Supplementary healthcare in Brazil faces constant challenges, from financial sustainability to the quality of care provided to beneficiaries. Traditionally, the predominant remuneration model is fee-for-service (FFS), where healthcare providers are paid for each procedure performed. Although this model is widely used, it has several disadvantages, including promoting volume over value, encouraging unnecessary procedures and raising overall costs.
Given this scenario, new forms of remuneration are being explored and implemented, with the aim of aligning financial incentives with the quality of care and the efficiency of the services provided. Below we will discuss some of these new forms of remuneration and their potential impacts on supplementary healthcare.
1. Capitation
Capitation is a payment model in which healthcare providers receive a fixed amount per registered patient, regardless of the services provided. This model encourages prevention and comprehensive care, since the provider receives the same amount regardless of the number of procedures performed.
Capitation can help control costs by promoting more efficient, patient-centered care practices. However, implementing this model requires a robust management and monitoring structure to ensure that the quality of care is not compromised.
2. Pay for Performance (P4P)
Pay-for-Performance (P4P) is a form of remuneration that links payments to the quality of the services provided. In this model, healthcare providers are rewarded for achieving or exceeding certain performance indicators, such as hospital readmission rates, adherence to clinical guidelines and patient satisfaction.
P4P encourages continuous improvement in the quality of care and can lead to better health outcomes for patients. However, the precise definition and measurement of performance indicators are significant challenges for the effective implementation of this model.
3. Bundles of Procedures
Bundled procedures, or payment per episode of care, involve a single payment for all services related to a specific treatment or condition, such as surgery or the treatment of a chronic disease. This model encourages the coordination of care between different providers and can reduce the fragmentation of health services.
By aligning financial incentives so that providers work together to provide efficient, high-quality care, procedural bundles can reduce costs and improve patient outcomes. However, defining bundles and splitting payments between providers can be complex and requires detailed negotiations.
4. Value-based models
Value-based models seek to align payments with the health outcomes achieved, rather than the volume of services provided. These models can include a combination of capitation, P4P and procedural bundles, and are designed to incentivize care practices that improve patient health and reduce costs in the long term. There is also a tendency for them to be related to outcomes that matter to patients and a population management vision for scalability.
The transition to value-based models requires significant changes in the organizational culture, care processes and IT systems of healthcare operators and providers. However, these models have the potential to transform the healthcare system, promoting more efficient, patient-centered care with great potential for reducing waste due to the alignment of interests.
Remuneration in supplementary healthcare - which way to go?
New forms of remuneration in supplementary healthcare represent a significant opportunity to improve the efficiency, quality and sustainability of the healthcare system.
Although each model presents its own challenges, combining different approaches can offer a balanced solution to the sector's current problems.
Managers of health insurance companies must be aware of these innovations and be prepared to adopt practices that promote more effective, patient-centered care, guaranteeing a more sustainable future for supplementary health in Brazil.
Use technology to handle the remuneration of all your providers with total transparency
The largest Brazilian healthcare operators are taking innovative steps to survive in this market, and definitely the most important of these is investing in technology. By adopting a software focused on cost management in supplementary healthcare, it is possible to break paradigms and leap ahead of the competition by capturing and interpreting the available data more accurately.
This type of solution centralizes data in one place, facilitating everything from the administrator's work, through employees and up to the management processes. audit. It is also possible to analyze histories, measure the number of each procedure and generate valuable information for future decision making.
These are the ways in which healthcare service providers are compensated and the ways in which these companies are trying to survive in this very competitive market.
Did you enjoy learning about the new ways of remunerating healthcare service providers? Want to know more about how to use technology to your health insurance company's advantage? contact one of our experts will present you with innovative solutions for cost management. You can achieve significant results in reduction of disallowances and claims in the first 3 months! ; )
