225831-Real-World-Case-Analysis-edited-docx
docx
keyboard_arrow_up
School
Chamberlain University College of Nursing *
*We aren’t endorsed by this school
Course
242
Subject
Health Science
Date
Jun 23, 2024
Type
docx
Pages
6
Uploaded by DeaconGoosePerson571
Running head: CASE
1
Real World Case Analysis
Student
Institution
CASE
2
Real World Case Analysis
Moving a Physician Group from Fee-For-Service Towards a Value-Based Focus
Changing revenue models with regard to physicians is very costly and far-reaching. Fee-
for-service models reward physicians for each service they provide, which frequently results in an excess of procedures and disjointed patient care. Value-based care emphasizes quality rather than quantity and matches the incentives of all stakeholders to patient outcomes. The economic model could allow doctors make money by using methods that will lead to improved health of patients, preventive care, or affordable and appropriate treatment methods. Several reasons are evident on why physicians would like to join Chillax. Therefore, moving towards the value-
based model facilitates a more integrated and patient-specific workflow for physicians who desire to have a profound effect on their patients' well-being. The second reason is that there will be low pay due to dropping insurance payments under a fee-for-service scheme. Working for an outward-looking entity such as Chillax guarantees financial security and growth opportunities. The balanced mix is what matters in incentives critical for PCPs and specialist groups. Physician resistance could be prevented by linking financial incentives with measures of quality, patient satisfaction, and costs. Another key aspect is to show support during the change, like through training and technology devices. Additionally, it is important to ensure that the change does not interrupt the fee-for-service operation of the organization. Assuaging this concern could be achieved by providing a smooth shift whereby physicians can retain part of their income in the fee-for-service system throughout the transformation period.
Addressing Physician Compensation Changes in A Medical Group
Physician compensation models become important because they ensure that financial incentives for quality are part of meeting the general objective of providing medical attention
CASE
3
services, which is providing good health for patients. Within the context of a value-based system,
quality metrics establish standards, compelling doctors towards preventive medical services, patients’ welfare, and health results. The change is vital in fostering a just and rewarding system which appreciates doctors’ performance rather than the number of services offered. Ideal candidates for leading compensation changes among physicians who have significant roles in community-based healthcare systems that drive down costs and improve the overall quality of care. PCPs have a primary role in preventative medicine, while specialists play an integral position regarding cost-effectiveness and patient results.
Forming A Multi-Organizational Clinically Integrated Network (CIN)
The cost of investment in building the CIN, as well as its governance and collaboration with payers, should be considered in business implications for Chillax. A financial commitment is inevitable whenever a partner is selected but it also helps in aligning incentives in partnership which Chillax's joint venture has exhibited. A collaborative approach in collaborations with other
entities may meet some challenges such as rivals' unwillingness to back another competitor's objective (Sanchis, Sanchis-Gisbert & Poler, 2020). Some benefits of collaborating with the buyer include the opportunity to share financial risk and align incentives. However, disadvantage
cases include instances of conflict of interest or dependence on a single-payer. Other options include partnering with a venture capital entity, fundholders, or establishing a joint organization between the company and a healthcare system.
Sharing Finances in a CIN
Chillax CIN will design the financial dashboard which will monitor KPI’s like revenue distribution, contract performance and overall financial health. KPIs should include:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
CASE
4
Patient Satisfaction Scores: Its success as a patient-centered approach to care.
Quality Metrics: The good practice and the positive health outcome.
Cost and Utilization Analysis: Measuring efficiency in resource utilization.
Contract Performance: An examination of the performance of value-based contracts.
Return on Investment (ROI): Evaluating the feasibility of tech projects and contracts.
The KPIs should be constantly monitored and compared to the projections values adjusted accordingly.
Governing and Managing a CIN
In enhancing Chillax Cin corporate governance, competent leaders with a financial grasp are needed to input the strategy. To secure the financial data, the management team should give more attention to cybersecurity. Periodic audits, encryption protocols, as well as employee training help to maintain data integrity. The use of blockchain technology can help in achieving higher levels of data integrity (Hasselgren et al., 2020). As a result, the leadership must handle changing landscape in healthcare, remain under regulations and undertake efficient financial policies. The CIN is required to take proactive measures such as continued evaluation of performance and strategic adjustments to minimize these risks and to maintain financial integrity
because CN is expected to develop trust among these stakeholders and sustain the CIN on the move.
Providing the CIN’s Infrastructure
Investing in both people, process and technology is the only way to set up Chillax CIN infrastructure. Financial leadership is also necessary for effective governance. Cybersecurity practices including regular audits and training of employees ensure the security of the financial data. More specifically, employee training affects their performance (Sugiarti 2022). The use of
CASE
5
complex analytics and predictive models allows to identify high-risk patients. Through collaboration with other health systems, health information on the population is pooled to strengthen the CIN to obtain health information. Chillax can build a sustainable structure to address the changing population's health demands and eventually provide quality, affordable care.
Establishing Relations with Payers and Health Systems
Setting strong ties with payers and health systems in place will help Chillax CIN thrive. Therefore, a financial dashboard for providers entails the measurement of KPIs like contractual performance and ROI. Chillax needs to interact with payers showing dedication to value-based contracts and economic programs. The CIN is committed to regularly monitoring and reporting on payment in line with the payers' expectations which enhances its finances. Chillax achieves trust building via transparency on financial numbers and expected value, which enables it to attract and sustain payer partnerships. Chillax will achieve sustainable funding support from payers and health systems by ensuring that its financial goals are consistent with value-based care, thereby creating an interactive and supportive ecology of healthcare.
CASE
6
References
Hasselgren, A., Kralevska, K., Gligoroski, D., Pedersen, S. A., & Faxvaag, A. (2020). Blockchain in healthcare and health sciences—A scoping review. International Journal of Medical Informatics, 134, 104040.
Sanchis, R., Sanchis-Gisbert, M. R., & Poler, R. (2020). Conceptualization of the three-
dimensional matrix of collaborative knowledge barriers. Sustainability, 12(3), 1279.
Sugiarti, E. (2022). The Influence of Training, Work Environment and Career Development on Work Motivation That Has an Impact on Employee Performance at PT. Suryamas Elsindo
Primatama In West Jakarta. International Journal of Artificial Intelligence Research, 6(1).
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help