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Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology
Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology
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Like the convenience of an instant PDF download, but still want a hard copy of this book? Order both versions and save 35 percent!

If one trend has transformed the healthcare industry post-ACA more than any other, it is the market's new business model rewarding value over volume.

The Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology provides a framework for healthcare's new value proposition, with advice from thought leaders steeped in the delivery and reimbursement of value-based care.

In this 65-page resource, industry early adoptors weigh in on the structure, data tools and processes at work in delivery models supporting pay-for-value: the patient-centered medical home (PCMH), accountable care organization (ACO), medical neighborhood, and others, as well as emerging incentives and payment structures being piloted in healthcare systems nationwide: bundled payments, shared savings, pay for performance, and hybrid reward structures.

Culled from hours of expert presentations on the value-focused vision of the new healthcare landscape, the Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology draws from initiatives at WellPoint, Highmark, BCBS Michigan, and advice from Optum, Navigant, Healthcare Strategy Group and others, structuring experts' give-and-take in an easy-to-follow Q&A format.

A sampling of questions covered in Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology include:

  • Value-Based Reimbursement Models:
    • What's the recommended frequency of provider payouts?
    • What are guidelines for specialist compensation?
    • What are the first steps in developing a physician compensation strategy?
    • What are start-up strategies for a bundled payment initiative?
    • What are key features of a high-functioning medical neighborhood?
  • Metrics and Risk Measurement:
    • What are key physician performance metrics?
    • How do you adjust for risk in total cost of care?
    • How do you measure Meaningful Use improvement?
    • How do you attribute non-compliant patients?
    • How do you risk-stratify within an episode of care?
    • What are some guidelines for sharing performance data?
  • Provider Engagement and Education:
    • How do you engage providers in clinical improvement?
    • What are the characteristics of physician thought leaders?
    • How do you overcome physician resistance?
    • What are common struggles of physician practices in value-based models?
    • How do you define physician citizenship?
  • Methodologies and Data Analytics:
    • How can a practice address patient access challenges?
    • What are four key sources of physician performance data?
    • What types of data exchange facilitate value-based reimbursement?
    • What is a time line to build a pay for performance program?
    • What is the role of the EHR in value-based compensation?
Among the industry experts sharing advice in this unique review of value-based payment innovations are the following:
  • Travis Ansel, MBA, manager of strategic services, Healthcare Strategy Group;
  • Julie Hobson, RN, BSN, manager of provider engagement, performance and partnership at Highmark Inc.;
  • Cynthia Kilroy, senior vice president of provider strategy and business development at Optum;
  • Robert Krebbs, director of payment innovation at WellPoint, Inc.,;
  • Terry McGeeney, MD, MBA, director of BDC Advisors;
  • Gregory Mertz, MBA, FACMPE, managing director of Physician Strategies Group, LLC;
  • Donna Saxton, field team manager, Blue Cross Blue Shield of Michigan (BCBSM) value partnerships program;
  • Julie Schilz, director of care delivery transformation for WellPoint;
  • Catherine Sreckovich, managing director, healthcare, Navigant;
  • Jay Sultan, associate vice president and chief product portfolio architect for TriZetto® and
  • Steven Valentine, president, The Camden Group.
Publication Date: October 2014
Number of Pages: 65
ISBN 10: 1-941329-42-X (Print version); 1-941329-43-8 (PDF version)
ISBN 13: 978-1-941329-42-9 (Print version); 978-1-941329-43-6 (PDF version)
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