This course will examine the factors that influence healthcare costs as well as the solutions that have been proposed to address cost, quality, and value in health care. Many blame high healthcare costs on payment models that pay healthcare providers for each service they provide to patients, essentially paying more for volume and service intensity. This is referred to as the Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable ones, include combining new payment models, care management, insurance plan designs, consumer engagement tools, and technology.
Using that data, we will look at a variety of scenarios, highlighting coordinated care and payment strategies that can be implemented to improve patient health and reduce the cost of healthcare delivery.
By the end of this course, the learner should be able to :
- Determine the drivers and trends in healthcare spending from the perspectives of various stakeholders, such as medical providers, insurers, government and private purchasers, and payment systems.
- Evaluate critically the impact of the ACA's strategic and financial approaches, as well as the various modifications.
- Assess the current state of healthcare payment models as well as the new direction that value-based payment is taking.
- Determine how financial and non-financial metrics can be effectively combined to improve the value proposition of healthcare stakeholders.
1. Current Healthcare Spend and Trend
- Course Introduction
- Introduction to Module
- What's the Fuss? Part 1
- What's the Fuss? Part 2
- Healthcare Differs from Other Transactions
- Sources of Funds
- Uses of Funds
- Healthcare Spend
- Healthcare Trend
- Article Intro: "Cost Conundrum"
- Consumer Perspective: Person-on-the-Street Interview: Cathy
- Consumer Perspective: Person-on-the-Street Interview: Keith
2. I Thought we were done with this: Insurance Markets
- Week 2 Introduction
- How Does Insurance Work?
- Risk Pooling
- Selection Impact on Risk Pools and Premium Cost
- Background on U.S. Health Insurance
- Affordable Care Act
- Access to Insurance
- Interview with Mark Guanya: Part 1
- Medicare Changes
- Insurance Sources
- Article Introduction: "The Bitter Pill"
3. Value-Based Payment Models
- Week 3 Introduction
- Contractual Reforms to Address Cost and Trend
- Managed Care
- Article Introduction: Dealing with Medical Practice Variations
- Fee-for-Service Payment Models
- Bundled Payments
- Healthcare Differences
- Medical Homes
- Capitation or Salary
- Reference Pricing and the Consumer
- What Drives Results?
- Interview with Mark Guanya: Part 2
4. Evolving Integrated Models: Putting It All Together
- Week 4 Introduction
- Congestive Heart Failure (CHF)
- Article Introduction
- Spine Care
- Article Introduction
- Iora Health
- Course Summary