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Pricing and paying for proactive care.

Scott MacStravic1

  • 1scottmacstra@earthlink.net

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|October 17, 2006
PubMed
Summary
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New healthcare payment models are emerging as third parties increasingly fund proactive health services. Common innovations include pay-for-performance bonuses and gainsharing arrangements.

Area of Science:

  • Healthcare Economics
  • Health Services Research

Background:

  • Proactive health services are increasingly funded by third-party payers.
  • This shift necessitates new approaches to healthcare pricing and reimbursement.

Purpose of the Study:

  • To identify and describe emerging pricing strategies for proactive health services.
  • To highlight novel financial incentives being adopted by healthcare payers.

Main Methods:

  • Review of current trends in healthcare reimbursement.
  • Identification of common alternative payment models.

Main Results:

  • Emergence of new pricing bases and types for proactive care.
  • Increased adoption of pay-for-performance bonuses.

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  • Bonuses tied to achieving specific disease or risk outcomes.
  • Implementation of gainsharing arrangements.

    • Conclusions:

    • Third-party payment for proactive health services is driving innovative pricing models.
    • Performance-based bonuses and gainsharing represent key shifts in healthcare finance.