Healthcare: Pricing Models and Financial Metrics
Description
Comprehensive understanding of healthcare pricing strategies, reimbursement models, and financial performance metrics, crucial for business sustainability, regulatory compliance, and IT solution design.
Learning Objectives
IT professionals will understand healthcare pricing methodologies, evaluate reimbursement and payment models, interpret vital financial metrics, and design IT solutions to optimize pricing, billing, and financial operations in healthcare organizations.
Topics (10)
DRG-based case-mix, allocation of costs, IT requirements for cost accounting, and financial analytics.
Overview of factors influencing healthcare pricing: input costs, competition, regulations, payer mix, technology, and pricing transparency.
Mechanisms, incentives, and IT impacts of key payment models including data collection and analytics for each.
Role in cost control, incentive alignment, quality improvement; challenges and IT system implications.
Rules, consumer-facing price tools, EHR/portal integration, and regulatory mandates on hospital and payer transparency.
Metric definitions, calculation methods, and use in strategic decision making, IT dashboards, and reporting.
Techniques for contract negotiation, risk-sharing, data requirements, and digital support for payer-provider arbitration.
Payment risk, population risk scoring, revenue calculations, data analytics, and system implementation for managed care.
Technical standards and IT systems for claims, billing, remittance, card and digital payments, blockchain, and mobile wallets.
Rules for reporting, analytics for fraud detection/prevention, dashboards for compliance, and linking finance to legal mandates.