Value-Based Care Reimbursement Models

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.

• Explain fee-for-service medical coding and payment mechanisms and why fee-for-service leads to higher costs without clearly improving outcomes.

• Describe the range of value-based payment options from the HCP-LAN Alternative Payment Model framework.

• Describe the importance of risk adjustment, quality scores, and patient satisfaction measures in value-based care contracts.

Syllabus

Syllabus - What you will learn from this course
Week 1
From Fee-For-Service to Value-Based Payments
Week 2
Quality and Risk Adjustment in Value-Based Payments
Week 3
Course Project: Making This My Own

FAQ

When will I have access to the lectures and assignments?

Access to lectures and assignments depends on your type of enrollment. If you take a course in audit mode, you will be able to see most course materials for free. To access graded assignments and to earn a Certificate, you will need to purchase the Certificate experience, during or after your audit. If you don't see the audit option:

What will I get if I subscribe to this Specialization?

When you enroll in the course, you get access to all of the courses in the Specialization, and you earn a certificate when you complete the work. Your electronic Certificate will be added to your Accomplishments page - from there, you can print your Certificate or add it to your LinkedIn profile. If you only want to read and view the course content, you can audit the course for free.

Is financial aid available?

Yes. In select learning programs, you can apply for financial aid or a scholarship if you can’t afford the enrollment fee. If fin aid or scholarship is available for your learning program selection, you’ll find a link to apply on the description page.

Is this activity accredited for Continuing Medical Education (CME)?

The American Academy of Family Physicians (AAFP) has reviewed Value-Based Care: Reimbursement Models and deemed it acceptable for AAFP credit. Term of approval is from 01/01/2021 to 12/31/2021. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Following this CME activity, participants will have the opportunity to earn an additional two Prescribed credits for participation in the Translation to Practice® exercise. Information on Translation to Practice® will be shared within the activity. Credit approval includes the following sessions:

3.00 Enduring Materials, Self-Study AAFP Prescribed Credit(s) - Value-Based Care: Reimbursement Models

2.00 Enduring Materials, Self-Study AAFP Prescribed Credit(s) - Value-Based Care: Reimbursement Models- Translation To Practice

Reviews

Its an excellent course with a lot of insights on how to develop models of reimbursement. Its very specific to the US however, and examples from other countries would be useful.