Impacts of pay-for-value on healthcare providers, health plans, and patients - New reimbursement models promise higher quality and lower cost

Perhaps one of the most controversial changes facing the healthcare industry today is the change in reimbursement models from fee-for-service to fee-for-value. The author of this capstone works for a population health management company and assists healthcare providers with this transition. In this capstone she examined the many issues faced by key stakeholders in health care as they transition from the fee-for-service reimbursement model to a fee-for-value model. This transition has been met with much difficulty. Research about the impact of this transition on the key stakeholders was conducted. Several studies were reviewed which discuss the impacts of various payment models on the stakeholders in health care. Highlighted in this capstone was the discovery that key stakeholders impacted by this transition often lack a clear understanding of the need for the transition. In addition to this, they lack an understanding of how to make this transition smoothly. It was concluded that better understanding of how to integrate the changes required for this transition greatly aids physicians, multi-level clinical staff, and healthcare administrators. Additionally, health plan administrators who learn methods for sharing data in a more transparent manner can create improved collaboration. Moreover, patient engagement improves by learning about how to work collaboratively with both their physician and their health plan to ensure that they are receiving the best care possible for the lowest cost. Various options of transitioning from fee-for-service to a value-based reimbursement model have been presented by different entities. These are reviewed and a model presented that is hoped to aide in transitioning these individuals successfully into the new model of population health management. Keywords: Health Care Administration, Dr. Dana Hart, Professor Maria DeGiglio, risk adjustment, hierarchical condition category, ICD-10-CM, clinical documentation, diagnosis code.