University of Houston
Value-Based Care: Reimbursement Models
University of Houston

Value-Based Care: Reimbursement Models

This course is part of Value-Based Care Specialization

Taught in English

Some content may not be translated

Susie Gronseth
Sara G. McNeil

Instructors: Susie Gronseth

3,846 already enrolled

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Course

Gain insight into a topic and learn the fundamentals

4.5

(40 reviews)

Beginner level

Recommended experience

5 hours (approximately)
Flexible schedule
Learn at your own pace

What you'll learn

  • Explain fee-for-service medical coding and payment mechanisms and why fee-for-service leads to higher costs without clearly improving outcomes.

  • Describe the range of value-based payment options from the HCP-LAN Alternative Payment Model framework.

  • Describe the importance of risk adjustment, quality scores, and patient satisfaction measures in value-based care contracts.

Details to know

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Assessments

2 quizzes

Course

Gain insight into a topic and learn the fundamentals

4.5

(40 reviews)

Beginner level

Recommended experience

5 hours (approximately)
Flexible schedule
Learn at your own pace

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This course is part of the Value-Based Care Specialization
When you enroll in this course, you'll also be enrolled in this Specialization.
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There are 3 modules in this course

In this course, you will build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. Then you will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. As you examine a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based. To build on those options, you will explore how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. This module is an introduction to and exploration of value-based payment models utilizing a framework from the Health Care Payment Learning and Action Network (HCP-LAN). As a preparatory step to that introduction and review, the module starts with a high-level review of current fee-for-service payments, coding for those payments, and the problems resulting in increased healthcare costs and lower-than-expected quality in the U.S. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!

What's included

10 videos2 readings1 quiz1 discussion prompt1 plugin

In the previous module, you examined the importance of coding to reflect chronic conditions and other diagnoses accurately. You also explored how value-based care and payments utilize these measures and data. As you explore the four categories of the HCP-LAN alternative payment models (APMs)—also known as value-based payment arrangements or value-based contracts – the acronym of the latter is also VBC. As with other acronyms, you will learn to read VBC in context to determine if we are talking about care or payments/contracts. The focus of this module is on two key aspects of value-based payment models: 1) The need for, and methods of, risk-adjustment in value-based contracts, and 2) Quality scores and patient satisfaction measures, which are critical parts of value-based care and contracts. At the end of this module, you will examine how those elements are utilized in value-based contracts. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!

What's included

11 videos1 reading1 quiz1 discussion prompt

In this course, you have examined how the fee-for-service model emerged from current medical coding and payment mechanisms and why this model has contributed to higher costs in the U.S. healthcare system. In the videos and discussion postings relating the quest to replace the fee-for-service model, you explored a range of value-based payment options and how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. Whether you are currently working in a healthcare provider or payer organization or aspiring to work in either, it is paramount that you be able to synthesize, reframe, and put into practice knowledge gained from this course. Even more important is to recognize that the responsibility for applying this knowledge is shared by providers and payers, as ultimately it is the provider-payer partnership that leads to successful value-based care.

What's included

1 peer review1 plugin

Instructors

Instructor ratings
4.5 (16 ratings)
Susie Gronseth
University of Houston
7 Courses13,176 learners

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