Programa especializado: Value-Based Care

COURSE 1 of 7. This course is designed to introduce you to the concept of value-based care (VBC). While the information you will explore is general, it will help you establish a solid foundation for continued learning and future thinking about the concept of VBC. Through a historical lens, you will explore the creation of Medicare and Medicaid and the evolution of commercial insurance, TRICARE, and the Veterans Health Administration. While history is an important filter for understanding healthcare in this country, you will learn how each of these mechanisms emerged, the populations served, and what changes occurred over time, with a focus on funding and expenditures. In addition, this course will help you establish a firm foundation for understanding the development and evolution of quality measures and outcomes in healthcare. By developing an understanding of what quality is and how it is measured, you can begin a knowledge-building exploration of the components of quality in healthcare. Why is this important? In value-based care models, providers must meet quality measures and improve the health outcomes of their patients. In the summative assignment, you use a national system of quality measures to develop a plan that would positively impact value within your healthcare organization.

COURSE 2 of 7. This course is designed to introduce you to the concept of population health and related key terms. Refine your understanding of population health and what influences health care costs. Gain an overview of population health management, beginning with a high-level review of four critical areas: addressing behavioral and social determinants of health, the prevalence of chronic disease, attributes of an aging population, and key barriers of access to health care. Use the Population Health Pyramid to organize a care delivery system to meet the needs of population groups—all with an eye towards achieving better outcomes through the fundamental premise of value-based care. In the summative assignment, bring together the elements of a community health assessment and community health improvement plan into a logical and organized whole by selecting a particular community that is important to you, applying data, and determining relevant assets.

COURSE 3 of 7. This course is designed to introduce you to critical office-based processes that a value-based practice must manage in the drive towards improved patient outcomes. In Module 2, we’ll focus on office-based and clinical patient-based supporting functions. At every level in healthcare, guidelines, processes, and functions exist to improve outcomes, and following a consistent process will return the best effect. Refine your understanding of value and learn strategies to provide real assistance to patients to manage chronic diseases and navigate the complex healthcare system. Gain an overview of panel management, a systematic, proactive approach to identify and address unmet chronic and preventive care needs of patients that leads to better health outcomes. Learn how clinical patient-based questions related to immunizations, cancer screenings, or diabetes care can generate data to support a strategy of identifying non-utilization patterns. In the summative assignment, you will demonstrate your knowledge by explaining and synthesizing the importance of office-based processes and patient-based supporting functions to improve patient outcomes and experience as well as clinical quality. As you reflect on what you have learned in this course, you will also have an opportunity to consider the relationship between managing these processes and functions and the fundamental premise of value-based care.

COURSE 4 of 7. This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. You will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts.