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| Section | Weight | Objectives |
|---|---|---|
| Health Cloud Analytics and Reporting | 15% | - Utilize Health Cloud for operational insights - Configure Health Cloud reports and dashboards - Implement clinical analytics |
| Provider Relationship Management | 15% | - Manage referral management - Configure provider network management - Implement provider search and matching |
| Clinical Data Model and Interoperability | 20% | - Configure clinical objects and relationships - Understand the clinical data model - Explain interoperability and FHIR integration |
| Health Cloud Basics and Administration | 20% | - Configure Health Cloud settings and custom metadata - Manage Health Cloud permissions and sharing - Explain the capabilities of Health Cloud |
| Patient Engagement and Clinical Operations | 30% | - Manage clinical encounters and assessments - Configure patient management workflows - Configure patient timelines and milestones - Implement care plans and care teams |
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NEW QUESTION # 113
Which Feature would an administrator setup to help their sales team view all provider related to a specific facility?
Answer: D
NEW QUESTION # 114
Bloomington Caregivers would like to display patient information from both Salesforce standard objects and data from an external system.
Which three Health Cloud features should a consultant recommend the company use to display this on the patient record page?
Choose 3 answers
Answer: A,B,E
Explanation:
Step-by-Step Explanation:
* Health Cloud Best Practice for Displaying Internal and External Data:
* FlexCards(part of OmniStudio) can display data from multiple sources in a unified view on a patient record.
* Integration Proceduresconnect to external systems and bring in data (e.g., from EHRs or other sources).
* DataRaptorsextract and transform Salesforce data for display and use in FlexCards.
* Salesforce Documentation Reference:
* "FlexCards can display internal Salesforce data and call Integration Procedures or DataRaptors to bring in external or standard object data."-OmniStudio Standard Guide
* "Integration Procedures are used to retrieve and update data from external systems and can be invoked directly from FlexCards or OmniScripts."-OmniStudio Integration Procedures
* "DataRaptors map Salesforce data to and from FlexCards and Integration Procedures, enabling seamless display of patient information."-OmniStudio DataRaptors
* Other Options:
* Salesforce Flows: Good for automation but not for real-time display of combined external and internal data on record pages.
* Visualforce Pages: Legacy solution, not recommended for modern Health Cloud patient page display, and does not natively integrate with OmniStudio tools.
References:
OmniStudio Standard Guide
OmniStudio Integration Procedures
OmniStudio DataRaptors
NEW QUESTION # 115
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: C,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.
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 # 116
Which 3 of the components are customizable in HC?
Answer: B,D,E
NEW QUESTION # 117
Three steps required to configure HC?
Answer: A,C,E
NEW QUESTION # 118
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