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所在平台: Coursera |
课程主页: https://www.coursera.org/learn/reimburse-models
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课程名称：基于价值的医疗：报销模型 概述：这是七门课程中的第四门。该课程旨在帮助学员建立对美国大多数医疗服务当前医疗编码和支付机制（即按服务收费）的高级知识。学员将探讨按服务收费模式如何导致美国医疗系统成本上升而未能明显改善健康结果的原因。课程将强调准确反映慢性病和其他诊断的编码重要性，以及基于价值的护理和付款如何利用这些措施和数据。在学习替代按服务收费模型的过程中，学员将会接触到一系列被视为基于价值的付款选项，并利用健康护理支付学习与行动网络（HCP-LAN）的框架进行探讨。为此，学员将学习如何将风险调整、质量评分和患者满意度测量纳入基于价值的护理与支付合同。最终任务中，学员需要通过比较按服务收费与基于价值的合同，使用具体例子解释并证明文档和编码的重要性，并识别风险调整和患者满意度如何融入基于价值的护理合同。 继续医学教育（CME）认证： 美国家庭医学会（AAFP）已批准此课程为继续医学教育规定学分。 课程大纲： 1. 从按服务收费到基于价值的付款： - 本模块将帮助学员高水平了解目前美国医疗服务的收费和编码机制，探讨按服务收费模式如何导致医疗成本增加和健康结果不佳。随后，学员将接触到一系列被视为基于价值的付款选项，并探索风险调整、质量评分和患者满意度在基于价值的护理与合同中的重要作用。 2. 基于价值的付款中的质量与风险调整： - 学员将进一步探讨编码对慢性疾病和其他诊断的反映如何影响基于价值的付款的质量和风险调整，熟悉HCP-LAN的分类和付款模型。 3. 课程项目：将知识应用于实践： - 学员将综合课程中学习的内容，从按服务收费模型和替代价值基于付款模型中提炼知识，理解提供者和付款人责任共享的重要性，最终实现成功的基于价值的护理。
Name:From Fee-For-Service to Value-Based Payments
Description:In this course, you will build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. Then you will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. As you examine a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based. To build on those options, you will explore how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. This module is an introduction to and exploration of value-based payment models utilizing a framework from the Health Care Payment Learning and Action Network (HCP-LAN). As a preparatory step to that introduction and review, the module starts with a high-level review of current fee-for-service payments, coding for those payments, and the problems resulting in increased healthcare costs and lower-than-expected quality in the U.S. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!
Name:Quality and Risk Adjustment in Value-Based Payments
Description:In the previous module, you examined the importance of coding to reflect chronic conditions and other diagnoses accurately. You also explored how value-based care and payments utilize these measures and data. As you explore the four categories of the HCP-LAN alternative payment models (APMs)—also known as value-based payment arrangements or value-based contracts – the acronym of the latter is also VBC. As with other acronyms, you will learn to read VBC in context to determine if we are talking about care or payments/contracts. The focus of this module is on two key aspects of value-based payment models: 1) The need for, and methods of, risk-adjustment in value-based contracts, and 2) Quality scores and patient satisfaction measures, which are critical parts of value-based care and contracts. At the end of this module, you will examine how those elements are utilized in value-based contracts. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!
Name:Course Project: Making This My Own
Description:In this course, you have examined how the fee-for-service model emerged from current medical coding and payment mechanisms and why this model has contributed to higher costs in the U.S. healthcare system. In the videos and discussion postings relating the quest to replace the fee-for-service model, you explored a range of value-based payment options and how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. Whether you are currently working in a healthcare provider or payer organization or aspiring to work in either, it is paramount that you be able to synthesize, reframe, and put into practice knowledge gained from this course. Even more important is to recognize that the responsibility for applying this knowledge is shared by providers and payers, as ultimately it is the provider-payer partnership that leads to successful value-based care.
COURSE 4 of 7. This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. You will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts. CME Accreditation The American Academy of Family Physicians (AAFP) has approved this course for Continuing Medical Education Prescribed Credits. Visit the FAQs for important information regarding 1) Term of approval and 2) Accreditation and Credit Designation statements.
