HCAD 640 Assignment 1: Reimbursement
You are the associate vice president for education and training for OtroRaza Health, the academic medical center and health system associated with Enormous State School of Medicine (ESSM). The vice president of medical affairs comes to you concerned about the viability of the school’s residency programs. Several of ESSM’s residency site stakeholders are seeking clarification regarding new reimbursement models being used by the system. Prepare a white paper – for the VP of Medical Affairs to share with the residency sites — outlining the differences between the new reimbursement models and prior, traditional models for stakeholders.
In your response, include the following:
- Description of each model, such as capitated payments, fee-for-service, including new and emerging models being introduced to the industry, such as value-based, MACRA, and others.
- In your review, compare and contrast the traditional and new models and explain the motivation / reasons for the emerging models. Finally, based on this evidence, describe what impact (if any) you perceive there would be on the cost, quality and access to patient care. Support your research with peer-reviewed sources and/or market data. use current reference sources, those published in the last 3-5 years. The use of professional charts / graphs to reinforce written content is encouraged. Ensure that your content and information is professional and can be followed by an executive audience.
Several example white paper formats can be viewed at: https://venngage.com/templates/. A free downloadable sample white paper can be found at: https://www.microsoft.com/en-us/download/details.aspx?id=17731.
Note: your product does not need to be this robust, but should follow the same basic framework.
Expert Solution Preview
Introduction:
This assignment requires a white paper outlining the differences between new reimbursement models and prior traditional models for stakeholders. The students are expected to explain both the traditional and emerging models and compare and contrast them, highlighting the motivation behind the emergence of the new models. Furthermore, students should describe the perceived impact of the new models on healthcare cost, quality, and access to patient care.
Answer:
Reimbursement for healthcare services is the process by which healthcare providers get compensated for the care they deliver. Historically, reimbursement models in the healthcare industry have been fee-for-service, where providers charge for individual services. In recent times, new reimbursement models have emerged, such as capitated payments, value-based, MACRA, and others.
Capitated payments involve providers receiving a fixed payment per patient, regardless of the services provided. Value-based reimbursement models shift the focus from the volume of services to the quality, with providers receiving bonuses for quality outcomes. MACRA is a reimbursement model that pays providers based on the value of healthcare services delivered.
The traditional model focuses on reimbursing providers for individual services provided with no consideration for the outcome or quality of care. On the other hand, new models emphasize the value of care, promoting quality care delivery and preventing unnecessary treatments and tests.
The motivation for emerging models is to incentivize providers to deliver quality care without incurring additional costs. Fee-for-service models have been criticized for promoting unnecessary procedures leading to higher costs and lower quality.
The impact of the new models on healthcare costs, quality, and patient access is considerable. The capitated model reduces the cost of healthcare, as providers are reimbursed for a fixed number of services regardless of the number of procedures or tests conducted. Quality-based models, such as value-based reimbursement, lead to improved overall care quality, as providers focus on outcomes rather than the volume of tests or services provided. The MACRA model encourages the delivery of value-based care and promotes quality outcomes.
Furthermore, these new models promote better care access, especially for vulnerable populations. With the value-based models, providers are incentivized to deliver preventive care, ultimately reducing hospital admissions. This way, the cost of healthcare is lowered, and access to care is expanded.
In conclusion, emerging reimbursement models are a shift from the traditional fee-for-service models. Their emergence is motivated by the need to promote quality care, reduce costs, and expand access to care for all. These new models promote preventive care and incentivize providers to deliver quality care. As such, the new reimbursement models are poised to make healthcare delivery more effective and affordable for patients.
