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Special Reports

Special Reports 2021-06-11T15:23:01+00:00

Special Reports

Alternative Reimbursement Models

Developing Alternative Reimbursement Models for Hospital Admissions related to COVID-19

When the COVID-19 epidemic began, the possibility of medical schemes being exposed to the costs was flagged as a risk. COVID-19 was further classed as a prescribed minimum benefit (PMB), which increased the risk. As a result, the concept of an ARM for COVID-19 hospital admissions was investigated as a feasible risk-mitigation strategy.

BHF spearheaded this initiative in collaboration with an industry Task Team consisting of actuaries and two industry clinicians. It is hoped that this initiative will empower various healthcare stakeholders to create alternate reimbursement arrangements that can improve the resilience of our healthcare system in the fight against COVID-19.

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Bottom-up Approach

Developing Alternative Reimbursement Models for Hospital Admissions related to COVID-19

This is the second part of a report released by the Board of Healthcare Funders (BHF) on the work done by the Industry Technical Advisory Team (ITAC). The group was tasked with exploring the feasibility of creating a global fee for COVID-related admissions. The first report was from the ‘top-down’ team: it analysed the variation in COVID admissions and assessed the possibility of a global fee. 

The second team in the ITAC group explored the same question but using a ‘bottom-up’ approach. We held a series of interviews with hospital groups and this paper is a summary of the learnings from our discussions with the hospital executives, analysts and clinicians interviewed. Hospital executives spanned clinical risk management and funder relations. 

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