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Health Care Reimbursement and Utilization Management

Accountable care organizations (ACOs) are designed to promote value and quality in health care. They use new payment and delivery models that include incentives to improve care coordination and utilization management. With these models, ACOs contract with private insurers and/or Medicare to receive reimbursement, and then the ACO determines how to contract with physicians and other medical providers to provide health care services to patients. Since not all providers are direct employees of ACOs, there are potential challenges with reimbursing the affiliated providers in a way to maximize efficiency, increase quality, and lower utilization. For this Discussion, examine the following scenario and recommend strategies for reimbursement and utilization management. This Discussion will be graded using this rubric: Discussion Rubric (Word document)As the CFO of the ACO in the provided scenario, recommend strategies for reimbursement and utilization management. Defend your recommendations. a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting. to at least of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by contrasting your colleagues’ recommendations with your own. Provide alternative perspectives.

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