Glossary · Payer
Glossary · PayerValue-Based Care (VBC)
Payment models that tie provider reimbursement to quality and cost outcomes rather than service volume. Includes shared savings programs, bundled payments, and full capitation.
Definition
Value-Based Care (VBC).
Payment models that tie provider reimbursement to quality and cost outcomes rather than service volume. Includes shared savings programs, bundled payments, and full capitation.
Sources
Primary references for this entry.
- CMS Innovation Center models.
- HFMA Value-Based Payment resources.
Related terms
Other terms in Payer.
- Payer
Accountable Care Organization (ACO)
A group of providers and suppliers that coordinates care for a defined population of Medicare or commercial patients and shares in the savings (or losses) generated against a benchmark.
Open entry - Payer
Allowed Amount
The maximum dollar amount a payer will reimburse for a covered service, set by the payer fee schedule or contract regardless of the provider's billed charge.
Open entry - Payer
Capitation
A payment arrangement where the payer pays the provider a fixed amount per patient per period (PMPM, per member per month) regardless of services rendered. Common in Medicare Advantage and managed-Medicaid contracts.
Open entry - Payer
Coordination of Benefits (COB)
The process of determining which insurance plan pays first when a patient has multiple coverages, and how secondary or tertiary plans pay against the remaining balance.
Open entry - Payer
Fee-for-Service (FFS)
The traditional payment model where providers are paid a discrete fee for each billable service, as opposed to capitation (per member per month) or value-based contracts (per outcome).
Open entry - Payer
Medicaid
The federal-state program providing health coverage to low-income U.S. residents. Each state administers its own Medicaid program with its own fee schedule, prior-auth rules, and managed-care plans.
Open entry
Frequently asked
About Value-Based Care (VBC).
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