人口健康服务

什么是人口健康? As defined by the Center for Disease Control (CDC), 《明升体育app下载》重点关注重大的健康问题，并探讨如何分配资源，以克服导致人口健康状况不佳的问题.“人口健康的使命是改善我们所服务社区的健康结果. 以价值为基础的合同的有关偿还是最常用于为该特派团提供资金的手段.

LBMC拥有一支强大的人口健康顾问团队，他们可以帮助您了解如何提高为社区员工和患者提供的护理质量, and how to optimize your value-based contracting reimbursement and incentives.

查看服务单张(PDF)

准备评估 & 策略

Value-based Contracting and Reimbursement Assessment
Clinically Integrated Network (CIN) and ACO 准备评估
策略 & 路线图设计

设计 & 实现

Accountable Care Organization (ACO) / CIN Network 设计
路线图的实施
站立能力 & 网络功能

Population Health Management

Facilitating Transitions of Care and Post-Acute Management
数据分析 Program Development
Care Management Program Development

Physician Network Development & 协议

Supporting Development of Health System & 供应商ACO/CIN网络
ACO and CIN Governance Structure, Participation 协议, Committees, & 任务部队

奖状

“It’s difficult to measure money not spent on healthcare, 但临床综合网络团队每个季度都向我们展示了干预是如何对员工的生活产生积极影响的. 护理经理亲自寻找并帮助明升体育app下载员工解决他们复杂的医疗问题，这不仅降低了成本，更重要的是提高了他们的生活质量，并提高了他们对我们作为一个关心员工的雇主的尊重.”

VP of 人力资源 at a large regional health system

“言语无法表达我对临床综合网络团队的感激之情. I work daily with them, specifically the care management team. 护理经理会不遗余力地帮助明升体育app下载员工解决他们的医疗问题. They not only help reduce the employee’s and employer’s cost, they also help with the stress an employee feels when faced with a medical obstacle. The team truly cares and it shows by the quality of their work.”

HR Generalist at a southeastern medical center

常见问题

我是否必须牺牲我的服务报销费用来参与基于价值的报销?

No. 以价值为基础的订约偿还额通常作为服务费用偿还额以外的额外奖励付款提供.

What channels (types) of value-based reimbursement programs do I pursue?

最简单的基于价值的计划是健康系统员工健康计划. Afterwards, other Large Self-insured Employer programs make sense to pursue. Medicare Advantage programs are also very popular, as well as the Medicare Shared Savings Program with CMS.

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

是的, 需要对护理管理资源和数据分析人员进行投资，以优化基于价值的报销. Leadership and governance resources are also required.

Is there an eventual return on investment in value-based contracting? How long before the return on investment becomes positive?

基于价值的合同和项目的投资回报历来好坏参半. 然而, when the proper strategy and governance structure is put in place, the return on investment is generally very positive after 2 years.

What is a Clinical Integration Organization (CIN)?

合作伙伴关系是医生和医院之间的伙伴关系，为特定人群提供医疗保健和保健服务. 治理通常是由两个合伙人的同等代表组成的董事会. The Board Chairperson is usually a physician.

CIN的成立是为了对特定人群的患者承担财务和质量表现的唯一上行风险. 收益(储蓄)由成员共享，有时成员可以与保险公司承担风险，以弥补潜在的损失.

Why do health systems and physician leadership form a CIN?

卫生系统和社区医生希望优化他们在当前和未来基于价值的报销方面取得成功的能力. An organized CIN is the preferred vehicle to achieve this. 虽然目前, the reimbursement model is still primarily fee for service, 新的报销模式包括基于成本效益和质量结果的额外报销. CIN可以为其医生和医院成员提供资源，帮助他们个人和集体在基于价值的护理和报销方面取得成功.

CIN的结构是怎样的? Will Physicians really have a voice in how it organized and operated?

CIN的法律结构通常是一个有限责任公司(LLC)，医院是唯一的成员. CIN的管理通常是一个由大多数医生和少数医院代表组成的董事会.

How do “value added” reimbursement payments figure into the CIN?

Unlike a Medicare down-side risk sharing arrangement, CIN协商合同，为实现低成本和高质量的供应商提供补偿, without the risk of paying for cost increases. 然而, gain sharing will only occur when there is both a cost savings, and successful achievement of the quality measures.

除了与医院员工人口健康计划签订合同外，CIN未来的潜在机会是什么?

The CIN can market its services to all insurers, and large self-insured community employers, 和医疗保险优势计划，并形成一个负责任的医疗组织，与医疗保险和医疗补助服务中心签订合同. 医院员工人口是学习人口管理的一个极好的起点，风险很小. 然后，CIN也有机会形成一个负责任的医疗组织，与医疗保险和医疗补助服务中心签订合同.

What are the differences between ACO and CIN?

CIN是问责医疗组织(ACO)的一种商业和私人付款形式。. CIN和ACO都签署了一个提供者网络，组成CIN临床团队, and will include community physicians and hospital-employed physicians. CIN initiatives are selected by local providers, whereas ACO initiatives are selected by CMS and the government. CINs通常只有上行风险，而ACOs在与CMS签订合同的后几年将承担下行金融风险.