Payment by Global Adjusted Budget (GBP)
Remuneration model based on history of annual remuneration, with predictability of adjustments
Remuneration model based on the history of the amounts paid annually to a specific provider to cover the contracted services. Based on this history, a global monthly amount to be paid to the provider is defined, with predictability of adjustments related to production and case complexity. Services are monitored using predefined indicators.
For the composition of the global budget, several information must be analyzed, such as: billing history, type of hospitalization of patients, disallowances and their reasons, minimum set of data for implantation of DRG (fundamental condition for hiring), relative weights and case-mix of the institution, assessment of data to identify possible indicators to be monitored, minimum set of epidemiological data for predictive calculations of care use, among others.
Application Profiles
Primary Care
Hospitals with a history of service volume with the paying source.
What are the positive points?
- Reduction of the billing cycle. The payment made is made in the month immediately following the service.
- No glosses. Payment is in full as negotiated, this reduces the administrative cost for both sides.
- Predictability of billing by the provider and cost predictability by the payer.
- Exemption from the need for the patient to wait for the release of guides for exams and/or procedures or OPSM.
What are the points of attention?
- The Global Adjusted Budget model must necessarily include Value metrics to be applied and considered for payments in addition to the defined global budget. Without linking these metrics, the risk of undertreatment and risk selection is enormous and will have a severe impact on patient care.
- It is essential to consider the creation of periodic adjustments and triggers that allow monitoring the volume and complexity of service, as significant changes in these items will certainly trigger an imbalance in the payer/provider relationship, compromising the contract.
- The advantages of hiring a preferred provider are many, mainly due to the bargaining power due to a demand direction. However, the GBP model, as it does not promote competition, precisely because of this direction, can compromise the quality of the services delivered.