Quality & Outcomes Evaluation and Measurements
(Comprises 18% of the Exam, approximately 27 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 heightened focus on quality, efficiency, safety, and value in healthcare.
Case managers are in a position to shine in this environment, by means of their opportunities to directly affect outcomes from patient admission through discharge and beyond. Case managers must be familiar with quality and outcome measures and must understand their role in ensuring organizations meet them.
- Accreditation standards and requirements
- Case load calculation
- Cost-benefit analysis
- Data interpretation and reporting
- Healthcare analytics (new)
- Program evaluation and research methods
- Quality and performance improvement concepts
- Quality indicators techniques and applications (new)
- Sources of quality indicators (e.g., Centers for Medicare and Medicaid Services [CMS], Utilization Review Accreditation Commission [URAC], National Committee for Quality Assurance [NCQA], National Quality Forum [NQF], Agency for Healthcare Research and Quality [AHRQ])
- Types of quality indicators (new)