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Overview of U.S. Health Care Payment and Policy
Course 1 of 6
Understand how Medicare, Medicaid, and private payers share responsibility for health care costs, and the financial impact on patients and families.
U.S. Health Care Payment and Policy 101
What You’ll Learn
The U.S. health care system is complicated. With a mix of government and employer-supported insurance coverage, a wide variety of payers, distinct payment rules for different services, changing financial interests and incentives, and ongoing efforts to drive better value, health care leaders must navigate carefully to balance high-quality care delivery with financial sustainability.
This unit contains six courses that provide foundational knowledge on health care payment, with a focus on structures and policies common to geriatrics and palliative care. The first course is a brief overview of how health care services are paid for in the U.S., and the remaining courses dive deeper into Medicare, Medicaid, payment and quality assurance mechanisms, alternative payment, and the incursion of private equity and the profit motive into health care. Learners who complete this unit will gain a solid understanding of the players and incentives driving U.S. health care delivery and be ready to lead future improvements.
What You’ll Earn
CAPC members can earn a Verification of Attendance certificate after completing the courses in this series.
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Medicare and Medicare Advantage: How they Work and the Impact on Care Delivery
Course 2 of 6
Examine what Medicare does and doesn't cover, while exploring the rise of Medicare Advantage and its impact on patients and providers.
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Medicaid, Veterans Health, and Long-Term Services and Supports
Course 3 of 6
Learn how Medicaid and VA benefits support vulnerable patients and families needing palliative care, and who qualifies for these programs.
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Fee-for-Service Payment and Quality Oversight
Course 4 of 6
Explore how fee-for-service payment works, its impact on quality, and strategies to optimize both revenue and performance under this model.
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Value-Based Payment and Alternative Payment Models
Course 5 of 6
Learn how value-based payment models tie quality to cost, and explore strategies for balancing priorities when navigating both fee-for-service and value-based care.
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The Role of Profit in U.S. Health Care
Course 6 of 6
Examine the rise of for-profit health care, why investors are drawn to the field, and the impact of profit incentives on care delivery.