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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Clinical Data Model and Interoperability | 20% | - Configure clinical objects and relationships - Explain interoperability and FHIR integration - Understand the clinical data model |
| Topic 2: Patient Engagement and Clinical Operations | 30% | - Manage clinical encounters and assessments - Configure patient timelines and milestones - Configure patient management workflows - Implement care plans and care teams |
| Topic 3: Health Cloud Analytics and Reporting | 15% | - Utilize Health Cloud for operational insights - Configure Health Cloud reports and dashboards - Implement clinical analytics |
| Topic 4: Provider Relationship Management | 15% | - Manage referral management - Configure provider network management - Implement provider search and matching |
| Topic 5: Health Cloud Basics and Administration | 20% | - Configure Health Cloud settings and custom metadata - Explain the capabilities of Health Cloud - Manage Health Cloud permissions and sharing |
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NEW QUESTION # 112
A customer wants to move its existing Patient-Reported Outcome Measures (PROMs) surveys to Health Cloud. It requires a solution that allows for question banks and version control for this standardized survey.
Which solution should a consultant recommend?
Answer: C
Explanation:
Salesforce Surveys is the best solution for moving existing PROMs surveys to Health Cloud. It allows for question banks and version control for this standardized survey.
NEW QUESTION # 113
In which three ways does Health cloud meet compliance and regulatory requirements? (Choose three.)
Answer: A,C,E
Explanation:
Health Cloud helps HLS organizations achieve HIPAA compliance (A), Health Cloud is HITRUST certified , and Health Cloud is GDPR certified (D) are three ways that Health Cloud meets compliance and regulatory requirements. Health Cloud is not HIPAA certified (B), as HIPAA certification does not exist. Health Cloud is not HL-7 compliant (E), as HL-7 is a standard for exchanging health information, not a compliance requirement.
NEW QUESTION # 114
A provider is looking to implement Utilization Management in Health Cloud and submit and track prior authorizations.
Which two capabilities should a consultant customize to achieve this?
Choose 2 answers
Answer: A,B
Explanation:
Health Cloud supports Utilization Management (UM) through the Service Request object, which tracks prior authorization requests, and through integration with electronic prior authorization systems using MuleSoft.
Customize the Service Request object:
Extract:
"The Service Request object is at the core of the Utilization Management process in Health Cloud. You can customize fields, page layouts, and automation to match your business processes for prior authorization." (Source: Administer Health Cloud - Utilization Management) Integrate using MuleSoft Direct for ePA:
Extract:
"Integrate Health Cloud Utilization Management with external systems using MuleSoft Direct, enabling electronic submission and tracking of prior authorizations." (Source: Administer Health Cloud - Utilization Management Integration) Why not B or D?
There is no standard custom setting called UtilizationManagementSettings for this process.
Support Process is more for standard Salesforce Cases and not directly linked to Utilization Management flows in Health Cloud.
NEW QUESTION # 115
Bloomington Caregivers needs to use the objects for the Clinical data model as part of its new Health Cloud implementation. Which preference should Bloomington Caregivers' administrator ensure is enabled?
Answer: B
Explanation:
To enable the Clinical Data Model in Salesforce Health Cloud, the FHIR-Aligned Data Model org preference must be activated. This preference ensures compatibility with the Fast Healthcare Interoperability Resources (FHIR) standard, which is widely used for managing healthcare data.
FHIR-Aligned Data Model:
* Supports the representation of clinical data such as medications, conditions, procedures, and encounters in a format compliant with the FHIR standard.
* Aligns Health Cloud's data structure with industry standards, facilitating interoperability with Electronic Health Record (EHR) systems and other healthcare platforms.
Why Not the Other Options?
* B. Clinical R4 Model org preference: This is not a valid preference in Salesforce Health Cloud.
* C. FHIR-Aligned EHR Data Model org preference: While EHR data models align with FHIR, this specific preference does not exist.
* D. Clinical Data Model org preference: This is not specific to the FHIR-aligned framework and may not meet interoperability requirements.
Implementation Steps:
* Navigate to Setup # Health Cloud Settings.
* Enable the FHIR-Aligned Data Model org preference.
* Configure the required objects and fields for the Clinical Data Model.
References:
FHIR-Aligned Data Model Overview
Clinical Data Model in Health Cloud
NEW QUESTION # 116
A payer needs to work with plan members and medical providers to influence decisions through a case-by- case review of the appropriateness of care.
When gathering requirements for this use case, which two Utilization Management processes should a consultant discuss with the client?
Choose 2 answers
Answer: B,C
Explanation:
Utilization Management is a critical component in healthcare that focuses on ensuring the appropriateness, necessity, and efficiency of healthcare services. For payers working with plan members and medical providers, the case-by-case review of care appropriateness requires thorough processes to streamline authorization and review tasks.
* Designing Care Requests to Seek Authorization (Answer B):
* Purpose: The Care Request object in Health Cloud is essential for seeking authorizations from a health plan for specific healthcare services, drugs, or admissions. This object ensures that requests are appropriately documented and tracked.
* Functionality:
* It allows users to create and manage care requests linked to plan members.
* Integrates with payer systems to capture critical details for authorization, such as service codes, plan information, and medical necessity documentation.
* Supports automation through workflows and approvals, speeding up the decision-making process.
* Relevance: By designing efficient Care Requests, the consultant ensures that all required details for preauthorizations or service reviews are captured seamlessly, meeting regulatory and operational needs.
* Considering Request Review Types (Answer C):
* Purpose: UM processes in Health Cloud must address the three primary types of reviews:
* Prior Authorization Review: Conducted before the service is provided to determine medical necessity.
* Concurrent Review: Evaluates the necessity of ongoing care during hospitalization or service delivery.
* Retrospective Review: Analyzes the appropriateness of care after it has been delivered.
* Implementation in Health Cloud:
* The consultant must design workflows and data models to capture the details of these review types, including timestamps, reviewer notes, and outcomes.
* Health Cloud supports tracking and documenting these reviews within the UM module, ensuring compliance with healthcare regulations.
* Relevance: These review types allow the payer to influence decisions by ensuring appropriate care is provided while managing costs and maintaining high-quality outcomes.
Why the Other Options Are Less Relevant:
* A. Designing Next Best Action and Recommendations for the Care Management Team: While recommendations and next-best-action features are beneficial for care management, they are not directly tied to the case-by-case review process of Utilization Management, which focuses more on care appropriateness and authorizations.
* D. Considering the Number of Intake Agents Using Health Cloud: While operational considerations like staffing are important, this is not a Utilization Management process. It's a broader organizational concern unrelated to the core functionality of UM in Health Cloud.
References:
Utilization Management Overview: Salesforce documentation outlines how to handle prior authorizations, service approvals, and related processes within Health Cloud. (help.salesforce.com) Care Requests and Authorizations: Details on managing care requests and integrating with payer systems for streamlined authorization workflows. (developer.salesforce.com) UM Process Design in Health Cloud: Guidance on implementing request review types and managing data models to support UM. (architect.salesforce.com) By addressing Care Requests and Request Review Types, the consultant ensures a robust Utilization Management setup, enabling effective collaboration between payers, providers, and members while optimizing care delivery and compliance.
NEW QUESTION # 117
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