This course is part of the Value-Based Care Specialization

4.5
stars
37 ratings

Susie Gronseth +1 more instructor

3,027 already enrolled

Offered By

Value-Based Care SpecializationUniversity of Houston

About this Course

5,528 recent views

COURSE 4 of 7. This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. 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. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts.
CME Accreditation
The American Academy of Family Physicians (AAFP) has approved this course for Continuing Medical Education Prescribed Credits. Visit the FAQs for important information regarding 1) Term of approval and 2) Accreditation and Credit Designation statements.

Flexible deadlines

Reset deadlines in accordance to your schedule.

Shareable Certificate

Earn a Certificate upon completion

100% online

Start instantly and learn at your own schedule.

Course 4 of 7 in the

Value-Based Care Specialization

Beginner Level

Beginning course

Approx. 5 hours to complete

English

Could your company benefit from training employees on in-demand skills?

Try Coursera for Business

What you will 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.

Skills you will gain

Health Education
value-based care
Patient Care
Public Health
Health Care

Flexible deadlines

Reset deadlines in accordance to your schedule.

Shareable Certificate

Earn a Certificate upon completion

100% online

Start instantly and learn at your own schedule.

Course 4 of 7 in the

Value-Based Care Specialization

Beginner Level

Beginning course

Approx. 5 hours to complete

English

Could your company benefit from training employees on in-demand skills?

Try Coursera for Business

Instructors

Instructor rating

4.66/5 (14 Ratings)

Susie Gronseth

Clinical Associate Professor

Curriculum and Instruction

9,332 Learners

7 Courses

Sara G. McNeil

Associate Professor

Curriculum and Instruction

70,447 Learners

8 Courses

Offered by

University of Houston

Established in 1927, the University of Houston empowers students in their pursuit of learning, discovery, leadership and engagement. Located in a sprawling metropolis, our premier Tier One campus provides students with cutting edge programs including undergraduate, graduate, doctoral, distance and continuing education. Ranked among the best colleges in America, UH is home to award-winning faculty, innovative research centers, has one of the most diverse student populations in the nation, and alumni who have become international leaders.

See how employees at top companies are mastering in-demand skills

Learn more about Coursera for Business

Syllabus - What you will learn from this course

Week1

Week 1

2 hours to complete

From Fee-For-Service to Value-Based Payments

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!

2 hours to complete

10 videos (Total 48 min), 2 readings, 1 quiz

10 videos

If this is your first VBC course, please watch our Welcome.37sHow This Course Works3mLevel Set2mCurrent and Historical Reimbursement Models4mCPT (Current Procedural Terminology) Codes4mICD (International Classification of Disease) Codes2mFee-For-Service: Volume Not Value2mPopulation Costs and Value: Think Like an Insurance Company10mMoving to Value8mExamples of Current Value-Based Arrangements in Traditional Medicare7m

2 readings

Explore the Optional Resources for Module 110mReferences for Module 110m

1 practice exercise

Module 1 Quiz30m

Week2

Week 2

2 hours to complete

Quality and Risk Adjustment in Value-Based Payments

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!

2 hours to complete

11 videos (Total 58 min), 1 reading, 1 quiz

11 videos

The History and Purpose of Risk Adjustment3mThe Role of Risk Adjustment in Value-Based Care and Payment Models7mMedicare Risk Adjustment (MRA) Payment Model7mRisk Adjustment Is a Collaborative Effort3mMeasuring and Paying for Quality3mMedicare Star Rating Program Framework4mConsumer Assessment of Healthcare Providers and Systems3mHEDIS5mPatient Safety Measures2mComprehensive Population-Based Payment Models from HCP-LAN9mA Value-Based Payment Spectrum5m

1 reading

Explore the Optional Resources for Module 210m

1 practice exercise

Module 2 Quiz30m

Week3

Week 3

1 hour to complete

Course Project: Making This My Own

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.

1 hour to complete

Reviews

4.5

8 reviews

5 stars
62.16%
4 stars
32.43%
3 stars
2.70%
1 star
2.70%

TOP REVIEWS FROM VALUE-BASED CARE: REIMBURSEMENT MODELS

by MKJun 15, 2022

Its an excellent course with a lot of insights on how to develop models of reimbursement. Its very specific to the US however, and examples from other countries would be useful.

View all reviews

About the Value-Based Care Specialization

Learners may study at their own pace to take any of the six courses and the Capstone Project course independently (receiving a certificate for each) or collectively for the specialization designation. This specialization is intended for healthcare professionals, faculty, and students pursuing healthcare-related studies to develop an awareness of Value-Based Care reimbursement and operating models. Through six courses and a Capstone project, you will develop an understanding of your individual responsibility to lead a culture of collaboration in the workplace focused on value-based care. Our industry partner, Humana, brings their expertise and years of experience in providing quality care.

Frequently Asked Questions

When will I have access to the lectures and assignments?
Access to lectures and assignments depends on your type of enrollment. If you take a course in audit mode, you will be able to see most course materials for free. To access graded assignments and to earn a Certificate, you will need to purchase the Certificate experience, during or after your audit. If you don't see the audit option:
The course may not offer an audit option. You can try a Free Trial instead, or apply for Financial Aid.
The course may offer 'Full Course, No Certificate' instead. This option lets you see all course materials, submit required assessments, and get a final grade. This also means that you will not be able to purchase a Certificate experience.
What will I get if I subscribe to this Specialization?
When you enroll in the course, you get access to all of the courses in the Specialization, and you earn a certificate when you complete the work. Your electronic Certificate will be added to your Accomplishments page - from there, you can print your Certificate or add it to your LinkedIn profile. If you only want to read and view the course content, you can audit the course for free.
What is the refund policy?
If you subscribed, you get a 7-day free trial during which you can cancel at no penalty. After that, we don’t give refunds, but you can cancel your subscription at any time. See our full refund policy.
Is financial aid available?
Yes. In select learning programs, you can apply for financial aid or a scholarship if you can’t afford the enrollment fee. If fin aid or scholarship is available for your learning program selection, you’ll find a link to apply on the description page.
Is this activity accredited for Continuing Medical Education (CME)?
The American Academy of Family Physicians (AAFP) has reviewed Value-Based Care: Reimbursement Models and deemed it acceptable for AAFP credit. Term of approval is from 01/01/2021 to 12/31/2021. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Following this CME activity, participants will have the opportunity to earn an additional two Prescribed credits for participation in the Translation to Practice® exercise. Information on Translation to Practice® will be shared within the activity. Credit approval includes the following sessions:
3.00 Enduring Materials, Self-Study AAFP Prescribed Credit(s) - Value-Based Care: Reimbursement Models
2.00 Enduring Materials, Self-Study AAFP Prescribed Credit(s) - Value-Based Care: Reimbursement Models- Translation To Practice

More questions? Visit the Learner Help Center.

Build employee skills, drive business results

Discover Coursera for Business

Value-Based Care: Reimbursement Models

About this Course

What you will learn

Skills you will gain