Reformed legislation and marketplace changes have spawned a new language for the healthcare industry. Here are a few important terms you will want to know as you prepare for what lies ahead.
- Bundled payments: A value-based reimbursement plan that moves away from our current “fee for services” model. Providers are given a single shared payment “per episode” for all services related to a treatment or condition, possibly spanning multiple providers in multiple settings. There are incentives provided for improved outcomes and for reducing or eliminating services that deliver little or no medical benefit.
- Clinical integration network (CIN): A group of physicians who agree to work together across their individual practice boundaries (and typically in partnership with healthcare systems) to coordinate the delivery of care, drive improvements in patient outcomes and reduce total healthcare costs. CINs can enter into pay-for-performance contracts with insurers that have financial incentives for meeting agreed-upon performance targets. Our Triad HealthCare Network is designed around a CIN model.
- Patient-Centered Medical Home: A promising model for transforming the organization and delivery of primary care that is patient-centered, comprehensive, coordinated, accessible and continuously improving through a system-based approach to quality and safety. Today, several organizations use those principles to establish accreditation, certification, achievement and recognition programs for the PCMH model.