Types of Reimbursement – Health Care Policy (Nursing)

00:00 Welcome back, everyone.

00:02 In today's health care environment, organizations and providers strive to be efficient with sometimes limited resources.

00:08 One way to help support this goal is to understand current reimbursement models.

00:13 The healthcare industry is experiencing a transformation involving reimbursement payment models.

00:19 Currently, there are two models: fee for service and value-based care.

00:23 Let's look at each one individually.

00:25 The Fee-for-Service, this is the most traditional payment model.

00:29 Reimbursement is based on the number of services provided and payments are made separately for each one of those.

00:36 Now sometimes payments may be made for services not needed or may not be based on current evidence.

00:44 Value-based Care.

00:45 In value-based care, clinicians really consider the quality and outcomes of care provided.

00:50 They strive for efficiency.

00:52 They consider best practices.

00:55 They encourage a holistic team approach to care.

00:59 They require coordination and communication between physicians across specialties.

01:04 Now let's look at the different types of value-based payment models.

01:08 First, pay-for-coordination.

01:10 This is where a primary care physician leads and coordinates care between multiple providers and specialists to manage a united care plan for patients and to ensure efficiency and quality.

01:20 Pay-for-performance.

01:22 Health care providers are incentivized to meet certain quality and efficiency benchmark measures.

01:27 Bundled payment or episode-of-care payment.

01:30 This encourages quality and efficiency because healthcare providers are reimbursed with a set amount of money to pay for a specific episode of care, such as a hip replacement, and any complications.

01:41 And, finally, shared savings programs.

01:45 Physicians form entity groups and provide population health management.

01:49 Quality and efficiency are achieved through coordinated team care and any realized net savings are given back to the provider.

01:57 Now let's look at fee-for-service versus value-based care.

02:00 In fee-for-service, patients face difficulty navigating a very complicated system alone.

02:06 The patients may see multiple doctors, specialists, and surgeons who do not communicate with each other.

02:12 And providers lack the technology and the incentives to coordinate patient care across the healthcare continuum.

02:18 Now in value-based care, this rewards physicians for providing appropriate coordinated care that keeps patient populations healthy.

02:25 It encourages healthcare providers to engage with patients.

02:29 And finally, it delivers a connected care experience where patients receive more cost-efficient, coordinated, appropriate, and effective care.

02:37 So, remember, value-based care incentivizes cost efficiency and quality and create structures that reward physicians for coordinated, appropriate, and effective care.

02:47 So in thinking about what we've covered today, I'd like you to consider this question.

02:51 What are four types of value-based payment models? They are pay-for coordination, pay-for-performance, bundled payment or episode-of-care payment, and shared savings programs.

03:11 I hope you've enjoyed today's video on reimbursement models.

03:13 Thanks so much for watching.