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Types of Reimbursement – Health Care Policy (Nursing)

by Christy Davidson

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    00:00 Welcome back, everyone.

    00:02 In today's health care environment, organizations and providers strive to be efficient with sometimes limited resources.

    00:08 One way to help support this goal is to understand current reimbursement models.

    00:13 The healthcare industry is experiencing a transformation involving reimbursement payment models.

    00:19 Currently, there are two models: fee for service and value-based care.

    00:23 Let's look at each one individually.

    00:25 The Fee-for-Service, this is the most traditional payment model.

    00:29 Reimbursement is based on the number of services provided and payments are made separately for each one of those.

    00:36 Now sometimes payments may be made for services not needed or may not be based on current evidence.

    00:44 Value-based Care.

    00:45 In value-based care, clinicians really consider the quality and outcomes of care provided.

    00:50 They strive for efficiency.

    00:52 They consider best practices.

    00:55 They encourage a holistic team approach to care.

    00:59 They require coordination and communication between physicians across specialties.

    01:04 Now let's look at the different types of value-based payment models.

    01:08 First, pay-for-coordination.

    01:10 This is where a primary care physician leads and coordinates care between multiple providers and specialists to manage a united care plan for patients and to ensure efficiency and quality.

    01:20 Pay-for-performance.

    01:22 Health care providers are incentivized to meet certain quality and efficiency benchmark measures.

    01:27 Bundled payment or episode-of-care payment.

    01:30 This encourages quality and efficiency because healthcare providers are reimbursed with a set amount of money to pay for a specific episode of care, such as a hip replacement, and any complications.

    01:41 And, finally, shared savings programs.

    01:45 Physicians form entity groups and provide population health management.

    01:49 Quality and efficiency are achieved through coordinated team care and any realized net savings are given back to the provider.

    01:57 Now let's look at fee-for-service versus value-based care.

    02:00 In fee-for-service, patients face difficulty navigating a very complicated system alone.

    02:06 The patients may see multiple doctors, specialists, and surgeons who do not communicate with each other.

    02:12 And providers lack the technology and the incentives to coordinate patient care across the healthcare continuum.

    02:18 Now in value-based care, this rewards physicians for providing appropriate coordinated care that keeps patient populations healthy.

    02:25 It encourages healthcare providers to engage with patients.

    02:29 And finally, it delivers a connected care experience where patients receive more cost-efficient, coordinated, appropriate, and effective care.

    02:37 So, remember, value-based care incentivizes cost efficiency and quality and create structures that reward physicians for coordinated, appropriate, and effective care.

    02:47 So in thinking about what we've covered today, I'd like you to consider this question.

    02:51 What are four types of value-based payment models? They are pay-for coordination, pay-for-performance, bundled payment or episode-of-care payment, and shared savings programs.

    03:11 I hope you've enjoyed today's video on reimbursement models.

    03:13 Thanks so much for watching.


    About the Lecture

    The lecture Types of Reimbursement – Health Care Policy (Nursing) by Christy Davidson is from the course Health Care Organizations (Nursing).


    Included Quiz Questions

    1. Value-based care
    2. Fee-for-treatment
    3. Incentive-based costs
    4. Cost-analysis payments
    1. Encourages a holistic team approach to care
    2. Does not require current evidence for payment
    3. Bases reimbursement on the individual's care plan
    4. Uses a traditional model of payment
    1. Shared savings program
    2. Joint health payments
    3. Group benefit plan
    4. Physician-directed bundling
    1. Lack of communication between multiple physicians or specialists
    2. Incorrect billing by separate medical entities
    3. Unclear reimbursement methods by the insurance company
    4. Patients being prevented from advocating for themselves
    1. Shared savings program
    2. Entity-of-care
    3. Pay-for-performance
    4. Pay-for-coordination

    Author of lecture Types of Reimbursement – Health Care Policy (Nursing)

     Christy Davidson

    Christy Davidson


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