Quality & Outcomes Evaluation and Measurements

(Comprises 10% of the Exam, approximately 15 questions)

Everyone—from policymakers to payers to accrediting bodies—is requiring the healthcare industry to focus on quantifiable outcomes. With the recent trend of healthcare reimbursement being tied to quantifiable outcomes, there is a heightened focus on quality, efficiency, safety, and value in healthcare.

Case managers are well-positioned to excel in this environment, given their opportunities to directly impact outcomes from patient admission through discharge and beyond. Case managers must be familiar with quality and outcome measures and understand their role in ensuring that organizations meet these measures.

• • Accreditation standards and requirements
  • Cost-benefit analysis
  • Data gathering, interpretation, evaluation, and reporting
  • Healthcare analytics
  • Sources of quality indicators
  • Quality indicators, applications, performance improvement, and evaluation methods
  • Quality and Performance Improvement Methods, Tools, and Processes
  • Impact of Case Management Practices on Value-Based Care