The health insurance industry is shifting dramatically in the methods they are using to determine the payment for patient services. The previous “fee-for-service(FFS)” system, which paid providers based on the quantity of specific services furnished, is rapidly transforming.
Now, health plans are instituting “value based payments;” methods where the quality and outcome of services to patients are used to determine or adjust provider payments. Such models as Accountable Care Organizations, Bundled Payments, and quality based bonuses are being used today. These models place a premium on data collection and analysis, and require a different set of information be collected by providers for each of their patients. We will provide an overview of the models, and the specific data elements which need to be collected to assure providers can succeed under these new models.
Why you should attend
Provider business models have not changed significantly over the last several years. Business practices still focus on collecting insurance information, and patient co-insurance and deductibles as the revenue stream. Under FFS, that might be all that was necessary. However, providers are facing new requirements from health plans to get paid the appropriate amount for their services. Medicare now requires quality and cost information for many of their programs to adjust payments, award bonuses, and reduce reimbursements. Providers are expected to show they are operating at a high level of quality, efficiency, and patient satisfaction. Not meeting health plan standards results in reduced payments and reduced referrals, as well as poor ratings on public websites.
It is difficult for providers to even track their progress against goals on a patient by patient basis. Providers may not even know that their patients are part of a value based program. It will be critical for providers to collect the right data to understand their patient population, health plan requirements, and progress towards goals.