Presentation Overview:

Reimbursement models continue to evolve towards being more episode-based and to contain payment components tied to quality. While current payment terms may still use traditional per diem, DRG, or percent of charge methodologies, evolving methodologies are increasingly encouraging clinical integration and enhanced coordination between hospitals, physicians, and other providers. Value-driven healthcare has gained considerable exposure as the industry's stakeholders contemplate how to achieve more transparent price, quality and service value.

This presentation provides a comprehensive review of current hospital reimbursement structures and evolving models that drive improved efficiencies, outcomes, and transparency. The session will provide attendees with the tools necessary to appropriately prepare for value-driven healthcare as it relates to a hospital's commercial contracts, Medicare and Medicaid. Attendees will be able to determine the financial, operational, and strategic implications of payor initiatives and weigh these against each other to arrive at an informed organizational response.

As a result of the presentation, attendees will be able to: 1. Understand key contracting priorities, initiatives, and terms that are being negotiated nationally and regionally; 2. Examine the models of value-driven healthcare that are being developed and implemented by national and regional health plans; 3. Understand the key drivers of financial and operational performance and efficiencies under these models; 4. Understand evolving reimbursement structures that encourage coordination between hospitals, affiliated physicians, and health plans; 5. Study key issues specific to past, current, and evolving reimbursement models including full and partial risk, P4P, episode based payments and care packaging, patient-centered medical home, and traditional Medicare-based and other payment systems adopted by health plans; 6. Explore how provider organizations are preparing for and responding to health care improvement, including interoperable health information technology, measuring and publishing quality information, measuring and publishing price information, and promoting quality and efficiency of care; 7. identify the challenges related to value-driven healthcare and evolving reimbursement models; 8. apply evaluation criteria to determine whether certain value-driven healthcare initiatives are appropriate for your organization.