Transitioning to Alternative Payment Models

by Doral Jacobsen and Nanci Robertson, Nanci Robertson

Overview

This book's goal is to offer medical practice leadership teams practical guidance on navigating the shift from volume-based to value-based managed care contractual relationships. Medical practices - both independent and affiliated - that understand how their organization can and should position themselves for the future will have a significant advantage over the competition.

Honestly identifying where you are and defining where you want to be begins with developing a clear understanding of national and local market dynamics, identifying potential arrangements within your local market and applying those factors to your organization's goals. This exercise can ultimately inform your value proposition, which becomes the cornerstone of your managed care contracting strategy.

The book will cover in detail the most common alternative payment models and what your practice should do to prepare for this transition.

Models detailed include:

• - Pay for performance
• - Bundled payments
• - Shared savings
• - Capitation

Product Details

ISBN-13:	9781568294902
Publisher:	MGMA
Publication date:	12/31/2016
Pages:	184
Product dimensions:	7.00(w) x 10.00(h) x 0.40(d)

About the Author

Doral Jacobsen, MBA, FACMPE is CEO of Prosper Beyond, Inc., a specialized healthcare consulting firm nestled in beautiful Asheville, North Carolina.Doral is a seasoned healthcare consultant with over 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for 'what's next.'Doral is known for assisting practices with next generation managed care contract negotiations, revenue cycle and payment reform. She is a Fellow in the American College of Medical Practice Executives. Doral graduated from Florida Atlantic University with a bachelor's in health services and obtained her master's in business administration from Webster University in Denver, Colorado.Doral has authored numerous articles on medical practice revenue cycle, managed care contracting and payment reform, and is a frequent speaker at national, regional and local healthcare forums.

Nanci L. Robertson, RN, BSN is a healthcare consultant specializing in managed care contracting. Nanci has 30 years of experience working in the healthcare field. Her primary emphasis is negotiating managed care contracts on behalf of physicians, Independent Practice Associations and ancillary providers.Prior to starting Robertson Consulting, Inc. in 2000, Nanci worked in several clinical positions as a Registered Nurse. Her managed care experience included managing and directing the Health Services, Provider Relations and Provider Contracting Department for a national carrier. Additionally, Nanci served as the Site Administrator for a physician management organization responsible for the implementation of global capitation contracts for commercial and Medicare populations.Most recently, Nanci spends her time putting together the puzzle pieces of healthcare reform. Her primary goal is to provide calm in the midst of chaos by assisting her clients with clear, concise, actionable work that promotes the Triple Aim and develops a long-term vision and strategy in the rapidly changing healthcare environment. Nanci holds a Master of Arts in Organizational Development from the University of Phoenix and a Bachelor of Science in Nursing from Loretto Heights College.

Table of Contents

Acronyms

Chapter 1: Introduction

Chapter 2: Triple Aim

Chapter 3: Narrow Networks

Chapter 4: Patient Liability

Chapter 5: Transparency

Chapter 6: Quality Metrics

Chapter 7: Connecting the Dots

Chapter 8: Fee-for-Service

Chapter 9: Pay-for-Performance

Chapter 10: Bundled Payments - Episodes of Care

Chapter 11: Shared Savings

Chapter 12: Capitation - Global Payment

Chapter 13: Setting up to Succeed

Chapter 14: Conclusion

About the Authors

Index