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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Clinical Data Model and Interoperability | 20% | - Configure clinical objects and relationships - Understand the clinical data model - Explain interoperability and FHIR integration |
| Topic 2: Provider Relationship Management | 15% | - Implement provider search and matching - Manage referral management - Configure provider network management |
| Topic 3: Health Cloud Basics and Administration | 20% | - Explain the capabilities of Health Cloud - Configure Health Cloud settings and custom metadata - Manage Health Cloud permissions and sharing |
| Topic 4: Patient Engagement and Clinical Operations | 30% | - Implement care plans and care teams - Configure patient management workflows - Configure patient timelines and milestones - Manage clinical encounters and assessments |
| Topic 5: Health Cloud Analytics and Reporting | 15% | - Implement clinical analytics - Utilize Health Cloud for operational insights - Configure Health Cloud reports and dashboards |
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NEW QUESTION # 103
How should a consultant recommend modeling a physician's locations of service, when the physician practices at multiple hospitals and clinics?
Answer: A
NEW QUESTION # 104
Which Intelligent Appointment Management, What products or feature can be leveraged to supplement? (Choose two)
Answer: A,D
NEW QUESTION # 105
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: A,D
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.
Reference:
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 # 106
A provider wants to get a comprehensive view of a patient's prescriptions, including history, to improve health outcomes.
Which Health Cloud capability should a consultant leverage to assist the provider?
Answer: B
Explanation:
Medication Managementin Health Cloud enables providers to view all of a patient's prescription history in one place, supporting medication reconciliation and review for better health outcomes.
* Extract:
"Use Medication Management to track and review patient prescriptions, past and present, ensuring a comprehensive view of medication history and supporting care team collaboration." (Source: Administer Health Cloud - Medication Management) Other options (Intelligent Appointment Management, Virtual Care, Integrated Care Management) do not provide comprehensive medication tracking.
NEW QUESTION # 107
A bug is assigned to a developer stating that when an address contains data in the Address Line 2 field, the FlexCard display adds additional line, causing formatting issues.
How should the developer handle this in a DataRaptor without changing the underlying data structures?
Answer: C
Explanation:
The developer should modify the Extract DataRaptor to concatenate the address fields by using a formula to handle this bug. An Extract DataRaptor is a component in OmniStudio that allows the developer to query data from Salesforce objects and display it on a FlexCard. The developer can use a formula to concatenate the address fields into one field and avoid adding an extra line when Address Line 2 contains data.
NEW QUESTION # 108
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