人口健康服务

什么是人口健康? 根据疾病控制中心(CDC)的定义, Population Health “brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.” The mission of population health is to improve the health outcomes of the communities we serve. The associated reimbursement from value-based contracting is the vehicle used most often to fund this mission.

LBMC utilizes a robust team of Population Health advisors who can help you learn how to improve the quality of care provided to your employees and patients in your community, 以及如何优化基于价值的合同补偿和激励机制.

查看服务单张(PDF)

准备评估 & 策略

基于价值的合同和偿还评估
临床整合网络(CIN)和ACO准备评估
策略 & 路线图设计

设计 & 实现

问责保健组织(ACO) / CIN网络设计
路线图的实施
站立能力 & 网络功能

人口健康管理

促进护理和急性后管理的转变
数据分析程序开发
护理管理计划开发

医师网络发展 & 协议

支持卫生系统发展 & 供应商ACO/CIN网络
ACO和CIN治理结构、参与协议、委员会、 & 任务部队

奖状

“很难衡量没有花在医疗保健上的钱, but the Clinically Integrated Network team has shown us each and every quarter how interventions have positively impacted the lives of our employees. The care managers seek out and intervene personally to help our employees solve their complex medical issues which reduces costs but more importantly improves their quality of life and their regard for us as an employer who cares.”

一家大型地区医疗系统的人力资源副总裁

“Words can’t adequately express my gratitude for the Clinically Integrated Network group. 我每天都和他们一起工作，特别是护理管理团队. The care managers go out of their way to help our employees navigate care for their medical issues. 它们不仅有助于降低雇员和雇主的成本, 它们还有助于缓解员工在面临医疗障碍时感受到的压力. 团队真的很关心，他们的工作质量也证明了这一点.”

东南医疗中心的人力资源通才

常见问题

Do I have to sacrifice my fee for service reimbursement to get involved with value-based reimbursement?

No. Value-based contracting reimbursement is usually provided as an additional incentive payment over and above the fee-for-service reimbursement.

我应该选择哪些基于价值的报销渠道(类型)?

The easiest value-based program to start with is the Health System Employee Health Plan. 之后，其他大型自保雇主计划也有意义. 医疗保险优势项目也很受欢迎, 以及医疗保险共享储蓄计划.

Do I have to invest in additional resources to optimize my value-based reimbursement?

是的, an investment in care management resources and data analytics personnel are required to optimize your value-based reimbursement. 还需要领导和治理资源.

基于价值的合同投资最终会有回报吗? 要过多久投资回报才会转为正收益?

The return on investment for value-based contracting and programs has historically had mixed results. 然而, 当适当的策略和治理结构就位时, 2年后的投资回报通常是非常积极的.

什么是临床整合组织(CIN)?

A CIN is a partnership between physicians and a hospital to provide medical and health care and wellness services to a defined population. The governance is usually a Board of Directors made up of equal representation from the two partners. 董事会主席通常是一名医生.

The CIN is formed to take financial and quality performance upside only risk for a defined population of patients. Gains (savings) are shared among the members and sometimes the members can take risks with insurers to cover potential losses.

为什么卫生系统和医生领导形成CIN?

Health Systems and community physicians want to optimize their ability to succeed with current and future value-based reimbursement. 有组织的CIN是实现这一目标的首选工具. 虽然目前, 报销模式仍然是以服务收费为主, the new reimbursement model includes additional reimbursement that is based on cost effectiveness and quality outcomes. A CIN can bring resources to its physician and hospital members to help them individually and collectively succeed at value-based care and reimbursement.

CIN的结构是怎样的? 内科医生真的会对其组织和运作方式有发言权吗?

The legal structure for the CIN is usually a Limited Liability Company (LLC) with the Hospital as the sole member. The governance of the CIN is usually a Board of Directors with a majority of Physicians and a minority of Hospital representation.

“增值”报销款项如何计入综合成本?

不像医疗保险的下行风险分担安排, the CIN negotiates contracts that reimburse providers for achieving low costs and higher quality, 没有支付成本增加的风险. 然而, 只有在双方都节约成本的情况下，才能实现收益分享, 并成功实现了质量措施.

What are potential future opportunities for a CIN beyond contracting with the hospital employee population health plan?

中国保险联盟可以向所有保险公司推销其服务, 以及自保的大型社区雇主, and Medicare Advantage programs and also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid 服务. The Hospital employee population is an excellent starting point to learn population management with little risk. The CIN then has an opportunity to also form an Accountable Care Organization to contract with the Centers for Medicare and Medicaid 服务.

ACO和CIN有什么不同?

A CIN is a commercial and private payor form of an Accountable Care Organization (ACO). The CIN and the ACO both sign up a network of providers that make up the CIN clinical team, 包括社区医生和医院聘用的医生. CIN计划由当地供应商选择, 而《明升app》则由CMS和政府选择. CINs are generally upside risk only while ACOs will assume downside financial risk in later years of their contract with CMS.