Why VBC?
How is VBC different from fee-for-service?
Providers are paid for health outcomes rather than services performed
_______ refers to how expensive a patient is likely to be.
Risk
Pay-for-performance was started by the _______ Act?
Affordable Care
Optum Coding (a product that helps providers bill for individual services) is designed for what type of payment?
Fee-for-service
Before the emergence of VBC, what type of care focused on controlling costs but not improving quality?
Managed care (this is when the concepts of bundled and capitated payments first came about, but no focus yet on quality and health outcomes)
What is the difference between bundled and capitated payments?
Bundled payments are a flat rate payment for single episode (ex: knee surgery)
Capitated payments are a flat rate for a single person’s whole constellation of healthcare needs
Independent Practice Associations are a type of ______.
Risk-bearing organization
UHC Spine & Joint Solutions offer employers access to UHC centers of excellence that pay surgeons a flat rate for an entire procedure; this is an example of _____
Bundled payments
Describe why VBC is important to UHG.
VBC is one of UHG’s five strategic growth pillars
_______ pays providers a “bonus” amount for quality based activities. It’s used as a way to nudge providers towards VBC.
Pay-for-performance
What is the difference between ACO and IPA?
ACOs are formed when a group of doctors, hospitals, and other health care providers come together; IPAs are formed when a group of physicians come together; both operate similarly
_______ are helping providers use EHRs to report on and improve quality measures and claims reporting.
Health Information Networks
Give an example of how VBC is influencing emerging technology
One possible answer: Current health technology focuses on billing but VBC focuses on quality tracking, coordination, and efficiency, creating new technology opportunities
Payers are increasingly pushing for more _____ risk arrangements? Why?
Two-sided; to put more cost accountability on providers
Name one way that CMS began tackling healthcare costs after enactment of the ACA.
Rolling out discrete bundled payment programs, followed by upside risk only arrangements, and then pushing providers to accept two-sided risk
Optum Behavioral Health Medication-Assisted Treatment Network gives behavioral health providers the freedom to provide non-billable services (like follow-up calls) because it uses ________ to pay providers.
Capitated payments
What components make up the Triple Aim?
1. Improving the health of populations
2. Reducing the per capita cost of health care
3. Improving the patient experience of care
Describe what a risk pool is.
In a capitation agreement, a risk pool is an agreed-upon percentage of the capitation amount that’s withheld from providers. Withheld funds are used to pay specialists and to settle deficits. Remaining funds are split between the health plan and providers at the end of the contract term.
Describe the 3 challenges that providers may face when trying to implement VBC.
1. The existing burden on providers alongside the added stress of new quality tracking, patient care methods, and any other process improvements can result in further provider burnout
2. Care coordination and attentiveness to patient experience increases the number of touchpoints and administrative burden
3. Access to the right tools, resources, and analytics to make informed decisions about closing gaps in care
Health Net California and John Muir Health came together to form a ________. Describe what this collaboration is an example of?
ACO; this is an example of collaboration between providers and payers working together to achieve shared quality and cost savings