HCM565 Payments for Health Services Providers

Payments for Health Services Providers (HCM565 CT 03)

Insurance is based on pooling of losses, payment for random losses, risk transfer, and indemnification. As a result, insurers use several different approaches to mitigate their risk and set premium rates, including:

the fee-for-service method

the cost-plus approach

• population health - capitation
• For your assignment, evaluate two global payment systems within healthcare and address each of the following items:
• Define the structure of the payment systems.

Identify risk to loss of revenue in each system.

Describe advantages and disadvantages of each system.

• Identify how pay for performance can be added to each payment system.