Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology

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. This answer book 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 60-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, Advocate Physician Partners, BCBS Michigan, Capital District Physicians' Health Plan (CDPHP) and other organizations, 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? *Why should payors partner in an ACO? *What are the most sustainable care models? *What are key features of a high-functioning medical neighborhood? *Metrics and Risk Measurement: What are key physician performance metrics? *How do you adjust for risk in total cost of care? *Can you describe the importance of aggregating payor data? *What are some benchmarks for measuring peer satisfaction? *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 some strategies for bringing together community and private practice? *How do you define physician citizenship? *Methodologies and Data Analytics: How can a practice address patient access challenges? *How do you measure meaningful use improvement? *What types of data exchange facilitate value-based reimbursement? *What are strategies to build practice capacity? *What is the role of the EHR in value-based compensation?