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HLTH 4980 Final Exam Questions and Answers: Healthcare Legislation and Payment Reform, Exams of Advanced Education

A comprehensive set of questions and answers related to healthcare legislation and payment reform, focusing on key topics such as the affordable care act (aca), medicare access and chip reauthorization act (macra), and accountable care organizations (acos). It delves into the structure and implementation of these legislative frameworks, exploring their impact on payment patterns, quality initiatives, and care coordination models. Particularly useful for students studying healthcare policy, administration, or related fields.

Typology: Exams

2024/2025

Available from 01/07/2025

professoraxel
professoraxel 🇺🇸

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Download HLTH 4980 Final Exam Questions and Answers: Healthcare Legislation and Payment Reform and more Exams Advanced Education in PDF only on Docsity!

HLTH 4980 Final Exam questions with

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**Whatiareitheitwoilandmarkipiecesiofihealthilegislationiresponsibleifor itheimostisignificantipaymentireformsiseeniinirecentidecades?i- iCorrectiAnswer- 1.iTheiPatientiProtectioniandiAffordableiCareiActiofi 2010 i(ACA) 2.iMedicare AccessiandiCHIPiReauthorizationiActiofi 2015 i(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 esiprovidersitoishiftitheiriframeiofireferencei 180 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

**Whatiisitheipurposeiofiaicareimodel?i-iCorrectiAnswer-- Useiofievidence- basediguidelinesiandidataitoimanage,itrack,iandiimproveioutcomesiof specificiconditions

  • Appropriateiaccessitoicare
  • Patientinavigation/coordination/ieducation
  • Collaborationiandicommunicationiwithiprimaryicareiasiaivirtualiteam **Whatiisiinvolvediinicareimodelitransformation?i-iCorrectiAnswer- Careimodelitransformationiaddressesipeople,iprocess,ianditechnology:

Multidisciplinaryicareiteams,ibothiinsideiandibeyondiofitheitraditionalif ouriwallsiofitheihospital andioffice

Engagementiofipatientsiandicaregiversiasicoreimembersiofitheicareitea m,ithroughiself-management skillsieducation,iindividualizedigoalsioficare,iandifeedbackionihowitoiim proveitheicareiexperience

Technologyibeyondijustiuseiofiaidigitalihealthirecord,isuchiasiintegration iofireal-timeidata

exchangei(whetheriacrossitheihallioriacrossitheination),iandiadvancedire moteipatientimonitoring devicesiandiapps

Advancedianalyticsithatisupportiriskistratificationiofipopulations,ipredic tiveimodelsiidentifying patientsiiniwhomianiinterventionitodayiisilikelyitoipreventiaibadioutcom eitomorrow,iandiperformance monitoring/feedbackitoolsiforiproviders

Innovationsiinicareideliveryichannels/venues,isuchiasitelemedicineiandi retail-basediclinics Oniwhatiisichangeicontingent?i-iCorrectiAnswer- budget,idesire,icommitment,iandiorganizationaliculture **Whatiisitheifirstistepiinicareicoordination?i-iCorrectiAnswer- Establishiaicareiteamiwithiclearirolesiandiresponsibilitiesitoisupportibusi nessiandiclinical operations **Whatiisitheiroleiofitheiofficeisupervisor?i-iCorrectiAnswer-- overseeipatientiflow

  • triageipatients
  • facilitateiaccess
  • superviseimedicaliassistantsi(MAs).i Theisupervisoriorganizesitheidailyihuddle,iwhichiisidesigneditoikeepitea mimembersiinformediandianticipatingitheiday'siwork. **Whatiisitheipurposeiofithei"dailyihuddle"?i-iCorrectiAnswer- Toikeepiteamimembersiinformediandianticipatingitheiday'siwork **WhatiisitheiroleiofitheiMAiinitheicareiteam?i-iCorrectiAnswer-- supportipatientiflowibyiroomingipatients
  • ofteniconsidereditheirightihandiofithe physician
  • takeivitalisigns
  • administeriinjections
  • collectiinformation,isuchiasiconfirming reasoniforivisit,imedicationichanges,iandiinformationioutlinedionipatien tihealthiquestionnaires WhatiisiaibasiciregulatoryirequirementiofiChroniciCareiManagementi(CC M)?i-iCorrectiAnswer-Aicareiplan,icreatediwithitheipatientiandisignedioff byitheiphysician,ifollowedibyi 20 iminutesiofi(documented)icoachingiiniai 30 - dayiperiod,iresultingiiniaibillableiencounter

**Whatiisidescribediasithei"lynchpiniofisuccess"iforiaivalue- basedicareimodel?i-iCorrectiAnswer-Careicoordination WhatiisitheiWHOidefinitioniofiSDOH?i-iCorrectiAnswer- Theiconditionsiiniwhichipeopleiareiborn,igrow,ilive,iwork,iandiageithatiaf fectiaiwideirangeiof health,ifunctioning,iandiquality-of-lifeioutcomesiandirisks. **Whatiisitheiadvantageiofiassigningiaicareicoordinatoritoitheisickestian dimostiat-riskipatients?i-iCorrectiAnswer-Helpsito manageitotalicostioficareibyiensuringicareiisideliverediinitheileastirestric tiveimedicalisettingi(ideallyitheiPCPioffice),itherebyiavoidingiexpensivei eventsisuchiasiavoidableiEDivisitsiandihospitalizations. **WhatiareitheitwoiPCMHiphilosophiesidescribediasitheikeyitoitrueiprac ticeiredesign?i-iCorrectiAnswer-Careicoordinationianditransitions **Whatiisitheiimportanceioficontinuityiinicareimanagement?i- iCorrectiAnswer- Continuityiensuresireferralsiareimanagediandithatiinformationifromireq uiredispecialistsiis obtainediandiavailableiforitheicareiteamitoireview. **WhatiisitheiroleiofiSkillediNursingiFacilitiesi(SNF)iinicareicoordination ?i-iCorrectiAnswer-

Manyiprovidersifeelithatitheseifacilitiesiprovideiongoingicareiforipatient siwhoihaveirehabilitationiorimedicalimanagementineedsithaticannotibei performediatihome.iTheitruthiisithatiwhile sometimesimedicallyinecessary,itheseitypesiofifacilitiesihaveibecomeian iepicenteriforipatientsiand familiesiwithicomplexicareineeds,isuchiasiend-of-lifeimanagement. **Whatiareitheinewlyidefinediservicesithatiformitheifoundationioficoor dinatedicare?i-iCorrectiAnswer- 1.iTheiAnnualiWellnessiVisiti(AWV),iaihighlyistructuredipreventiveicareiv isitithatiaddresses commonigeriatricirisksisuchiasifalls,idepression,ihearingiloss,iandiimpair edicognition.iTheibulkiofithe AWVicanibeiaccomplishedibyiainon-physicianimemberiofitheicareiteam. 2.iAdvanceiCareiPlanningi(ACP),iaidetailedidiscussioniandidocumentatio niofitheipatient's goalsioficarei(particularlyiatitheiendiofilife),ieitheriasiaistandaloneiservic eioriattacheditoianotherivisit. 3.iTransitionsiofiCareiManagementi(TCM),iaisingleipaymentifori 30 idaysio fimonitoring followingidischargeifromiaihospital,iSNF,ioriobservationistay.iThisiinitiat iveirequiresioutreachitoithe patientiwithinitwoibusinessidaysiofidischargeiandithenianiin- personivisitiwithi 7 iori 14 idaysidepending onicomplexity.iMedicationireconciliationiisiairequiredicomponentiofithe ivisit.iWhileianiEvaluation

andiManagementi(E/M)icodeicanibeibilledifollowingitheivisit,itheiTCMic odeicannotibeibillediuntil post- dischargeidayi 31 iaftericonfirmingithatitheipatientiwasinotireadmittediwi thinithei 30 - dayiepisode. 4.iChroniciCareiManagementi(CCM),iaimonthlyipaymentiforiongoingitel ephonicimonitoring andicareicoordinationiofipatientsiwithispecificichroniciconditions,iagaini primarilyiaiserviceithaticanibe providedibyiaicareiteamimemberiotherithaniaiphysician.iPracticesiiniCPC +iareinotialloweditoibillifor thisiservice,isinceiitiisianialternativeitoitheimonthlyicareicoordinationife eiinithatiprogram. 5.iTelehealthicodes,inewiini2019,idesigneditoicompensateiforibriefitelep honicicheck-insiwith patientsioriconsultationsibetweeniproviders. PayingiforiPerformanceiiniPopulationiHealth:iLessonsifromiHealthiCarei Settings:iWhyiisiitidifficultitoiapplyipay-for- performanceiapproachesitoipopulationihealth?i-iCorrectiAnswer-Pay- for- performanceihasifocusedioninarrowiclinicaliproblemsiwhoseisuccesside pendsioniidentifiableiactorsiwithitheimotivationiandiresourcesitoichang eiclinicaliprocessesiorioutcomes.iInicontrast,ipopulationihealthihasibroa digoals,imanyiantecedents,iandinoisingle,iidentifiableifiduciary.

**PayingiforiPerformanceiiniPopulationiHealth:iLessonsifromiHealthiCar eiSettings:iPay-for- performanceisystemsiareibasedionitheiassumptionithatifinancialiincenti vesiwillihelpitoiachieveihealthicareirelatedigoals.iWhatiareitheifouricondi tionsirequirediforithisitoibeitrue?i-iCorrectiAnswer- First,ithereimustibeisomeistakeholderiwillingitoipayiforiperformance. Second,ithereimustibeisomeiagentiwithitheiabilityitoiachieveithatiperfor manceiwhoican,iif successful,ibeipaid. Third,ithereimustibeisomeimeasuresiofithatiperformanceioniwhichitoiju dgeisuccessiandibase payment. Fourth,iinitheiendithereimustibeisomeievidenceithatitheiapproachiachie vesiitsioveralligoalsioriatileastithatitheisystemionitheiwholeiproducesimo reigoodithaniharm. PayingiforiPerformanceiiniPopulationiHealth:iLessonsifromiHealthiCarei Settings:iWhatiareitheithreeicategoriesiofiperformanceimeasuresithatica nibeiusediinievaluatingihealthicare?i-iCorrectiAnswer- Structure,iprocess,iandioutcomes

**PayingiforiPerformanceiiniPopulationiHealth:iLessonsifromiHealthiCar eiSettings:iWhatiareitheiconcernsiwhenitryingitoiapplyipay-for- performanceiapproachesitoipopulationihealth?i-iCorrectiAnswer--pay- for- performanceiwillilikelyirewardiprogramsioriareasithatihaveibetteriresou rces,ipenalizeithoseithatidoinot,ianditherebyiwidenidisparitiesiinicare

  • someiperformanceimeasuresifocusionitheiwrongithings
  • justibecauseisomethingiisimeasurableidoesinotimeaniitiisiimportant **Atiwhatilevelidoesimostiofitheipolicyimakingiaffectingipopulationiheal thioccur?i-iCorrectiAnswer-federalilevel **Whatiareitheipoliticaliconsiderationsibroughtiupiinicraftingipolicy?i- iCorrectiAnswer-Doesitheipolicyioptionihaveibipartisanisupport? Whoiareitheisupportersiandiwhoiareitheiopponentsiofitheipolicyioption? Doesitheipolicyioptioniconcernianiissueithatiaffectsitheientireipopulatio niorijustiaisubset? Whoiwillibenefitifromiandiwhoiwillibeiadverselyiimpactedibyitheipolicyio ption? Doesitheipolicyioptioniaddressianiissueiatitheination'siforefront? Doesitheipolicyioptioniaddressiaicontroversialiissue? Areithereidata,ioutcomes,ioricostiimplicationsithatisupportitheipolicy?

**WhatiareiPAYGOibudgetilawsiandihowidoitheyiaffectitheifinancingiofi policyichanges?i-iCorrectiAnswer- Payiasiyouigo,i"PAYGO"ibudgetilawsiiniCongressirequireithatiincreasesii nifederaliprogram spendingioritaxicutsimustibeioffsetibyicutsitoifederaliprogramispendingio ritaxiincreases elsewhere.iTherefore,iunderiPAYGO,iaimemberiofiCongressichampionin giailegislativeiproposalithatiisiestimateditoiincreaseifederalispendingiorir educeitaxirevenuesiisifacediwithitheitaskiofiproposingihowitoioffsetithes eicosts. **Whatiareitheiquestionsiraisediinitheiimplementationiofiaipolicyioptio n?i-iCorrectiAnswer- Doesitheipolicyioptionirequireitheienactmentiofiailawioritheipromulgati oniofiairegulation? Doesitheipolicyioptionirequireitheicreationiofiainewigovernmentiprogra mioritheicreationiofia newigovernmentiagency,ioricaniitiinsteadibeiimplementediwithiniexisti ngiprogramsiandiagencies? Doesitheipolicyioptionientailiaimarkedichangeifromicurrentipolicyipriorit iesiandirequire significanticultureichange? Doesitheipolicyioptionihaveisupportifromithoseiwhoiwilliexecuteitheipol icy,iincludingistate, local,ioriotherirelevantistakeholderigroups?

Whoiisitheimajoristakeholderiinihealthcareipolicyimaking?i- iCorrectiAnswer-Theifederaligovernment **Howidoifederaligovernmentipurchasingiandihealthcareideliveryipolici esiinfluenceiotherinon- federalihealthiinsuranceipurchasersiandiproviders?i-iCorrectiAnswer- Asitheilargestiemployeriandipurchaseriofihealthcareiservices,itheifedera ligovernmentifinancesiandiprovidesicoverageitoinearlyi 130 imillionigover nmentiemployees;itheipoor,idisabled,iandielderly; activeidutyiandiformerimilitaryipersonnelianditheiridependents;iandiNa tiveiAmericansiandiotheripopulations. Whatibranchesiofigovernmentiareiinvolvediinipolicymakingiatitheifeder alilevel?i-iCorrectiAnswer-Legislativeiandiexecutiveibranches WhaticommitteesiinitheiHouseiofiRepresentativesihaveitheimostiinfluen ceionihealthipolicy?i-iCorrectiAnswer-- TheiCommitteeioniWaysiandiMeansi(W&MiCommittee)ihasijurisdictioni overithe provisioniofipaymentsiforihealthicare,ihealthideliveryisystems,iorihealthi research.iThisiincludes healthcareiprogramsiunderitheiSocialiSecurityiAct,iincludingiMedicaidia ndiMedicare,ianditaxicreditianditaxideductioniprovisionsirelateditoihealt hiinsuranceipremiumsiandihealthcareicosts.

TheiCommitteeioniEnergyiandiCommercei(E&CiCommittee)ihasijurisdicti onioverihealth

programsiunderitheiPubliciHealthiServiceiActiasiwelliasitheiSocialiSecurit yiAct,iwhichiincludeipublic health,imentalihealth,iandihealthiinformationitechnology.iTheicommitt eeialsoiaddressesimattersirelated toiMedicareiandiMedicaid,itheiChildren'siHealthiInsuranceiProgrami(CHI P),imedicaliresearch,iandifoodiandidrugisafety.

TheiCommitteeioniEducationiandiLaborihasiprimaryijurisdictionioverima ttersirelatingito laboriandiworkforceiissues,iincludingiemployer- sponsoredihealthibenefits. WhaticommitteesiinitheiSenateihaveitheimostiinfluenceionihealthipolicy ?i-iCorrectiAnswer-- TheiCommitteeioniFinancei(FinanceiCommittee)ihasijurisdictionioverihe althiprograms underitheiSocialiSecurityiAct,iincludingiMedicare,iMedicaid,iCHIP,iandiot herihealthiandihuman servicesiprogramsifinancedibyiaispecificitaxioritrustifund.

TheiHealth,iEducation,iLaboriandiPensionsiCommitteei(HELPiCommittee )ihas jurisdictionioverihealthiprogramsiunderitheiPubliciHealthiServiceiActian ditheiOlderiAmericansiAct. Theicommitteeiconsidersilegislationioniissuesisuchiasipublicihealth,ibio medicaliresearchiand

development,ifoodiandidrugisafety,iaccessitoihealthicare,iemployer- sponsoredihealthibenefits,iaging, andiindividualsiwithidisabilities. **WhatiisiMACPACiandiwhatidoesiitido?i-iCorrectiAnswer- TheiMedicaidiandiCHIPiPaymentiandiAccessiCommission,iisiainonpartisa nilegislative branchiagencyiauthorizedibyitheiACA.iMACPACiconductsipolicyiandidata ianalysisiandidisseminates itsifindingsiandirecommendationsiinireportsithatiareireleasediiniMarchia ndiJuneiofieachiyear. **WhatiisitheiCBOiandihowidoesiitiinfluenceipolicyimaking?i- iCorrectiAnswer- TheiCongressionaliBudgetiOffice,iTheiCBOiisitheinonpartisani"scorekeep er"iforiCongressionalilegislationiandiprovidesibudgetiandieconomiciinfo rmation,iespeciallyiasiitirelatesito legislation.iAsipartiofithisirole,iCBOiprovidesilegislatorsiwithidata,iestim ates,ianalyses,iand implicationsiofilegislativeiproposals. DescribeiandidiscussihowitheivariousidivisionsiwithiniHHSiinfluenceiheal thipolicyimaking.i-iCorrectiAnswer- TheseidivisionsiincludeitheiCentersiforiDiseaseiControliandiPreventioni( CDC),itheiOfficeiof

theiAssistantiSecretaryiforiPlanningiandiEvaluation,itheiSubstanceiAbus eiandiMentaliHealthiServices Administration,ianditheiHealthiResourcesi&iServicesiAdministration.iTh eseidivisionsiworkionikeyipopulationihealthiissuesiincludingiZika,iHIV/AI DS,iinfluenza,ichildhoodiobesity,imaternalimortality, ruralihealthiissues,iandisubstanceiabuse,iincludingiongoingieffortsitoico mbatitheiopioidiepidemic. **WhatiisitheiroleiofiONC?i-iCorrectiAnswer- ONCileadsitheiexecutiveibranchihealthiinformationitechnologyi(HIT)- relatedieffortsitoiimplementinationwideiHITiadoption,iuse,iandiinterop erability.iONCiisitheiprimaryifederaliagencyiresponsibleiforienhancingiHI Tiinfrastructure,isupportingiHITiadoption,iandipromotingihealth informationiexchange.iONC'simissioniisitoiimproveitheihealthiandiwell- beingiofiindividualsiandicommunitiesithroughitechnologyiandiensuringi healthiinformationiisiaccessible. **Whatiisi"meaningfuliuse"iandiwhatiwereitheiobjectivesiofitheiMeanin gfuliUseiprogram?i-iCorrectiAnswer- TheiMeaningfuliUseiprogramiutilizedicertifiediEHRitechnologyi(CEHRT)it oiimproveipopulationihealthimanagementiandioutcomes.iSpecifically,it heiMeaningfuliUseiprogramihaditheifollowingiobjectives:

  • Improveiquality,isafety,iandiefficiency,iandireduceihealthidisparities
  • Engageipatientsiandifamilyimembers
  • Improveicareicoordination,ipopulationihealth,iandipublicihealth
  • Maintainiprivacyiandisecurityiofipatientihealthiinformation **Whatiisi"informationiblocking"?i-iCorrectiAnswer- Informationiblockingioccursiwhenipersonsiorientitiesiknowinglyioriunre asonablyiinterfere withitheiexchangeioriuseiofielectronicihealthiinformationiexchange. **Whatiareitheithreeicriteriairequireditoiestablishithatiinformationibloc kingihasioccurred?i-iCorrectiAnswer- 1.iInterference:iSomeiactioricourseioficonductithatiinterferesiwithitheiab ilityiofiauthorized personsiorientitiesitoiaccess,iexchange,ioriuseielectronicihealthiinformat ion. 2.iKnowledge:iAispecificidecisionitoiengageiiniinformationiblockingikno wingithatithisiisilikely toiinterfereiwithitheiexchangeioriuseiofielectronicihealthiinformation. 3.iNoireasonableijustification:iInformationiblockingishouldibeireservedif oriconductithatiisiobjectivelyiunreasonableitoipublicipolicyigoalsi(action sitoicomplyiwithifederalioristateiprivacyirequirementsiwouldinotibeiunre asonable). Whatiisitheioriginalibasisiforidemonstrationiprojects?i-iCorrectiAnswer- Sectioni 1115 iauthorizeditheisecretaryiofiwhatiisinowiHHSitoiauthorizeie xperimental,ipilot,ior demonstrationiprojectsithatiareilikelyitoiassistiinipromotingitheiobjectiv esiofitheiprogramsicoveredibyitheiSocialiSecurityiAct.

HowididitheipassageiofitheiACAiaffectitheidevelopmentiofidemonstratio nimodels?i-iCorrectiAnswer- TheipassageiofitheiACAiini 2010 iresultediiniaimajoripolicyishiftiasitheiACAi providedinewilegaliauthorityitoiCMS. **AccordingitoiTablei 13 - 1,iwhatiareitheicategoriesiofitheiCMMI'sidemonstrationimodels?i- iCorrectiAnswer- iAccountableicare iEpisode-basedipaymentiinitiatives iPrimaryicareitransformation iInitiativesifocusedionitheiMedicaidiandichipipopulation iInitiativesifocusedioniMedicare-Medicaidienrollees iInitiativesitoiaccelerateitheidevelopmentianditestingiofinewipaymenti andiserviceideliveryimodels iInitiativesitoispeeditheiadoptioniofibestipractices **Whatiisiadvocacy?i-iCorrectiAnswer- Inigeneral,iadvocacyiisianyiactionitoisupportiaicertainicause. **Whatiisilobbyingiandihowidoesiitidifferifromiadvocacy?i- iCorrectiAnswer- Advocacyiinitheipolicymakingiprocessiofteniisiaccomplishedithroughilob bying,iwhich

generallyiisidefinediasiattemptingitoiinfluenceipolicymakingiinitheilegisl ativeioriexecutiveibranchesiofigovernment.iEssentially,iallilobbyingiisiad vocacy,ibutinotialliadvocacyiisilobbying. **Compareiandicontrastigrassrootsilobbyingiwithigrasstopsilobbying.i- iCorrectiAnswer-- Grassrootsilobbyingirefersitoiencouragingimembersiofitheipublicitoireac hioutitoipolicymakersiinitheilegislativeioriexecutiveibranchesitoiinfluenc eipolicy.i

Grasstopsilobbyingirefersitoiencouragingiainarroweriscopeiofiindividual s,iusuallyileadersi(e.g.,ithoughtileaders,icommunityileaders,iorganizatio nileaders)itoireachioutitoipolicymakersiinitheilegislativeioriexecutiveibra nchesitoiinfluenceipolicy. **Whatifactorsidetermineitheilobbyingimethodsiselected?i- iCorrectiAnswer-1)iadvocate'sipreferences 2)iresourcesiavailable 3)ilikelihoodiofisuccessiofitheilobbyingimethod. Underiwhatiamendmentiisilobbyingiaiprotectediactivity?i- iCorrectiAnswer-Firstiamendment Whatiareicoalitionsiandihowidoitheyiinfluenceilobbying?i- iCorrectiAnswer-

Coalitions,iwhichiconsistiofiindividualsiandiorganizationsiwithidifferenti missionsioripriorities, butitemporarilyijoiningitogether,iofteniengageiinilobbyingieffortsiasiwel liforiaisharedipublicipolicy option. WhatiisiNashvilleHealthiandihowiwasiitiestablished?i-iCorrectiAnswer- Firstiestablisheditheinot-for- profitiorganizationiNashvilleHealth,iwithiaimissionitoisubstantiallyiimpr oveitheihealthiandiwell- beingiofiNashvilleiresidents.iThoroughlyisteepediinirelevantiexperiencei andirelationships. WhatiareitheinineicriteriaiusedibyiNashvilleHealthitoinarrowitheirangeio fihealthiprioritiesitheyiwouldiaddress?i-iCorrectiAnswer- IsithisiairealiandipressingihealthiissueiforiNashville? Isithereipartner/sponsoriinterestiinithisiarea? Areithereisuccessfuliprogramsithaticanibeimodeleditoiaddressithisiissue ? Areimeasurable,iachievableimetricsiforimonitoringiandievaluatingiprogr essiapplicable? IsithereireliableidataiaboutithisiissueiiniNashville? Doesiitiaddressihealthiequity? Isiitinovel? Isithereiaifeasibleipossibilityiofishowingisuccessiiniaitimelyimanner?

Isiitiscalable? WhatiwereitheithreeiinitialipriorityiareasiidentifiedibyiNashvilleHealth?i

  • iCorrectiAnswer-TobaccoiCessation,iHypertension,iandiChildiHealth **MeasuringitheiImpactiofiPubliciHealthiPolicy:iPublicihealthiinterventi onsioftenioccuriatimultipleilevels.iWhatiareithey?i-iCorrectiAnswer- upstream,imidstream,iandidownstream **MeasuringitheiImpactiofiPubliciHealthiPolicy:iAccordingitoiKingdon,iw hatiareitheithreeipolicyi"streams"ithatimusticomeitogetheritoimakeipoli cyichanges?i-iCorrectiAnswer- 1.idefinitioniofitheiproblemi(eg,iaihighicancerirate) 2.idevelopmentiofipotentialipoliciesitoisolveithatiproblemi(eg,iidentifica tioniofipolicyimeasures toiachieveianieffectiveicancericontrolistrategy) 3.itheiroleiofipoliticsiandipubliciopinion (eg,iinterestigroupsisupportingioriopposingitheipolicy) **MeasuringitheiImpactiofiPubliciHealthiPolicy:iAccordingitoiKingdon'sit heory,iwhatiisitheikeyiobjectiveiofipublicihealthipractitionersiandiresear chers?i-iCorrectiAnswer-toiidentifyimetricsifor assessingiburden,isettingipriorities,iandimeasuringiprogress

MeasuringitheiImpactiofiPubliciHealthiPolicy:iWhatiareitheithreeidomai nsiofievidence-basedipolicy?i-iCorrectiAnswer- Process,icontent,ioutcome **MeasuringitheiImpactiofiPubliciHealthiPolicy:iAccordingitoithisireadin g,ipolicyimakersiofteniaskithreeiquestionsiwhenidecidingiwhetheritoitak eiactionioriprioritizeiresources.iWhatiareitheithreeiquestions?i- iCorrectiAnswer-1)iIsithereiaiproblem?i 2)iDoiweiknowihowitoifixitheiproblem? 3)iHowimuchiwilliiticost? **MeasuringitheiImpactiofiPubliciHealthiPolicy:iForiwhichiofitheithreeiq uestionsidoiweitypicallyihaveitheileastidata?i-iCorrectiAnswer- Howimuchiwilliiticost? **MakingiBetteriUsesiofitheiPoliciesiandiFundingiWeiAlreadyiHave:iWha tiareitheiopportunitiesitoipromoteipopulationihealthiindependentiofima jorichangesiiniresourcesioripubliciauthority?i-iCorrectiAnswer- enforcingilawsialreadyiinieffect

  • clarifyingiandiupdatingitheiapplicationiofilong-standingipolicies

leveragingigovernment'sianditheiprivateisector'sipurchasingiandiinvest menticlout

  • facilitatingiaccessitoiprogramsibyieveryoneiwhoiisieligibleiforithem

evaluatingitheieffectivenessiofipopulationihealthiprograms,iagencies,ia ndipolicies

  • interveningitoistopiagenciesiandipoliciesifromioperatingiaticross- purposes **MakingiBetteriUsesiofitheiPoliciesiandiFundingiWeiAlreadyiHave:iWha tiareitheithreeiwaysitoicalculateioridefinei"communityibenefit"?i- iCorrectiAnswer- 1.iAitraditionaliregulatoryiviewiequatesicommunityibenefitinarrowlyiwi thi"charityicare"i(freeior discountediepisodicicare,iusuallyiinihospitaliemergencyidepartments)ifo rilowiincomeipatientsiwho cannotipayisomeiorialliofitheicost.i 2.iAimainstreamiperspectiveiiniprovideriorganizationsicountsicharityicar eiplusiresearch,ihealthiprofessionals'ieducation,iandilossesioniunderirei mbursedipublic programsisuchiasiMedicaid.i 3.iAipopulationihealthiperspective,iinicontrast,iviewsicommunityibenefi tiasiaiwideiarrayioficommunityihealthiimprovementiactivities,idetermin edibyiassessingilocalihealthineeds **MakingiBetteriUsesiofitheiPoliciesiandiFundingiWeiAlreadyiHave:iWh oiareithei"eligibleibutinotienrolled"iandiwhyiareitheyiimportantiiniimpro vingipopulationihealth?i-iCorrectiAnswer--millionsiofilow- incomeipeopleiwhoiareiqualifiedifor

butinotienrollediinipublicibenefits,iincludingihealthiinsurance,ifoodiandi heatingiassistance,iandisocial services.i

Aniestimatedi25%iofipeopleiwhoiareieligibleiforiMedicaidianditheiChildr en'siHealth InsuranceiProgrami(17)iandi34%iofithoseieligibleiforifoodistampsi(18)iar einotienrollediinithese programs. **MakingiBetteriUsesiofitheiPoliciesiandiFundingiWeiAlreadyiHave:iWha tiareitheibarriersitoienrollmentithatitypicallyilimititheinumberiofipeoplei receivingihealthibenefits?i-iCorrectiAnswer-- frequentirequalificationiperiods

  • lengthyiapplicationiforms
  • complexidocumentationirequirements
  • multipleiin-personiinterviews
  • inaccessibleivenuesiforiapplication
  • linguisticiandiculturalibarriers
  • lackiofipubliciinformation. **Whatiisiai"cultureiofiwellness"?i-iCorrectiAnswer- Aicultureiofihealthiandiwellnessiisidefinedibyiitsioutcomes.iParticipantsii niaicultureiofihealth