Lets consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them?
Next, lets consider what might happen if value-based reimbursement completely replaces volume-based (i.e., fee-for-service) reimbursement. What are the implications for providers? For patients? For healthcare managers and administrators?
150 WORDS OR MORE WITH APA CITATION
RESPONSE TO THE FOLLOWING DISCUSION:
1, Hello Professor and Class,
Health insurance differs from other types of insurance in three key ways:
Health insurance covers routine expenses and covers the cost of predictable things, like an annual check-up, mammograms, or cholesterol tests.
Health insurance covers small, random expenses. People expect health insurance to pay to visit a doctor for minor things, like confirming that we have the flu or wart removal.
Many Americans get their health insurance through their employers. As a result, a lot of people do not know how much they are paying for their insurance, and they do not know how much their health care costs.
(Author Unknown, 2009).
Health insurance is a type of insurance that pays the bill for medical and surgical expenses.
The similarities of these insurances are that we have to pay for both types of insurance, where life insurance is an installment type, health insurance is a lump sum type. Both insurances will give benefits in different ways health insurance gives during illness and accident, life insurance gives during the end of the policy or annuity.
Value-based reimbursement or Value-based Care is a form of reimbursement that ties fees for care or services based on the quality of care provided. This form of reimbursement rewards the health care providers for their efficiency and adequacy. This type of reimbursement has developed as an option and potential substitution for Volume based reimbursement or fee- for – service reimbursement. Volume-based reimbursement is a traditional system of payments for the care provided. It promoted the number of services. If Value-based reimbursement completely replaces Volume-based reimbursement, it will advance mainly three areas such as better care for the Clients, health care cost reduction, and improvement in health management strategies for the public (LaPointe, 2016).
Providers: Volume-based reimbursement pays suppliers or providers reflectively for services delivered according to the bill charges or yearly fee schedules while the Value-based reimbursement is calculated by using different measures for the quality of services provided. It is driven by data because the suppliers of services must report to the payers on specific metrics and it should show the sign of improvement. Service providers have to track the information regarding readmission to the hospital, adverse events report the same. When clients get better coordinated, appropriate, and effective care, providers are rewarded.
Patients: Lower health care costs and better outcomes are the benefits for patients by Value-based reimbursement. Some chronic diseases like Diabetes, Hypertension, Obesity, Cancer can be costly, and they are long term illnesses. Value-based Care or reimbursement focus on quality care thereby helping patients recover from illness, reduces doctor’s visit, less medical test, and procedures.
Health care managers and administrators:
Value-based reimbursement helps them by giving benefits from being able to balance their products and services with positive patient outcomes and reduced costs. It also helps in reducing overall cost spent on health care (Brown and Crapo, 2014).
Author Unknown. (2009). Health Insurance Isnt Really Insurance, Researchers Says. Retrieved from: https://www.insurancejournal.com/news/national/2009/09/11/103684.htm (Links to an external site.)
Brown, B., and Crapo, J. (2014). The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement. Retrieved from: https://www.healthcatalyst.com/insights/hospital-transitioning-fee-for-service-value-based-reimbursements (Links to an external site.)
LaPointe, J. (2016). What us Value-Based Care, What it Means for Providers. Retrieved from: https://revcycleintelligence.com/features/what-is-value-based-care-what-it-means-for-providers (Links to an external site.)
Edited by April Schamberger on Jul 19 at 5:33pm
RESPONSE FOR THE ABOVE DISCUSSION: 150 WORDS OR MORE USE APA CITATION
Health insurance coverage is both different and the same as auto or home insurance. What these insurance coverages have in common is that they all cover you in the event of an emergency, they each charge a monthly premium, and they each have a deductible that is dependent on the type of plan.
What these insurance coverages do not have in common is how often claims are processed against them; more claims are filed for healthcare services than auto or home. And, many services are included for the cost of the health insurance premium than auto or care insurance such as wellness visits and support classes to improved overall health for the insured.
If value-based reimbursement were to completely replace fee-for-service reimbursement, there would be a higher level of care provided by healthcare providers since how much they make would be dependent on the health outcome of the patient. This methodology is quite different than how fee-for-service reimbursement works since the emphasis shifts from how many services can a healthcare provider charge a patient to increase the amount of reimbursement they receive, no matter if the patient benefits from any of the services or not, to focusing on which services the patient would actually benefit from the most.
About 10 years ago, I went to the doctor with a complaint that led the doctor to performing a multitude of test, starting with the most expensive, most invasive and ending with the least expensive, least invasive test to determine what was causing the ailment. It was the last, and least expensive, least invasive test that led to discovering what was causing the ailment.
And though I was grateful to finally learn the cause of what was ailing me, all these tests left me with a huge out-of-pocket expense to the tune of over $2000. I remember wondering why didnt the doctor start with the least expensive, least invasive test and then escalate the tests as needed? I figured it had to due with how much money the doctor and medical facility made, which led me to finding a new doctor in the end. Base on my personal experience, I believe that the value-based reimbursement methodology provides better care to patients with lower out-of-pocket expenses.
HealthPartnes.com. (2019). How your health insurance is (and isnt) like car insurance. Retrieved from https://www.healthpartners.com/blog/how-your-health-insurance-is-and-isnt-like-care-insurance
Keller Graduate School of Management. (n.d.). HSM541. Modules Week 3: Lesson. Health Insurance: The Major Financing Mechanism for U.S. Healthcare. Summer 2020. Retrieved from https://devryu.instructure.com/courses/59108/pages/week-3-lesson?module_item_id=732250
RESPONSE TO THE ABOVE: PLEASE USE 150 WORDS OR MORE TO RESPONSE USE APA STYLE FOR CITING REFERENCES:
It has to be at lease three references: one is the attached text book
Chapter 3: The Payment Process: Insurance and Third-Party Payers
Chapter 4: The Payment Process: Government Payment Programs