Managing provider reimbursement levels is an important function for health plans. Provider reimbursement analytics can offer health plans the foundation they need to effectively manage reimbursements.
In their article “Provider reimbursement analytics,” Milliman consultants David Lewis and Charlie Mills highlight the advantages and disadvantages of the two primary analytical approaches for evaluating provider reimbursement levels. The authors also discuss the pros and cons of the three main baseline fee schedules used in provider contract benchmarking, one of which includes Milliman GlobalRVUsTM.
Global relative value units (GlobalRVUs) allow measurement of unit price and efficiency across physician groups for accountable care organizations (ACOs), shared saving and total cost of care programs, and bundled payment and other capitated arrangements. GlobalRVUs are essentially an extension of Medicare’s resource-based relative value scale (RBRVS) so that every medical service has an RVU. The RVUs are based on Healthcare Common Procedure Coding System (HCPCS), diagnosis-related group (DRG), or National Drug Code (NDC) Pharmacy classifications and are not affected by the contractual allowed amount.
Milliman’s Will Fox offers perspective in this MedInsight blog post where he provides an example for the comparison of delivery systems.
For a more detailed account of Milliman GlobalRVUs download the white paper here.