Passed Exam Today CPHQ

Pay-for-performance (P4P) programs tie reimbursement to specific quality metrics, requiring a clear understanding of the measures to guide improvement efforts.

Option A (Obtaining a copy of the current measures for the physician): This is the correct answer. The NAHQ CPHQ study guide states, “To improve performance in pay-for-performance programs, the first step is to understand the specific measures and targets assigned to the provider” (Domain 4). Knowing the measures (e.g., HbA1c control rates) allows the quality professional to assess gaps and tailor interventions.

Option B (Suggesting the physician take a course on measurement): Education may be helpful later, but it is not the initial step, as it assumes a knowledge gap without assessing performance data.

Option C (Writing a plan to improve processes in the office): A plan is premature without knowing the specific measures and performance gaps.

Option D (Researching benchmarking data for practices in the area): Benchmarking is useful for comparison but secondary to understanding the physician’s specific measures and performance.

CPHQ Objective Reference: Domain 4: Performance and Process Improvement, Objective 4.6, “Support provider performance improvement in quality programs,” emphasizes starting with a clear understanding of performance measures. The NAHQ study guide notes, “Quality professionals must first identify the metrics in pay-for-performance programs to focus improvement efforts effectively” (Domain 4).

Rationale: Obtaining the current measures provides the foundation for assessing performance, identifying gaps, and developing targeted interventions, aligning with CPHQ’s data-driven improvement approach.

Lean is a methodology focused on eliminating waste and improving efficiency. Among its concepts, the one associated with rapid improvement is most relevant to the question.

Option A (Kaizen): This is the correct answer. Kaizen, meaning “continuous improvement” in Japanese, involves rapid, incremental improvements through focused events (e.g., Kaizen blitz) where teams address specific process issues quickly. NAHQ CPHQ study materials identify Kaizen as a Lean tool for achieving swift, collaborative improvements.

Option B (Six Sigma): Six Sigma focuses on reducing variation and improving quality through data-driven methods (e.g., DMAIC), but it is typically a longer, more analytical process, not rapid improvement.

Option C (Poka-yoke): Poka-yoke refers to mistake-proofing techniques to prevent errors (e.g., color-coded labels). While effective, it is not specifically about rapid improvement but error prevention.

Option D (Kanban): Kanban is a Lean tool for managing workflow and inventory (e.g., visual boards). It supports efficiency but is not centered on rapid improvement events.

Detailed Explanation:

In order to prioritize a neighborhood for additional interventions, the quality professional should consider which neighborhood has the highest percentage of patients who are not adhering to their medication regimen, as this indicates a greater need for support and resources.

Interpretation of Data Trends:

Neighborhood A: Medication non-adherence increased from 5% to 10%.

Neighborhood B: A slight improvement in adherence, with a decrease from 43% to 42%.

Neighborhood C: A significant increase in non-adherence, from 20% to 40%.

Neighborhood D: The highest rate of non-adherence, rising from 38% to 44%.

Analysis ofPriority for Intervention:

Neighborhood D has the highest percentage of patients not taking their medications for 30+ days in Year 2 (44%).

Although Neighborhood C shows a sharp increase in non-adherence (from 20% to 40%), Neighborhood D has both a higher baseline and an increase, suggesting a consistently higher risk that requires priority intervention.

Conclusion:

Based on these trends, Neighborhood D should be prioritized because it has the highest current rate of non-adherence and an upwardtrend, signaling a significant barrier to medication adherence among residents.

Alternative Payment Models (APMs) are payment approaches developed by the Centers for Medicare & Medicaid Services (CMS) and other payers that provide added incentives to clinicians to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Option A: Patient-Centered Medical Home (PCMH)

PCMH is a care delivery model where patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it. While it focuses on care coordination and communication, it is not primarily a payment model.

Option B: Shared Savings Program

The Shared Savings Program is an APM that encourages providers to reduce healthcare costs for a defined patient population by offering them a percentage of any net savings realized as a result of their efforts. This model aligns financial incentives with the goal of improving patient outcomes and reducing unnecessary spending.

Option C: Hospital at Home Program

This program provides hospital-level care to patients in their homes. While it represents an innovative care delivery model, it is not primarily structured as a payment model.

Option D: Collaborative Care Model

This model integrates mental health services into primary care settings. It focuses on care delivery and is not primarily a payment model.

Therefore, among the options provided, the Shared Savings Program (Option B) is the example of an Alternative Payment Model (APM).