decisionhealth Newsletters, Part B News - 2015 Issue 2 (February)
Focus staff on care management to get ahead of changing payment mechanisms
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Article Overview
This practice management article explains how medical groups can assess whether to add embedded care management staff or reassign existing personnel as payment moves toward value-based and quality-driven models. It is aimed at physicians, practice administrators, and billing or health care business leaders who want to understand the operational and financial considerations behind care management, payer contracts, and readiness for integrated care arrangements. The article covers staffing options, practice readiness, payer incentives, and broad reimbursement concepts tied to care coordination.
Why This Topic Matters
As payment systems increasingly reward quality, coordination, and population management, practices need to decide whether their staffing and workflows can support care management services and related reimbursement opportunities.
Article Sections
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Practice management
Introduces the article’s focus on care management staffing decisions in the context of changing reimbursement incentives and practice operations.
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Assess your practice’s readiness
Reviews factors that may affect whether a practice is prepared to add or redistribute care management responsibilities, including operational infrastructure and practice size.
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To embed or not to embed: Define your goals
Outlines broad planning considerations for integrating care management into a practice, including alignment with payer arrangements, financial planning, and staffing goals.
What You Will Learn
- How care management fits into value-based payment environments
- What practice characteristics may influence staffing decisions
- How payer arrangements can affect care management strategy
- What operational factors are commonly considered when planning for embedded care management
- How practices may think about financial and workflow readiness for care coordination services
Who Should Read This
- Physicians
- Practice managers
- Medical group administrators
- Billing and reimbursement staff
- Health care consultants
Codes Discussed
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