Future Healthcare Payment Models

Go to Course: https://www.coursera.org/learn/healthcare-payment-models

Introduction

### Course Review: Future Healthcare Payment Models on Coursera In today’s rapidly evolving healthcare landscape, understanding the economics and payment structures that drive healthcare delivery is more important than ever. The course "Future Healthcare Payment Models," available on Coursera, addresses this essential topic by delving into the complexities of healthcare costs and the innovative payment solutions being proposed. With a compelling overview that highlights the issues posed by traditional Fee-for-Service (FFS) models, this course is highly recommended for healthcare professionals, policy-makers, and anyone interested in the financial sustainability of healthcare systems. #### Course Overview The "Future Healthcare Payment Models" course takes a critical look at the existing payment frameworks, particularly the notorious Fee-for-Service model which compensates healthcare providers for the quantity of services rendered rather than the quality of care provided. This course is structured to dissect the contributing factors to rising healthcare costs and evaluate potential pathways toward addressing these challenges through new payment strategies and care management models. #### Syllabus Breakdown 1. **Current Healthcare Spend and Trend** The opening week sets the stage, introducing the various stakeholders in the healthcare sector and examining the fluctuating costs associated with healthcare services. Participants will engage with the fundamental "math" of healthcare spending—a necessary foundation for understanding the complexity of future payment models. This week encourages critical thinking about how these drivers of cost impact the delivery of healthcare services. 2. **I Thought We Were Done with This: Insurance Markets** In the second week, the course dives deeper into the US health insurance landscape, notably the Affordable Care Act (ACA). This segment covers crucial elements like third-party payment structures and risk pooling, helping students grasp the legislative influences that underpin contemporary insurance markets. Insights into the ACA’s provisions reveal their significant impacts on healthcare financing and cost management. 3. **Value-Based Payment Models** Moving further into the course, participants explore the inadequacies of the Fee-for-Service model. The discussion covers alternative payment structures that prioritize value over volume and examines the outcomes associated with their implementation. This critical analysis not only highlights existing issues within FFS but also raises thought-provoking questions about the persistence of this model despite its known dysfunctions. 4. **Evolving Integrated Models: Putting It All Together** The concluding week of the course synthesizes the concepts learned by applying them to real-world scenarios. By utilizing both fictitious examples and published research, students will develop a nuanced understanding of integrated models that could potentially address the complexities of healthcare quality, cost, and value. This interactive approach emphasizes creativity and critical analysis, urging participants to think outside traditional paradigms. #### Course Recommendation Overall, "Future Healthcare Payment Models" is a robust course that is both informative and practical. It equips learners with a clear understanding of the current and potential future states of healthcare payment systems, making it ideal for healthcare practitioners, economists, policy-makers, and students of health administration. The course’s engaging content, combined with real-world applications and critical discussions, provides a comprehensive view of the pressing issues and innovative solutions in the field of healthcare finance. If you’re looking to enhance your knowledge of healthcare economics and contribute to meaningful changes in how care is delivered and paid for, I highly recommend enrolling in this course. Not only will you gain valuable insights into current trends and future possibilities, but you will also be part of a vital conversation about the sustainability and quality of healthcare services in the times to come.

Syllabus

Current Healthcare Spend and Trend

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.

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.

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?

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!"