The healthcare landscape is rapidly changing, as new payment and program models evolve that reward healthcare organizations based on the value of their care. Previously, increasing the quality of care provided was financially counterproductive. Provider’s margins would shrink as the quality of care increased due to the inherent costs of providing high-quality care, fewer reimbursable visits needed by healthy clients, and the lack of increased reimbursement based on outcomes. Now, with a new incentive model referred to as value-based payments, how much a provider can earn is directly tied to the quality of care offered, as measured by performance metrics. As you can surmise, this approach is heavily data-driven and requires providers to understand how to calculate their cost of care and their value, how to benchmark, and how to forecast.
In this course, you will learn about the current healthcare landscape and how networks and providers’ margins are not improved by providing their members with the highest quality of care. You will then learn about value-based payments; a promising method for payers that helps to quantify the quality and value of care while sharing accountability and risk with providers. Finally, you will be exposed to various payment models, strategies, and concerns as you attempt to maximize your value of care and margins.
The healthcare landscape is rapidly changing, as new payment and program models evolve that reward healthcare organizations based on the value of their care. Previously, increasing the quality of care provided was financially counterproductive. Provider’s margins would shrink as the quality of care increased due to the inherent costs of providing high-quality care, fewer reimbursable visits needed by healthy clients, and the lack of increased reimbursement based on outcomes. Now, with a new incentive model referred to as value-based payments, how much a provider can earn is directly tied to the quality of care offered, as measured by performance metrics. As you can surmise, this approach is heavily data-driven and requires providers to understand how to calculate their cost of care and their value, how to benchmark, and how to forecast. In this course, you will learn about the current healthcare landscape and how networks and providers’ margins are not improved by providing their members with the highest quality of care. You will then learn about value-based payments; a promising method for payers that helps to quantify the quality and value of care while sharing accountability and risk with providers. Finally, you will be exposed to various payment models, strategies, and concerns as you attempt to maximize your value of care and margins.
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Arkansas State Board Of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
As a Jointly Accredited Organization, Relias LLC is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Relias LLC maintains responsibility for this course. Social workers completing this course receive 1.00 General continuing education credits.
Provider approved by the California Board of Registered Nursing, CEP# 13791
Nurses will receive 1.00 contact hours for participating in this course.
This program has been pre-approved by The Commission for Case Manager Certification to provide 1.0000 hours of continuing education credit to CCM® board certified case managers.
District of Columbia Board of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling (CEBroker Provider #50-290)
Florida Board of Nursing (CEBroker Provider #50-290)
Georgia Board of Nursing (CEBroker Provider #50-290)
Kentucky Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Mississippi Board of Nursing (CEBroker Provider #50-290)
New Mexico Board of Nursing (CEBroker Provider #50-290)
Relias, LLC is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0009.
Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of licensed master social work and licensed clinical social work in New York. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice for an LMSW and LCSW. A licensee who practices beyond the authorized scope of practice could be charged with unprofessional conduct under the Education Law and Regents Rules.
As a provider of online, asynchronous education, some courses offered by Relias Learning are considered “self-study” under section 74.10(c)(2)(ii)(b)(4) of the Commissioner’s Regulations. The regulations limit self-study activities taken from a provider approved by the Education Department to no more than 12 hours in the 36-month registration period or one-third of the hours in a registration period other than 36 months.
Social workers will receive 1.00 continuing education hours for participating in this course. This activity is approved for 1.00 contact hours.
North Dakota Board of Nursing (CEBroker Provider #50-290)
Ohio Counselor, Social Worker and Marriage and Family Therapist Board (CEBroker Provider # 50-290)
South Carolina Board of Nursing (CEBroker Provider #50-290)
South Carolina Board of Social Work Examiners (CEBroker Provider 50-290)
West Virginia Board of Registered Nursing (CEBroker Provider #50-290)
West Virginia Board of Social Work (CEBroker Provider #50-290)
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: The Current Healthcare Landscape
Jacob’s Story
Health Outcomes
Social Determinants of Health
Integrating to Improve Member Health
Can Cost, Quality, and Experience Co-Exist?
Review
Summary
Section 3: Introduction to Value-Based Payments
What are Value-Based Payments (VBP)?
How Do You Define Quality?
Measuring Quality
Conceptualizing Value in a VBP Model
Value is Relative
Achieving High Value in a VBP Model
Review Exercise: Where Does My Network Stand?
Summary
Section 4: Value-Based Models In-Depth
Integration, Accountability, and Risk in a VBP Model
Sharing of Accountability and Risk
Example in Action: Capitation
Making the Most of a VBP Model: Organization-Level Factors
Making the Most of a VBP Model: Data
Care Management in a VBP Model
Challenges and Barriers in a VBP Model
Review
Summary
Section 5: Conclusion
Course Summary
Course Contributors
References
Kathleen Matson is the Nurse Administrator for Nursing Resources at Mayo Clinic in Arizona. Kathleen has 39 years of hospital experience, with at least 25 of those years spent in different nursing administration roles. She has published on leadership and has been a featured speaker on the topic of managing staffing resources at national conferences. Kathleen is an Assistant Professor for Nursing with the Mayo College of Medicine and Adjunct Faculty at Grand Canyon University Colleges of Nursing and Health Sciences. Kathleen has her MHA and MSN degrees, is a Board Certified Nurse Executive. She is currently a candidate for a Doctoral Degree in Health Administration from the University of Phoenix.Writer: Nicole Strickland, BA, BSN, RN, CPAN
Nicole Strickland, BA, BSN, RN, CPAN has cared for patients at every acuity level over more than a decade as a nurse. She has devoted much of her nursing career to training nurses and nursing students as a Certified Post Anesthesia Nurse (CPAN). She holds a BA in English Language and Literature from Temple University and worked as a medical editor for the National Board of Medical Examiners before returning to school to obtain a BSN from Duke University. She is now pursuing a M.Ed. in Learning Design and Technology from The University of North Carolina at Charlotte while continuing her passion for the creation of evidence-based and engaging education as an acute care SME writer at Relias.
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