandated fields that prompt the physician to fully complete the prescription and to the order being easier to read. A care coordinator is working with a woman who has an intellectual disability. The woman's son is interested in reading his mother's medical records and asks the care coordinator for help. Which action must be taken to prevent a Health Insurance Portability and Accountability Act (HIPAA) violation? - ANSWER Have the son obtain a medical power of attorney Without the mother having the ability to give consent, the son would be required to obtain a medical power of attorney in order to read the chart. This would meet HIPAA requirements. Which mechanism is a useful tool when formally documenting the benefits of case management efforts? - ANSWER Cost avoidance reporting Cost avoidance reporting correlates with necessary documentation in case management reporting and is important for internal usage. This tool is useful when formally documenting the benefits of case management efforts. A client has been given a lot of information on their disease and the stage that they are at with a specific condition. As the coordinator working with the client and family, how do you explain curative and comfort measures? - ANSWER Curative measures are treatments that work toward reversing conditions whereas comfort measures focus on providing the quality of life that will allow the client to be comfortable as possible throughout life with this condition. Curative measures focus on treatments to improve or cure a condition. Comfort measures focus on providing therapies that support the quality of life that is most comfortable for the client throughout their lifespan. You have a client that has reached the end of their therapy and have now chosen to only do supportive care. They want to be at home for their last days. What efforts by the coordination care team need to be put in place? - ANSWER Organization of the care delivery services that will be needed for the home environment Discovery of the impact of a chronic condition can be overwhelming for the client and family. Discussions related to the quality of care need to be included in these situations. How would you approach introduction of advance directives with the client and family? - ANSWER The approach to advance directives should be made after establishment of a trusting relationship with the client and family. A discussion of what the client wants at the end of their life, where they want it to occur, and whether heroic measures need to be in place. The care coordinator is discussing care options with a patient diagnosed with end-stage renal disease. What should the care coordinator explain about palliative and hospice care? - ANSWER Palliative care can begin immediately. Palliative care can begin once a patient has been diagnosed with a serious illness. It is specialized care that manages the pain, symptoms, and side effects of a serious illness with the goal to increase the quality of life for patients and their families. The care coordinator is discussing treatment options with a patient who has hypertension. Which type of care should the coordinator explain if the patient desires addressing the condition with diet and exercise? - ANSWER Curative Curative measures are interventions provided with the intent of curing the disease or illness. The care coordinator encourages a patient with amyotrophic lateral sclerosis (ALS) to apply for the Medicare hospice benefit. What should the coordinator explain about eligibility for this benefit? - ANSWER Agree to forgo curative treatment A patient with a serious illness has to agree to forgo life-saving, curative treatment in order to be eligible for the Medicare hospice benefit. Medicare will pay for all medically necessary hospital and physician care regardless of cost. What are ethics? - ANSWER Considering all the perspectives and then doing what is right for that situation Ethics is doing the right thing in a given situation. Remaining professional and following the regulations established through best practice to encourage attainment of the right outcome. There are six things to consider when looking at ethical situations to ensure the right decision is made. What are the six factors? - ANSWER Honesty, Courage, Fairness, Respect, Caring and Trust When ethical considerations are being considered, it is important to have these six factors of honesty, courage, fairness, respect, caring and trust. As the coordinator caring for a client that has identified his wishes for end of life decisions. These decisions conflict with the family's wishes. At the family's request, an EEG was completed, and brain death has been diagnosed. The client determined his wish to donate his organs for procurement, but the family refuses this service. Because the client has specifically identified this well before impending incapability for decision making, you feel ethically compelled to grant this wish. What steps should be considered to resolve this issue? - ANSWER Client stays on life-support while a decision is considered. An ethics committee is called, and the family is notified that this decision will determine the outcome of this case. The correct action is to call for an ethics committee review because the client has determined his wished and the family refuses this service. The care coordinator is required to consider the clients wishes first and then support the family. A decision to call the ethics committee allows for an unbiased group that comprise of quality, legal, regulatory, medical, nursing as well as a non-medical person from the community are called to make an informed decision. What is the highest verification of a professional's level of competency in a specific subject matter? - ANSWER Credentials Credentials validate a professional's specialized knowledge and experience. What is the difference between being credentialed as a care coordinator and being certified? - ANSWER The term "credentialed" is being appointed to work in the field of care management. Certification is a process whereby a person must prove that they have completed the necessary pre-requisite education by taking and passing a certification exam. A care coordinator who is "credentialed" has been appointed to work in the field of care management. Certification is a process whereby a person must prove that they have completed the necessary pre-requisite education by taking and passing a certification exam. Which organization outlines content for the Case Management Administrators' Certification (CMAC)? - ANSWER The Center for Case Management (CFCM) The Center for Case Management (CFCM) outlines content for the Case Management Administrators' Certification (CMAC) What is the easiest method to accidentally transmit HIPAA inappropriately? - ANSWER The smart phone Society grows more and more dependent on the use of smart phones to communicate and stay aware of current events. It is important to remember that HPI is something that cannot be transmitted across unsecure devices. Securing the cell phone with a secure texting and securing the camera are to areas where information can be lost. Your organization is considering the use of personal devices to communicate with the physicians about clinical care issues. What is the major concern with using a personal phone for this purpose? - ANSWER Placing an API on the device to secure the information The concern is ensuring that the device is secured for the communication of PHI of the client. This can be done via placement of an application (API) on the phone that protects the transmission to include only individuals that use this application. This allows for tracking of the exchange and a record for the organization if any questions arise. You are reading social media and note that there are pictures of a client that you are caring for online. This information has been posted to an account of a friend, what should you do? - ANSWER Privately contact the individual that posted it and have them remove it and notify the compliance department at the organization. It is important to prevent further breach, if possible. Ethically, a member of the healthcare team is responsible to report any potential HIPPA concerns. What is the role of the care coordinator related to supervision of the members of the team? - ANSWER The care coordinator is responsible for overseeing the care coordination for all members of the healthcare team. The care coordinator is responsible for overseeing the care coordination for all members of the healthcare team, recognize potential improvement that each member makes and provide encouragement to continue efforts to improve. What are two types of reflection that should be part of the healthcare teams analysis? - ANSWER Self-reflection and supervision The team member should always use self-reflection on their decision, recommendations and process improvement to continue the learning and growing in their decision-making processes. Supervision is also an element that needs to be considered since most care team members report to a superior and this is a good way to gain insight into their outlook on your progress. What is constructive criticism? - ANSWER This is criticism that is based on building up a skillset rather than tearing down a person. Constructive criticism is based on providing an analysis of a personal skill set and then presenting them in a non-hurtful manner to assist the individual grow in their position or person. What is a cost-effective method to ensure clinical communication is HIPAA compliant? - ANSWER Encrypt a text message and send by