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Related Concept Videos

Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Introduction To Health Care Delivery System01:18

Introduction To Health Care Delivery System

The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
Standards of Care I01:22

Standards of Care I

Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
Health Information Technology and Healthcare Information System01:30

Health Information Technology and Healthcare Information System

Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:

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Related Experiment Video

Updated: Jun 11, 2026

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
08:13

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

Published on: January 20, 2019

Managed care contracting and payment reform: avoiding a showdown.

Michael E Nugent1

  • 1Navigant Consulting, Inc., Chicago, USA. mnugent@navigantconsulting.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|July 9, 2010
PubMed
Summary

Health reform necessitates a shift from traditional provider reimbursement to value-based contracting. Payers and providers must adapt by evolving relationships and strategic planning to ensure optimal patient value.

Related Experiment Videos

Last Updated: Jun 11, 2026

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
08:13

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

Published on: January 20, 2019

Area of Science:

  • Health Policy
  • Healthcare Economics
  • Provider Reimbursement

Background:

  • Healthcare reform is reshaping reimbursement models for providers by both CMS (Centers for Medicare & Medicaid Services) and commercial payers.
  • Traditional provider-payer relationships are often adversarial and transaction-based, hindering the optimization of value for purchasers and patients.

Purpose of the Study:

  • To outline critical actions for commercial payers and providers to navigate upcoming health reforms.
  • To guide stakeholders in transitioning towards value-based contracting models.

Main Methods:

  • Analysis of current payer-provider relationship dynamics.
  • Identification of strategic imperatives for adapting to health reform.
  • Framework development for value-based contracting implementation.

Main Results:

  • Historical transactional relationships are unsustainable under new reform models.
  • A proactive approach involving strategic planning and operational adjustments is essential.
  • Key actions include recognizing relationship limitations, developing value-based roadmaps, and mitigating operational challenges.

Conclusions:

  • Providers and commercial payers must move beyond outdated models to embrace value-based contracting.
  • Strategic foresight and operational readiness are crucial for successful adaptation to health reform.
  • Focusing on purchaser and patient value is paramount for future reimbursement success.