Integrated Delivery System (IDS) Payment Models

After enumerating the sorts of IDS and organization models of integration, the posts context has leaded us to the point of payment terms within integration frame work of medical system. payment pathways starting from working accounting and funds movement among providers and state institutions figure the final result of whole processes of integrations from design till execution. Honestly; it is not easily matter at all, that if controlled properly could save a lot of effort later in order to correct human mistakes and keep all medical delivery system automated without interruptions.  In coming lines; we going to discuss few various payment options ranging from shared savings to full capitalization.

Shared Saving: to exaggerate collaboration between different medial system& partners; provider, funders (insurance) & receivers. Saving strategy is one of most old and effect one; produce high responsiveness among patients and also restrict widely expenses current of useless purpose. Frugal strategy among medical workers provides the organization with two main rewards; first create awareness that expenses must be under control and that important if workers do not feel the importance how they cut excess expenditures? Second; decrease hospitalization rate and improve out-patient service through put the demanded services on borders; means the provider will never offer unnecessary services because he will lose this money with insurance firm if could not provide the prove that was in need to the patient.

Blended Payment for Primary Care: is different methodology of payment be applied with additional services provided by healthcare providers such as; care coordination, health information technology, communication and remote monitoring. Blended payment method enhance payment tool for medical home care and practices per member/ per month management fees. In addition to lightens regular visits of providers and open new resources for funding with additional value provision.

Episode-Based Payment: is way of payment of care over a period of time; means takes longer than only single visit or hospitalization. this method of payment unlike pay-for-service; strengthens the coordination and efficiency between healthcare involved partners and doesn’t depend on solitary procedure. Episode-based payment categorized into:

Ø  payment for acute care episodes that include hospital services only

Ø  payment for acute care episodes that include both hospital and physician services

Ø  payment for chronic care episodes that include outpatient care only, such as diabetes care for 1 year

Ø  payment for chronic care episodes that include outpatient plus inpatient care

Bundled Payment: is a means of payment to physicians and hospitals through one provider, multiple kind of services can be bundled and delivered by one provider. In deed this method of payment widely used in Medicare& Medicaid centers in US. Bundled Payment method encourages physicians, nurse, medical care providers to work utmost together to improve care quality to end receivers.

Capitation or Global Payment: also called full capitation, global per-member, per-month payment through capitation contract; each physician receives certain amount of money per patient on the base pay for-performance (Crosson & Tollen). This means of payment shifts the financial risk to the providers that will not paid for extra or additional services unless basic ones not in appropriate way. Global payment care mostly measures service quality to incentive the process of improvement and development among medical providers and resists against underutilization. There is no incentive to increase revenues by increasing volume of services. Full health J