NAHQ Updated CPHQ Exam Questions and Answers by erica

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry12. It is used by more than 90 percent of health plans to measure performance on important dimensions of care and service1. Just as important, it is absolutely crucial for meeting the information needs of health plans1. HEDIS measures are typically obtained through claims data12. Claims data are used because they are readily available, reliable, and can be used to track a health plan’s ability to manage health outcomes2.

References: 12.

When a physician’s readmission rate is significantly higher than their peers, the next step for a quality professional should be to review a sample of recent individual cases of the physician’s readmissions (Option D). This will help identify any patterns or issues that could be contributing to the higher readmission rate12. Reporting the surgeon to the medical board (Option A) is a drastic step that should only be taken if there is evidence of serious misconduct or incompetence. Reviewing the physician’s privileges against the procedures performed (Option B) could be useful, but it would not directly address the issue of the high readmission rate. Comparing the physician’s readmission rate with peer physicians (Option C) has already been done, as stated in the question. Therefore, the most appropriate next step is to review individual cases to gain a deeper understanding of the reasons for the high readmission rate345.

The first step in building a new population health program is to analyze the data infrastructure capabilities and sources of information. Effective population health management requires robust data collection, integration, and analysis capabilities to identify and stratify patient populations, track health outcomes, and monitor program effectiveness. Understanding the current data infrastructure will enable the director to assess whether the existing systems can support the new program and what enhancements may be needed.

Implement artificial intelligence programs to stratify patients into categories of risk (A): While important, this is a later step that depends on having a solid data infrastructure in place.

Identify strategies to incorporate social determinants of health screenings (B): This is also crucial but should follow an understanding of the data infrastructure and capabilities.

Design a complex care management program focused on chronic health conditions (C): Designing the program is important but must be informed by a thorough analysis of the data capabilities.

References

NAHQ Body of Knowledge: Data Management in Population Health Programs

NAHQ CPHQ Exam Preparation Materials: Steps to Building a Population Health Program

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