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Value-Based Reimbursement
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6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability
6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability
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In today's value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory.

The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians' skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

In this 40-page resource, Gregory Mertz, MBA, FACMPE, managing director of Physician Strategies Group, LLC, helps organizations assess which value-based healthcare delivery model is right for their organization, while Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, explores the key structure, issues and challenges of these evolving reimbursement models.

This HIN special report provides details on the following:

  • Recognizing shared savings opportunities and the care model necessary for success;
  • Understanding the economics of value and the return on investment potential;
  • The new definition of 'alignment' and exploring physician alignment models that create a mutually beneficial business environment;
  • Evaluating which value-based delivery models are sustainable and where shared savings might be headed in the next three to five years;
  • How physicians are gaining efficiencies and incentives around high-risk patients by identifying and managing the risk;
  • The new performance metrics for providers, including citizenship and peer satisfaction;
  • How to use real-time EHR data to identify risk, manage gaps in care and analyze performance to manage population health and total cost of care;
  • From withholds to capitation, how to determine which payment method and adjustment will work for each practice;
  • Advice on sharing performance data within the provider population; and
  • Tying upside and downside risk for physicians to the medical loss ratio.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability goes on to respond to more than 25 questions on this subject, from suggestions for staff incentives to the future of the accountable care organization.

Table of Contents

  • Which Physician Compensation Model Is Right for You?
    • Impact of "Better Care, Lower Cost Act" on ACOs
    • Model 1: Process Improvement
    • Model 2: Physician-Hospital Organization
    • Model 3: Shared Savings
    • Model 4: Case Pricing and Bundled Payments
    • Model 5: Co-Management
    • Model 6: Population Management
    • The Cost of Accountable Care
    • How Physicians Can Help with Quality Improvement
    • First Steps Toward Model Selection
  • Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives
    • 5 Market Trends Impacting Value-Based Reimbursement
    • Healthcare’s Shifting Compensation Models
    • 12 Elements of a Successful Physician Compensation Strategy
    • Physician Compensation Maturity Model
    • 11 Characteristics of a Value-Based Physician Compensation Model
    • Flow of Funds in Different Models
    • 6-Step Process for Engaging Physicians in Performance Metrics
    • 5 Characteristics of Good Performance Metrics
    • Applying Analytics to Performance Metrics
    • Importance of Risk Profiles for Physician Panels
    • 7 Benefits of Sharing Unblinded Performance Metrics
  • Q&A: Ask the Experts
    • Key Physician Performance Metrics
    • Effect of Sharing Peer Performance Data on Physicians
    • Defining Physician Citizenship
    • Characteristics of Physician Thought Leaders
    • Recommended Frequency of Payouts
    • Market Differentiators for Incentive Structure
    • High-Cost Procedures for Shared Savings Agreements
    • Incentives for Provider Staff
    • Guidelines for Specialist Compensation
    • Addressing Patient Access Challenges
    • EHR’s Role in Value-Based Compensation
    • Other Sources of Performance Data
    • Predictions for Profit in Value
    • Thoughts on "Better Care, Lower Cost Act"
    • Most Sustainable Care Models
    • Evolution of ACOs
    • Metrics for Measuring Peer Satisfaction
    • Timeline for Physician Review of Performance Data
    • Preferred Method for Risk Adjustment
    • Variable-Based Compensation
    • Recommended Care Management System
    • Duration of Shadow Incentive Reimbursement Period
    • Engaging Providers in Clinical Improvement
  • Glossary
  • For More Information
  • About the Speakers
Publication Date: April 2014
Number of Pages: 40
ISBN 10: 1-941329-06-3 (Print version); 1-941329-07-1 (PDF version)
ISBN 13: 978-1-941329-06-1 (Print version); 978-1-941329-07-8 (PDF version)
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