Certified Professional in Healthcare Information and Management Systems (CPHIMS) Practice Exam

When a healthcare entity provides care on an at-risk basis, what is an appropriate use of quality-related data?

1. Determine reimbursement opportunities

2. Develop a research study for a new clinical compound

3. Identify opportunities for clinical care improvement

4. Target network security weaknesses

The correct answer is: Identify opportunities for clinical care improvement

When a healthcare entity provides care on an at-risk basis, using quality-related data to identify opportunities for clinical care improvement is highly appropriate and aligns well with the goals of at-risk care models. At-risk care involves managing patient care proactively to ensure high-quality outcomes while controlling costs. By analyzing quality-related data, the organization can pinpoint specific areas where clinical practices may be enhanced, leading to better patient outcomes and more efficient use of resources. This approach aligns with the essential principles of value-based care, where the focus is on delivering better health outcomes for patients rather than merely increasing the volume of services provided. Through the identification of care improvement opportunities, healthcare providers can implement targeted interventions to enhance the quality of care and patient satisfaction, ultimately leading to better health results. In contrast, determining reimbursement opportunities, developing a research study, or targeting network security weaknesses, while important in their own contexts, do not directly focus on improving the quality of clinical care in an at-risk environment. The emphasis should be on utilizing quality-related data specifically for enhancing care delivery and achieving superior patient outcomes within the framework of at-risk arrangements.