Discussion Guide: Contracting with Payers-Discussion Guide for Contracting with Payers course

Discussion Guide for Contracting with Payers course

Pdf Summary

The Home Centered Care Institute (HCCI) provides a discussion guide for a group activity based on their online course, "Contracting with Payers: Demonstrating the Value of Home-Based Primary Care (HBPC)." The guide aims to help facilitators prompt discussions on demonstrating value to payers when negotiating funding for patient needs.<br /><br />**Purpose:** The discussion is designed to highlight strategies for proving the value of HBPC services during payer negotiations.<br />  <br />**Audience:** Intended for those who have completed the online course, the session should last no more than 60 minutes.<br /><br />**Materials:** Required materials include hard copies of the "Next Steps" handout and a flipchart for capturing ideas.<br /><br />**Learning Objectives:**<br />- Identify different payer types relevant to HBPC and their characteristics.<br />- Determine the key individuals to contact during contract negotiations.<br />- Show the value of HBPC programs using patient quality, utilization, outcome data, and compelling patient stories.<br /><br />**Agenda:**<br />1. **Introduction (5 mins):** Initiate discussions using prompts about non-medical needs that improve care quality and the reimbursement methods (Fee-for-Service, Fee-for-Service plus care management fee, and per enrollee per month).<br />  <br />2. **Payer Types (5 mins):** Discuss the four payer types covered in the course, which payer accounts for most patient services, and which accounts for the least.<br /><br />3. **Key Players (5 mins):** Explore who to contact during negotiations and strategies for building connections with these individuals.<br /><br />4. **Demonstrating Value (20 mins):** Determine how different data types—patient satisfaction, hospital admissions, healthcare cost savings, goals of care, and medication reconciliation—demonstrate value. Discuss current data sources and potential patient stories to highlight value.<br /><br />5. **Debrief (5 mins):** Review and commit to next steps from "Next Steps" handout, sharing ideas for implementation.<br /><br />Overall, the guide aims to arm participants with practical strategies and talking points to effectively negotiate with payers and secure necessary funding for HBPC, reinforcing the benefits of such programs.

Keywords

Home-Based Primary Care

HCCI

payer negotiations

demonstrating value

contracting

patient needs

discussion guide

learning objectives

payer types

healthcare cost savings