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Payment Models

 Scenario

Metropolitan Memorial is seeking to expand its service offerings into underserved rural communities. The Board of Directors has expressed concerns given the emergence of new payment models, low reimbursement from Medicare and Medicaid, and uncertainty in terms of provider incentives offered through the Affordable Care Act. The Board of Directors has requested an executive summary outlining the organization’s financial viability given the challenges facing health organizations, particularly those operating in rural communities.

Instructions

The CEO has asked you to prepare an executive summary to present to the Board of Trustees, discussing the following information:

  • Identify the different types of healthcare payment models that could be utilized by Metropolitan Memorial.
  • Research the Triple AIM and discuss ways the organization can achieve the goals of the Triple AIM (improving the experience of care, improving the health of populations, and reducing per capital costs of health care ).
  • Discuss possible ways the payer mix may impact hospital revenue.
  • Explain how value-based healthcare delivery could be utilized to save money.

Rubric: 

-Comprehensive identification of the different types of healthcare payment models that could be utilized by Metropolitan Memorial. Includes multiple examples or supporting details per topic. 

– Clear and thorough explanation of the ways the organization can achieve Triple AIM of improving the experience of care, improving the health of populations, and reducing per capital costs of healthcare. Includes multiple examples or supporting details per topic. 

– Clear and thorough identification of the impact of the payer mix on the revenue. Includes multiple examples or supporting details. 

– Comprehensive explanation of how value-based healthcare delivery can be utilized to save money. Includes multiple examples or supporting details. 

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