Fee-for-Service
FFS definition
What is healthcare providers being paid a separate fee for each service or procedure they perform?
Value Based Care definition
What is a fixed, upfront monthly payment per patient given to a doctor or clinic, regardless of how many times the patient visits?
Bundled Payments definition
What is a single, fixed reimbursement given to health care providers for all services and supplies required to treat a specific medical condition or procedure during a defined?
ACOs Definition
What are groups of doctors, hospitals, and other health care providers who unite voluntarily to give coordinated, high-quality care to a specific group of patients?
Cash/Credit Definition
What is allowing patients to pay for medical services out-of-pocket, via standard credit/debit cards, or through specialized financing?
FFS cons
What is overutilization, increased costs, and less focus on patients?
Paitent Centered Care definition
What is doctors and hospitals being paid adequately to cover the real costs of delivering high-quality, evidence-based care tailored to each patient’s needs?
The amount of money set for a payment is not enough due to complication
What is the risk sharing model for uncertainties that predefines prices and how gains and losses will be split between the insurance and the provider?
Doctor Payment
What is being paid as a team for keeping the paitent healthy?
When patients usually pay without an insurance claim
What is being uninsured or having a high deductible?
FFS pros
What is providers promoting a wide range of services and simplicity?
Value Based Care pros and cons
What is predictable revenue, preventive focus, and cost control?
What is financial risk, risk of undertreatment, and over-enrollment?
Bundled Payment Pros
What is provide a single, fixed payment for an entire episode of care, lower costs, and simple billing?
The Goal
What is stopping you from getting super sick in the first place?
Helps patients pay over time if they can’t afford an immediate large payment
What are medical credit cards?
Where the payment comes from
What is insurance and self-payment?
Patient Centered Pros and Cons
What is fair compensation for complexity, focus on prevention and health, aligned quality incentives, and improved quality of care?
What are measurement difficulties, risk of under-treatment, and initial costs?
First step in a Bundled Payment
What is setting a specific timeframe and amount of money?
The Reward
What is the big insurance group giving the doctor team a bonus reward of extra money to share if you stay healthy and they don't waste money on repeat tests?
Cash-to-card kiosks purpose
What is converting physical cash into a prepaid credit card?
Types of services
What are surgeries, visits, tests, and treatments (glasses, physical therapy, etc)?
Types of Capitation
What is full capitation, partial capitation, and blended capitation?
Bundled Payment Examples
What are the initial consultation, pre-surgical testing, the surgery itself, hospital stay, post-surgical care, physical therapy and follow-up visits?
The Rule
What is not getting extra reward money for doing a sloppy job and you getting sicker because they didn't talk to each other?
Major Payment Networks
What is Mastercard, Visa, American Express, and Discover?