​Healthcare Domain: Key Concepts for the FACHE Exam

 

 

1. Key Terminology & Acronyms

 

The exam will assume your fluency in the language of healthcare management. Be comfortable with these terms:

• Payer/Provider/Patient: The three primary stakeholders in healthcare.

• Fee-for-Service (FFS): The traditional model where providers are paid for each individual service rendered.

• Capitation: A payment model where providers receive a fixed amount per patient (per member per month) regardless of how many services are used.

• Value-Based Care (VBC): A broad model focused on paying for health outcomes and quality, not just quantity of services.

• Managed Care Organizations (MCOs): Health plans like HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations) that aim to manage cost, quality, and utilization.

• Key Acronyms:

  • ACA: Affordable Care Act

  • ACO: Accountable Care Organization

  • CMS: Centers for Medicare & Medicaid Services

  • HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems (patient satisfaction survey)

  • HIPAA: Health Insurance Portability and Accountability Act

  • IDN: Integrated Delivery Network

  • MACRA: Medicare Access and CHIP Reauthorization Act (drives value-based payment)

  • SDOH: Social Determinants of Health

  • TJC: The Joint Commission (major accrediting body)

 

2. Industry Trends

 

Exam questions will often be framed around current challenges and future directions.

• Shift from Volume to Value: This is the most important trend. Understand that the industry is moving away from FFS towards models that reward providers for efficiency, quality outcomes, and patient satisfaction (e.g., ACOs, bundled payments).

• Healthcare Consumerism: Patients are behaving more like consumers, demanding price transparency, convenience, and a high-quality experience. The rise of telehealth, urgent care centers, and digital health tools reflects this.

• Consolidation: Health systems are growing through mergers and acquisitions (M&A) to gain market share, achieve economies of scale, and increase negotiating power with payers.

• Workforce Challenges: Widespread burnout, staffing shortages (especially in nursing and primary care), and an aging workforce are major operational and strategic challenges.

• Data Analytics & Digital Transformation: Healthcare organizations are increasingly using data to manage population health, improve clinical outcomes, and streamline operations. Cybersecurity is a major associated risk.

 

3. Continuum of Care

 

This refers to the system of services that supports a patient through all phases of life and health. Understand the function of each component and how they connect.

• Primary Care: The "front door" of healthcare. Focuses on prevention, health maintenance, and managing chronic conditions. The Patient-Centered Medical Home (PCMH) is a key model here.

• Specialty Care: Services provided by specialists (e.g., cardiology, orthopedics) upon referral from primary care.

• Acute Care: Short-term, intensive care for immediate health conditions, primarily delivered in a hospital.

• Post-Acute Care: Services for patients after a hospital stay. This includes:

  • Skilled Nursing Facilities (SNFs): For patients needing 24-hour nursing and therapy.

  • Inpatient Rehabilitation: Intensive, hospital-based rehab.

  • Home Health Care: Skilled nursing and therapy provided in a patient's home.

• Long-Term Care: Custodial care for individuals who cannot perform activities of daily living (ADLs).

• Palliative & Hospice Care: Focus on comfort and quality of life. Palliative care can be provided at any stage of a serious illness, while hospice care is for patients with a terminal diagnosis (typically <6 months to live).

 

4. Types of Organizations

 

Be able to differentiate the major structures and their incentives.

• Ownership Structure:

  • Not-for-Profit (NFP): The most common type of hospital. They are tax-exempt and must provide "community benefit." All revenue must be reinvested into the organization.

  • For-Profit (Investor-Owned): Owned by shareholders and aim to generate a profit. They pay property and income taxes.

  • Public/Government: Owned and operated by federal (e.g., VA), state, or local governments.

• System Integration:

  • Integrated Delivery Network (IDN): A network of providers (hospitals, physician groups, post-acute facilities) connected to provide a coordinated continuum of care to a specific population. Example: Kaiser Permanente.

  • Accountable Care Organization (ACO): A group of doctors, hospitals, and other providers who come together voluntarily to give coordinated, high-quality care to their Medicare patients. The goal is to reduce spending and improve quality.

 

5. Population Health Management (PHM)

 

This is a critical concept that ties many other topics together.

• Definition: The process of improving clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement, supported by financial and care models.

• Key Idea: It is proactive, not reactive. It focuses on keeping a population healthy and managing risk, rather than just treating sick individuals.

• Core Activities:

  • Risk Stratification: Using data to identify high-risk patients who need the most support (e.g., those with multiple chronic conditions).

  • Care Management/Coordination: Providing dedicated support (e.g., from nurse navigators) to help high-risk patients manage their conditions and navigate the healthcare system.

  • Preventive Care & Wellness: Focusing on screenings, immunizations, and wellness programs.

 

6. Social Determinants of Health (SDOH)

 

SDOH are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, live, work, and age. The exam will expect you to know that these factors are often more impactful on health than clinical care.

The five key domains are:

1. Economic Stability: Poverty, employment status, food security, housing stability.

2. Education Access and Quality: Early childhood education, enrollment in higher education, literacy.

3. Healthcare Access and Quality: Access to healthcare, health literacy.

4. Neighborhood and Built Environment: Access to healthy foods, quality of housing, crime and violence, environmental conditions.

5. Social and Community Context: Social cohesion, civic participation, discrimination, incarceration.

How to Apply This Knowledge for the Exam: The FACHE exam uses scenario-based questions. It won't just ask, "What is an ACO?" Instead, it will describe a situation (e.g., a health system struggling with high readmission rates for heart failure patients) and ask for the best strategy. The correct answer will often involve applying these concepts—for instance, launching a population health initiative that uses care managers to address SDOH like lack of transportation to follow-up appointments.