Assigment 515(88)

Payments for Health Services Providers

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.

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    CT_Rubric_100
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    100 Points
    Rubric Detail
    Levels of Achievement
    Criteria
    Exceeds Expectation
    Meets Expectation
    Some Expectations
    Unsatisfactory
    Content
    33 to 35 points
    29 to 32 points
    26 to 28 points
    0 to 25 points
    Demonstrates
    substantial and
    extensive knowledge of
    the materials, with no
    errors or major
    omissions.
    Demonstrates adequate
    knowledge of the
    materials; may include
    some minor errors or
    omissions.
    Demonstrates fair
    knowledge of the materials
    and/or includes some
    major errors or omissions.
    Fails to demonstrate
    knowledge of the
    materials and/or
    includes many major
    errors or omissions.
    33 to 35 points
    29 to 32 points
    26 to 28 points
    0 to 25 points
    Provides strong thought,
    insight, and analysis of
    concepts and
    applications.
    Provides adequate
    thought, insight, and
    analysis of concepts and
    applications.
    Provides poor though,
    insight, and analysis of
    concepts and applications.
    Provides little or no
    thought, insight, and
    analysis of concepts and
    applications.
    15 to 15 points
    13 to 14 points
    11 to 12 points
    0 to 10 points
    Sources go above and
    beyond required criteria
    and are well chosen to
    provide effective
    substance and
    perspectives on the
    issue under
    examination.
    Sources meet required
    criteria and are
    adequately chosen to
    provide substance and
    perspectives on the issue
    under examination.
    Sources meet required
    criteria but are poorly
    chosen to provide
    substance and perspectives
    on the issue under
    examination.
    Source selection and
    integration of knowledge
    from the course is clearly
    deficient.
    15 to 15 points
    13 to 14 points
    11 to 12 points
    0 to 10 points
    Project is clearly
    organized, well written,
    and in proper format as
    outlined in the
    assignment. Strong
    sentence and paragraph
    structure, contains no
    errors in grammar,
    spelling, APA style, or
    APA citations and
    references.
    Project is fairly well
    organized and written
    and is in proper format as
    outlined in the
    assignment. Reasonably
    good sentence and
    paragraph structure, may
    include a few minor
    errors in grammar,
    spelling, APA style, or APA
    citations and references.
    Project is poorly organized
    and written and may not
    follow proper format as
    outlined in the assignment.
    Inconsistent to inadequate
    sentence and paragraph
    development, and/or
    includes numerous or
    major errors in grammar,
    spelling, APA style or APA
    citations and references.
    Project is not organized
    or well written and is not
    in proper format as
    outlined in the
    assignment. Poor quality
    work; unacceptable in
    terms of grammar,
    spelling, APA style, and
    APA citations and
    references.
    Analysis
    Sources
    Demonstrates
    college-level
    proficiency in
    organization,
    grammar and
    style.
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