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case management

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Healthcare Case Management Program Article

Good article for certified case managers to review

Please also review our healthcare case management program

Please also review our healthcare case management program

Please also review our healthcare case management program

The article, “Limited Healthcare Payment Incentives Challenge Care Management”  states

“Misaligned healthcare payment incentives topped the list of challenges providers and payers faced when implementing effective care management programs under Medicare Advantage plans with capitated payments, a recent Robert Graham Center for Policy Studies in Family Medicine and Primary Care report stated.

“Absent coordination of incentives, care management programs often result in offices hosting multiple care managers,” researchers wrote. “Different care managers can run services and inclusion criteria. This leads to confusion for both the patient and provider, and distraction from the objectives of each program.”

Using data from a literature review, expert insights, and site visits to successful models in the field, researchers found that risk-based capitated payments under Medicare Advantage plans offered the greatest opportunity to advance care delivery and decrease healthcare costs.

Capitated payments under Medicare Advantage plans presented the opportunity because the claims reimbursement model facilitated provider and payer alignment.

“The incentives inherent in Medicare Advantage’s capitated (fixed) monthly payment for patients encourage providers and payers to work together and share data at the level of population health and in real time for individual patient care,” the report stated. “These incentives align to enable providers to think creatively about delivering care and innovate.”

To read the entire article, please click here

Please also review our healthcare case management program

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