ASSIGNMENT ID
137455
SUBJECT AREA Health
DOCUMENT TYPE Coursework
CREATED ON 25th March 2017
COMPLETED ON 26th March 2017
PRICE
$40
15 OFFERS RECEIVED.
Expert hired: josekk2016

Health Care Reimbursement and Utilization Management

Scenario: Medicare and private payers have expanded reimbursement under Accountable care organizations (ACO). You are the chief financial officer (CFO) of a hospital system that is forming an ACO to participate in these payment models. The ACO seeks to improve care coordination for its patients with chronic conditions. To provide better care management, the ACO is interested in investing in primary care physicians and physician’s assistants to provide more intensive care management services. After formation, the ACO will enter contracts with Medicare and private insurers under alternative payment models, including shared savings, bundled payments, and global capitation. The ACO will need to determine how to set up reimbursement payments to ACO providers and consider whether financial incentives are required to ensure ACO providers deliver efficient care. To prepare for this Discussion: Read the provided scenario. Consider strategies for reimbursement and utilization management, including financial incentives. How might you set up the reimbursement payments to ACO providers, considering the alternative payment models (i.e., fee for service, shared savings, bundled payments, or global capitations)? What utilization management controls might you add to align the interests of ACO providers? Post a cohesive response to the following: As the CFO of the ACO in the provided scenario, recommend strategies for reimbursement and utilization management. Defend your recommendations. Support your response by identifying and explaining key points and/or examples presented in the Learning Resources. Read a selection of your colleagues' postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.
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25 March 2017
User created a project for Health
25 March 2017
15 experts responded
25 March 2017
User contacted expert josekk2016
25 March 2017
User hired expert josekk2016 who offered a price of $40 for the project and has experience doing similar projects
26 March 2017
The expert completed the project Health Care Reimbursement and Utilization Management for 1 day, meeting the deadline
26 March 2017
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26 March 2017
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