Value-Based Payments: A Payer's Perspective

Course overview

The healthcare landscape is rapidly changing, as new payment and program models evolve that reward healthcare organizations based on the value of their care. Previously, increasing the quality of care provided was financially counterproductive. Providers margins would shrink as the quality of care increased due to the inherent costs of providing high-quality care, fewer reimbursable visits needed by healthy clients, and the lack of increased reimbursement based on outcomes. Now, with a new incentive model referred to as value-based payments, how much a provider can earn is directly tied to the quality of care offered, as measured by performance metrics. As you can surmise, this approach is heavily data-driven and requires providers to understand how to calculate their cost of care and their value, how to benchmark, and how to forecast. In this course, you will learn about the current healthcare landscape and how networks and providers margins are not improved by providing their members with the highest quality of care. You will then learn about value-based payments; a promising method for payers that helps to quantify the quality and value of care while sharing accountability and risk with providers. Finally, you will be exposed to various payment models, strategies, and concerns as you attempt to maximize your value of care and margins.