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Value-Based Care: Reimbursement Models
  • Level Foundation
  • Duration 5 hours
  • Course by University of Houston
  • Offered by

About

COURSE 4 of 7. This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. You will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts. CME Accreditation The American Academy of Family Physicians (AAFP) has approved this course for Continuing Medical Education Prescribed Credits. Visit the FAQs for important information regarding 1) Term of approval and 2) Accreditation and Credit Designation statements.

Modules

Introduction to Module 1

    • 3 Videos
    • 1 Plugin
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3 Videos

  • If this is your first VBC course, please watch our Welcome.
  • How This Course Works
  • Level Set

CPT and ICD Codes

    • 3 Videos
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3 Videos

  • Current and Historical Reimbursement Models
  • CPT (Current Procedural Terminology) Codes
  • ICD (International Classification of Disease) Codes

Fee-For-Service and Value-Based Care

    • 4 Videos
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4 Videos

  • Fee-For-Service: Volume Not Value
  • Population Costs and Value: Think Like an Insurance Company
  • Moving to Value
  • Examples of Current Value-Based Arrangements in Traditional Medicare

Module 1 Wrap-Up

    • 1 Discussion
    • 1 Assignment
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1 Assignment

  • Module 1 Quiz

1 Discussions

  • Fee-For-Service to Value-Based Payments

Sources To Explore (Optional Resources)

    • 2 Readings
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2 Readings

  • Explore the Optional Resources for Module 1
  • References for Module 1

Risk Adjustment

    • 4 Videos
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4 Videos

  • The History and Purpose of Risk Adjustment
  • The Role of Risk Adjustment in Value-Based Care and Payment Models
  • Medicare Risk Adjustment (MRA) Payment Model
  • Risk Adjustment Is a Collaborative Effort

Measuring Quality

    • 5 Videos
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5 Videos

  • Measuring and Paying for Quality
  • Medicare Star Rating Program Framework
  • Consumer Assessment of Healthcare Providers and Systems
  • HEDIS
  • Patient Safety Measures

Payment Models

    • 2 Videos
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2 Videos

  • Comprehensive Population-Based Payment Models from HCP-LAN
  • A Value-Based Payment Spectrum

Module 2 Wrap-Up

    • 1 Discussion
    • 1 Assignment
Show info about module content

1 Assignment

  • Module 2 Quiz

1 Discussions

  • Quality and Risk Adjustment in Value-based Payments

Sources To Explore (Optional Resources)

    • 1 Readings
Show info about module content

1 Readings

  • Explore the Optional Resources for Module 2

Reimbursement Models Summative Assignment

    • 1 PeerReview
    • 1 Plugin
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1 Peer Review

  • Peer Review

Auto Summary

Unlock a comprehensive understanding of the evolving landscape of U.S. healthcare payments with our "Value-Based Care: Reimbursement Models" course, a pivotal part of a seven-course series within the Health & Fitness domain. This course delves into the intricacies of medical coding and the traditional fee-for-service model, shedding light on its contribution to rising healthcare costs without clear improvements in health outcomes. Under the expert guidance of Coursera, you’ll investigate the importance of accurate coding for chronic conditions and other diagnoses, and gain insights into the value-based care framework developed by the Health Care Payment Learning and Action Network (HCP-LAN). You'll explore various value-based payment options, and understand how elements like risk-adjustment, quality scores, and patient satisfaction are integral to these models. Designed for those seeking foundational knowledge, this course is perfect for healthcare professionals looking to enhance their understanding of modern reimbursement models. With CME accreditation from the American Academy of Family Physicians, participants can also earn Continuing Medical Education credits upon completion. The course spans approximately 300 minutes and is accessible through Coursera's Starter subscription. By the end, you'll be equipped to compare fee-for-service and value-based contracts, advocate for precise documentation and coding, and appreciate the role of risk-adjustment and patient satisfaction in value-based care contracts. Join us to transform your approach to healthcare reimbursement and contribute to a more efficient and effective healthcare system.

Susie Gronseth
Instructors

Susie Gronseth

Sara G. McNeil
Instructors

Sara G. McNeil