01 Mar Announcing a new book geared towards helping healthcare professionals transition to new payment models.
This book is described here on the publisher’s website.
This book’s goal is to offer medical practice leadership teams practical guidance on navigating the shift from volume-based to value-based payer 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
Gain real-world insight into managed care contracting best practices including:
- Practical guidance for developing a powerful value proposition to use in contract negotiations.
- Contracting check lists for each type of reimbursement model.
- Practical tips to incorporate MACRA program elements into your managed care contracting strategy.
- A how-to guide for assessing payment models and approaching payer partners in today’s environment.
- Clear examples of how the math works in these models, including attributes, key drivers and negotiation considerations.
- And more!
Table of Contents
TRANSITIONING TO ALTERNATIVE PAYMENT MODELS
CHAPTER 1 … Introduction 1
CHAPTER 2 … Triple Aim 11
CHAPTER 3 … Narrow Networks 15
CHAPTER 4 … Patient Liability 27
CHAPTER 5 … Transparency 31
CHAPTER 6 … Quality Metrics 35
CHAPTER 7 … Connecting the Dots 39
CHAPTER 8 … Fee-for-Service 43
CHAPTER 9 … Pay-for-Performance 61
CHAPTER 10 .. Bundled Payments —Episode of Care 83
CHAPTER 11 .. Shared Savings/Risk 101
CHAPTER 12 .. Capitation — Global Payment 119
CHAPTER 13 .. Setting up to Succeed 147
CHAPTER 14 .. Conclusion 169
About the Authors 171
Nanci & Doral have succeeded in presenting a thorough review of the healthcare transformation from fee for service to value based evolution. This book will serve as a valuable resource tool for practicing physicians, physician executives, practice managers, and health plan executives who seek to stay ahead of the rapid changes in healthcare.
Ellen Burkett, MD, Medical Director, MedSouth, Inc., (clinically integrated IPA) and practicing physician, internal medicine.
In working with healthcare providers across the country, I’ve found that every market is at various stages of the transformation from volume to value. This book is an essential tool for providers and practice leaders to refer to as their particular market advances. The knowledge shared in this book is an invaluable resource to have on hand in this time of immense change in the industry wherever your market is in the transition from volume to value.
Karen Lloyd, Director, Health Care Practice, Wipfli LLP CPAs and Consultants
A thoughtfully and well written ‘go to’ guide of the ever changing and complexities of the delivery system and strategies that are evolving in the health care markets. Taking those complexities and helping to define strategies that are very useful regardless of what side of the negotiation table you reside are extremely helpful. We all need to work together for a better system and I truly respect the balanced effort that this book provides.
Janet Pogar, Regional Vice President, Anthem Blue Cross and Blue Shield.
An excellent resource on Alternative Payment Models, proving insightful information physicians need to frame discussions with payers.
Winifred Bragg, MD, Spine and Orthopedic Pain Center, PC
A simply stated but elaborately researched book that provides an easy to understand road map for managed care contracting in a value based payment world…a must-have desk reference for Physician Practice Executives.
Carol Campbell, Vice President, Integrated Health and Physician Services, Murphy Medical Center
Real world guidance on a complex subject that will prove essential in guiding our evolution in these new models.
Margaret A. Bumgarner, FACMPE, FACHE Vice President, Clinic Operations Kaua’i Medical Clinic