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Salesforce Health Cloud Accredited Professional 認定 Health-Cloud-Accredited-Professional 試験問題 (Q44-Q49):

質問 # 44
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

A. Considering the number of Intake agents who will be using Health Cloud
B. Designing Care Requests to seek authorization from a health plan for drugs, services, and admissions
C. Considering the Request Review Types; Prior Authorization Review, Concurrent Review, and Retrospective Review
D. Designing Next Best Action and Recommendations for the care management team

正解：B、C

解説：
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.

質問 # 45
Clinicians want to see an overview of the patient's life, like Starting a New Job, Birth of a Baby, Divorce, etC. to understand the patient better and help them with a personalized care plan. What should the administrator configure in the Health Cloud so the clinicians can access this information in one place?

A. Life Goals
B. Life Map
C. Life Events
D. Milestones
E. Household Map

正解：C

質問 # 46
Which Data Model Leverages external objects to support the use Case?

A. Clinical Service Requests
B. Member Plan
C. Claims
D. Care Observations

正解：C

質問 # 47
A provider uses an external appointment management system. The default solution provided by Health Cloud is not viable for the How should a consultant implement a robust system for the provider?

A. Create a custom FHIR Adapter to make calls to Health Cloud.
B. Use a package created by ISV (Independent Software Vendor) for Health Cloud.
C. Create an Apex class and leverage Intelligent Appointment Management.
D. Use an electronic health record (EHR) routing system to book the appointment in Health Cloud.

正解：B

解説：
To implement a robust appointment management system for a provider that uses an external system, a consultant should use a package created by ISV (Independent Software Vendor) for Health Cloud. This would allow the provider to leverage existing solutions that are integrated with Health Cloud and offer features such as scheduling, reminders, cancellations, rescheduling, and confirmations. Using an EHR routing system, creating a custom FHIR Adapter, or creating an Apex class are not viable options for this requirement3.

質問 # 48
A Health Cloud administrator is working to create an external facing site to allow patients to find providers within their network. The site is being built by Experience ClouD. The administrator needs to determine what access external users must be granted to allow patients to search and find Providers that fit selected criteri A.
Which object do the external user need read access to?

A. CareProviderSearchConfig
B. CareProviderFacilitySpeciality
C. CareProviderSearchableField
D. HealthcarePractitionerFacility

正解：C

解説：
According to the Health Cloud Data Model Developer Guide, CareProviderSearchableField is the object that external users need read access to allow patients to search and find providers that fit selected criteria. CareProviderSearchableField is a custom object that defines which fields on the CareProvider object are searchable by external users. CareProvider is a custom object that represents a provider who delivers care or services to patients. CareProviderFacilitySpeciality, HealthcarePractitionerFacility, and CareProviderSearchConfig are not objects that external users need read access to for provider search.

質問 # 49
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