Value-Based Reimbursement Models: Assessing Community Needs in the Healthcare Payment System

ASSIGNMENT INSTRUCTIONS:

Identify an aspect of the health care payment system.
Provide an overview of the criteria and parameters for implementation.
PAYMENT SYSTEM IS: Value-Based Reimbursement Models
MY TOPIC OF THE PRESENTATION IS: Does the payment system meet community needs?
The presentation is original work and logically organized. Followed current APA format including citation of references.
The powerpoint presentation with slides was clear and easy to read. Speaker notes expanded upon and clarified content on the slides.
Your PowerPoint presentation should be formatted per APA and references should be current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions).
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to the current APA style (the library links to an external site. that has a copy of the APA Manual).

HOW TO WORK ON THIS ASSIGNMENT (EXAMPLE ESSAY / DRAFT)

Over the past ten years, the healthcare payment system has seen a considerable upheaval with a move toward value-based compensation models. A system that rewards healthcare providers based on the caliber of treatment they offer has taken the place of the traditional fee-for-service model, in which clinicians were paid for each service rendered. Value-based reimbursement models aim to save healthcare costs while enhancing patient outcomes. This essay looks at whether the payment system satisfies community demands and provides an outline of the requirements and parameters for establishing value-based reimbursement models.

Criteria and Implementation Parameters

Specific requirements and constraints must be addressed before value-based reimbursement models may be implemented. The following standards for value-based reimbursement models have been created by the Centers for Medicare and Medicaid Services (CMS):

measurements of quality: The payment system must include evidence-based, patient-centered quality measurements.

Measures of outcomes – The payment system must incorporate measures of outcomes that are pertinent and significant to patients, such as lowering hospital readmission rates and raising patient satisfaction.

Cost measures: To motivate providers to offer cost-effective care, the payment system must track healthcare expenses, including expenditures associated with pointless tests and procedures.

Engagement of providers – To improve patient outcomes, the payment system must promote provider engagement, including cooperation and communication between healthcare professionals.

Patient involvement – To improve patient outcomes, the payment system must promote patient involvement, including patient education and participation in decision-making.

Does the Payment System Meet the Needs of the Community?

Value-based reimbursement models have been implemented, and improvements to patient outcomes and decreases in healthcare expenditures have been encouraging. It is still unclear, though, if the payment method satisfies community demands. When implementing value-based reimbursement models, the needs of the community must be taken into account because the payment system must be created to meet the specific healthcare requirements of the community.

Value-based reimbursement models had a favorable influence on quality and patient outcomes for Medicare enrollees in urban areas, according to a study by Song et al. (2021). The same study did discover, however, that rural areas had lower quality ratings than urban areas, suggesting that value-based reimbursement models would not be as successful in rural locations. In a different study by Tsugawa et al. (2020), it was discovered that value-based reimbursement models decreased healthcare expenses but did not raise quality ratings at safety-net hospitals, which treat patients with limited financial resources and no insurance.

Conclusion

Value-based reimbursement models have been put in place to enhance patient outcomes while lowering medical expenses. Quality measures, outcome measures, cost measures, provider and patient participation, as well as other conditions have been set forth by the CMS for the implementation of the payment system. Value-based reimbursement models must take into account the community’s particular healthcare demands even if studies have indicated that they can improve patient outcomes and save healthcare expenditures. The efficiency of the payment system in meeting the particular requirements of various communities must be further investigated.

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