HCMG LATEST QUESTIONS AND ANSWERS UPDATE: A
MASTERING A+ MATERIAL!
Health care is distinctive in many features yet is not unique in any of these features
what is unique about healthcare is the ______ and ___ _______ of distinctivefeatures.
combination, large number
Iron Triangle of Health Care
cost, quality, access
Cost of Resources =
quantity of services x (quantity of resources)/(quantity of services) x price of resources
Shift from volume to value-based care: 3 points to value based care
Transition from FFS payment models to ones based on value
reduction in inefficient or unnecessary treatments
focus on population health management (through prevention, advanced data analytics and
targeted programs)
How do we enable the transition from Volume to Value based care?
Shift risk from insurers to providers and patients
Develop a system perspective
Transform the care continuum by enhancing care coordination
System perspective
increase vertical integration across providers and care teams
Barriers to adoption and scaling of value-based payments
1. Near term financial constraints
--Current system is lucrative
2. Short term focus
-inconsistent time horizons
, 3. Resistance to change
-risk and perceived risk (resistance to change)
Stakeholders in HC Ecosystem
Regulators
Manufacturers
Providers
Payers
Patients
The connection between _____ and ____ ______ is not nearly as direct or immediate as most
discussions would have us believe
health and medical care
_____ rather than _____ have major influence on their ______ while physicians rather than
patients have major influence on the ____ of medical care
Patients rather than physicians have major influence on their health while physicians rather
than patients have major influence on the cost of medical care
Insurance companies' core business is:
Processing claims (justification for scale)
Spreading risk (justification for scale)
Population health management
Providers' core business is:
Care delivery
Population health management
Distinctive (but not unique) features of Healthcare
Uncertainty
Prominence of Insurance
Asymmetric Information
MASTERING A+ MATERIAL!
Health care is distinctive in many features yet is not unique in any of these features
what is unique about healthcare is the ______ and ___ _______ of distinctivefeatures.
combination, large number
Iron Triangle of Health Care
cost, quality, access
Cost of Resources =
quantity of services x (quantity of resources)/(quantity of services) x price of resources
Shift from volume to value-based care: 3 points to value based care
Transition from FFS payment models to ones based on value
reduction in inefficient or unnecessary treatments
focus on population health management (through prevention, advanced data analytics and
targeted programs)
How do we enable the transition from Volume to Value based care?
Shift risk from insurers to providers and patients
Develop a system perspective
Transform the care continuum by enhancing care coordination
System perspective
increase vertical integration across providers and care teams
Barriers to adoption and scaling of value-based payments
1. Near term financial constraints
--Current system is lucrative
2. Short term focus
-inconsistent time horizons
, 3. Resistance to change
-risk and perceived risk (resistance to change)
Stakeholders in HC Ecosystem
Regulators
Manufacturers
Providers
Payers
Patients
The connection between _____ and ____ ______ is not nearly as direct or immediate as most
discussions would have us believe
health and medical care
_____ rather than _____ have major influence on their ______ while physicians rather than
patients have major influence on the ____ of medical care
Patients rather than physicians have major influence on their health while physicians rather
than patients have major influence on the cost of medical care
Insurance companies' core business is:
Processing claims (justification for scale)
Spreading risk (justification for scale)
Population health management
Providers' core business is:
Care delivery
Population health management
Distinctive (but not unique) features of Healthcare
Uncertainty
Prominence of Insurance
Asymmetric Information
