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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?
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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:
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Travis Ansel, MBA, manager of strategic services, Healthcare Strategy Group;
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Julie Hobson, RN, BSN, manager of provider engagement, performance and partnership at Highmark Inc.;
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Cynthia Kilroy, senior vice president of provider strategy and business development at Optum;
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Robert Krebbs, director of payment innovation at WellPoint, Inc.,;
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Terry McGeeney, MD, MBA, director of BDC Advisors;
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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;
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Julie Schilz, director of care delivery transformation for WellPoint;
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Catherine Sreckovich, managing director, healthcare, Navigant;
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Jay Sultan, associate vice president and chief product portfolio architect for TriZetto® and
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Steven Valentine, president, The Camden Group.
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