HS Cost and Quality Flashcards
Sets fee based on diagnosis, forces hospitals to develop standards of care and limits ordering of procedures
Diagnosis Related Group
Prior authorizations, benefit denials. Capitation and PMPMs, resulted in consolidation of providers and rise of physician groups
Managed Care/HMOs
Incites providers to order and use more services. Typically rewards newer technologies and procedures with higher reimbursement
Fee for Service
What are the 3 components of Meaningful Use?
Use of certified EHR in meaningful manner
Use of EHR for electronic exchange of health information
Use of EHR to submit quality measures and other measures
Based on cost of care for attributed patients, quality and meaningful use reporting
Value Based Modifier
ACO goals
High quality
Low cost
Positive patient experience
ACO outcomes
Big data Building large network of primary care Created narrow networks Providers owning the insurance Rise of population health management
Program for those not participating in Medicare APM
MIPS
What is the Triple Aim?
Population health
Experience of Care
Per Capita Cost