NANO Medical HUB
What is a NANO Medical Hub?
Nano HUB is a data exchange system exhibiting the transactions between Healthcare Providers and Payers that can help in facilitating the security of exchange of health insurance claims related data. The Nano HUB portal is designed with a clear idea and intension to focus on workflows that connects providers and payers with transactions attributing to insurance claims using international code standards.
Below are the list of transactional requests and reponses that the Nano HUB as an support system provides between the Provider & the Payer
Transactional Requests and Responses
Conducting the eligibility checks of the each claim submitted in the portal
Verifying the electronic prescriptions to ensure the medications prescribed by the healthcare provider is meeting the norms of value based healthcare system
Pre-authorization requests and approvals
Claim submissions
Volume-Based Healthcare
- Fee for Service
- Providers are reimbursed for no interventions performed
- Perform endless interventions to maximize reimbursement
- Siloed approach specialty drive
- Complex all pu
- Individual patient episode
- No rewards for quality
- No IT investment Incentives
Value-Based Healthcare
- The quality or Performance-based service
- Providers are reimbursed for health outcomes
- Keep patients healthy and reduce unnecessary interventions
- Team-based across the continuum
- Outcomes across (Disease/patient)
- Incentives & penalties for quality metrics
- IT core part of strategy too
Value Based Payments
Value Based Payment is the process in which the Healthcare regulators (government, employers, and consumers) and Healthcare Payers (both public and private) hold the Healthcare Providers (physicians and other providers, hospitals, etc.) accountable for both quality and cost of country-level healthcare delivery system.
Value here is mostly defined as paying for high quality service at a reasonably
lower billing cost.
Most commonly used value based payment models:
Pay for Performance : With this model, we can drive outcomes, share best practices, and improve the patient satisfaction through verily timely interventions. This Program mostly favors Healthcare Providers
Bundled Payments : Improved care integration and Decreased health care costs due to the reimbursement model that uses a single yet comprehensive payment to address an entire episode of care received during an episode of care
Shared Savings : Improved overall medicare as the healthcare providers are incentivized based on the quality, and experience provided during the time of care.
Shared Risk : When both payers & providers share risk, there will be an improved medical care quality and reduced costs, due to increased vigilance.
Capitation : This payment method will improve the overall healthcare system as the billing will mostly be on the quality of service provided but not quantity.
Value Based Healthcare
Value based healthcare is a reimbursement program that benefits healthcare providers with incentives based on the quality of care they provide to the patients.
Essentially, value based healthcare models always revolve around the patient’s treatment and how well the care team can improve patient outcomes based on certain metrics, such as reducing hospital readmissions, improving preventative care, providing quality care, and using particular kinds of certified health technology.
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Value Based Care vs Fee-For-Service Care (Volume Based Care) :
Fee-for-service is the more traditional & also a good program for healthcare reimbursement model, based on the kind of services a healthcare provider performed. This system incentivizes providers to order more laboratory tests and procedures thereby increasing the cost and total number of patients in order to bring in more money.
This is the key difference with value based care vs. fee-for-service care. The former provides incentives and feel proud of their approach for quality, while the latter stresses more on quantity.
