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所在平台: Coursera |
课程主页: https://www.coursera.org/learn/healthcare-payment-models
课程评论：没有评论
课程名称：未来医疗支付模式 概述：该课程将审视医疗成本的驱动因素以及为应对成本、质量和医疗价值而提出的解决方案。许多人将高昂医疗费用归咎于以服务数量和服务强度付费的支付模式，即按服务收费（FFS）模式。相对而言，更可持续的解决方案是结合新支付模式、护理管理、保险计划设计、消费者参与工具和技术的综合策略。通过这些信息，我们将探讨各种情境，展示可以实施的协调护理和支付策略，以改善患者健康和医疗服务的交付成本。 学习目标： 1. 识别医疗支出的驱动因素和趋势，考虑各种利益相关者的视角，包括医疗提供者、保险公司、政府和私人采购者及支付方。 2. 批判性地评估《平价医疗法案》（ACA）及其各种修订所实施的战略和财务方法的影响。 3. 评估当前的医疗支付模式及基于价值的支付正在迈向的新方向。 4. 确定如何将财务和非财务指标适当结合，以改善医疗利益相关者的价值主张。 课程大纲： 1. 当前医疗支出与趋势：本周重点了解医疗中的各种利益相关者，审查医疗成本及其波动的“数学”，识别医疗支出的驱动因素和趋势。 2. 保险市场：本周描述美国健康保险的各种要素，关注《平价医疗法案》中对保险市场、融资、医疗成本和支付模型影响的条款。 3. 基于价值的支付模式：本周将关注按服务收费支付模式的不足，转向已经实施的替代支付模式，并回顾这些新支付模式所实现的结果。 4. 演变的综合模型：将焦点转向将各种模型和概念应用于“现实世界”的情境，鼓励学生思考医疗成本、质量和价值问题的多种解决方案。 通过本课程的学习，学员将理解复杂的医疗支付体系，并掌握改善医疗价值的方法和策略。
Name:Current Healthcare Spend and Trend
Description:This week's focus will be on understanding the various stakeholders in healthcare. We will review the "math" surrounding healthcare costs and how it can fluctuate. Healthcare drivers will be reviewed to identify trends. As you move through the weekly material, I encourage you to think about the impact that the drivers have on the delivery of the healthcare services.
Name:I Thought we were done with this: Insurance Markets
Description:This week we will describe the various elements which underline health insurance within the United States. For example, third party payment structures and risk pooling, to name a few. This week we will focus some time on the Affordable Care Act (ACA) which is a very complex piece of legislation. Special attention will be made on provisions of the ACA that impact insurance markets, financing, healthcare costs, and payment models.
Name:Value-Based Payment Models
Description:This week will continue to "follow the money". We will focus much of our attention on the shortcomings of a Fee-for-Service payment model. Our attention will shift to alternative payment models that have been implemented, allowing for certain comparisons to be made. Lastly, we will review some results that have been achieved because of the new payment models. This week I will leave you by asking, If we know that the Fee-for-Service payment model is dysfunctional, why is it continuously used?
Name:Evolving Integrated Models: Putting It All Together
Description:This week we shift our focus from reviewing current payment models and strategies to applying some of the models and concepts to "real-world" scenarios. We will use fictitious examples, as well as published articles to bring together all of the concepts. As with most things, there is not one single answer to solving the healthcare cost, quality, and value problems. I encourage you to think "outside of the box" and as always, "follow the money!"
This course will review the drivers of healthcare cost and solutions that have been proposed to address cost, quality and value of health care. Many point blame for high costs on payment models that pay healthcare providers for every service they provide to patients, essentially paying more for volume and service intensity. This is called a Fee for Service (FFS) payment model. Some solutions, arguably the more sustainable solutions, are the combined strategies of new payment models, care management, insurance plan designs, consumer engagement tools, and technology. Using that information we will explore various situations, showcasing coordinated care and payment strategies that can be implemented to improve patient health and the cost of delivery of healthcare services. By the end of this course, the learner should be able to: 1. Identify the drivers and trends of healthcare spending from the perspective of various stakeholders, including medical providers, insurers, government and private purchasers and payments 2. Critically assess the impact of strategic and financial approaches that have been put in place by the ACA and the various modifications. 3. Evaluate how healthcare payment models currently work and the new direction that value-based payment is taking. 4.Identify how financial and non-financial metrics can be appropriately combined to improve a healthcare stakeholders’ value proposition.
