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Welcome back, everyone.
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In today's health care environment,
organizations and providers
strive to be efficient
with sometimes limited resources.
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One way to help support this goal
is to understand current
reimbursement models.
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The healthcare industry
is experiencing a transformation
involving reimbursement payment models.
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Currently, there are two models:
fee for service and value-based care.
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Let's look at each one individually.
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The Fee-for-Service,
this is the most traditional
payment model.
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Reimbursement is based
on the number of services provided
and payments are made separately
for each one of those.
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Now sometimes payments
may be made for services not needed
or may not be based
on current evidence.
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Value-based Care.
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In value-based care, clinicians
really consider the quality
and outcomes of care provided.
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They strive for efficiency.
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They consider best practices.
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They encourage
a holistic team approach to care.
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They require coordination
and communication
between physicians
across specialties.
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Now let's look at the different types
of value-based payment models.
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First, pay-for-coordination.
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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.
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Pay-for-performance.
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Health care providers are incentivized
to meet certain quality
and efficiency benchmark measures.
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Bundled payment
or episode-of-care payment.
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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.
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And, finally, shared savings programs.
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Physicians form entity groups
and provide population health management.
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Quality and efficiency are achieved
through coordinated team care
and any realized net savings
are given back to the provider.
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Now let's look at fee-for-service
versus value-based care.
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In fee-for-service,
patients face difficulty navigating
a very complicated system alone.
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The patients may see multiple doctors,
specialists, and surgeons
who do not communicate
with each other.
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And providers lack
the technology and the incentives
to coordinate patient care
across the healthcare continuum.
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Now in value-based care,
this rewards physicians
for providing appropriate
coordinated care
that keeps patient populations healthy.
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It encourages healthcare providers
to engage with patients.
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And finally, it delivers
a connected care experience
where patients receive
more cost-efficient, coordinated,
appropriate, and effective care.
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So, remember, value-based care
incentivizes cost efficiency and quality
and create structures that reward
physicians for coordinated, appropriate,
and effective care.
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So in thinking about
what we've covered today,
I'd like you to consider this question.
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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.
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I hope you've enjoyed today's video
on reimbursement models.
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Thanks so much for watching.