Matching Training to Payer Requirements

The changing health care environment, and in particular changing payer reimbursement requirements, may affect how you choose to train your workforce. A NIATx webinar on The Impact of Billing and Third Party Participation on Your Workforce from May 10, 2011, hosted by John Morris, MSW and Wayne Dailey, PhD reviewed the workforce implications of changing financial structures, and found that payment type seemed to influence selection, training and deployment of front line workers. The more recent (2016) NIATx Third Party Billing Guide can offer additional options on change, but they noted the following examples: 

Under Fee-For-Service models there is a fee for each unit (hour, e.g.) of service provided.

Workforce training emphasis should be on:

  • Productivity (days/encounters)
    • Goal Setting and Performance Monitoring
    • Client retention/reduction of no-shows
  • Efficiency
    • Technologies
    • Supervision
    • Careful documentation of services
    • Service provision that met definitional requirements set by the payer
    • Achieving balance between recovery goals and productivity
    • Monitoring and adjusting to meet changing needs

The workforce selection emphasis should be on:

  • Determination/Efficiency
  • Writing and technology skills
  • Staff credential requirements

Under Capitated models, the provider is paid a contracted rate for each member assigned, referred to as "per-member-per-month" rate, regardless of the number or nature of services provided.

Workforce training emphasis should be on:

  • Cost avoidance, Prevention
  • Anything it takes approach, Non-traditional interventions
  • Team cohesion and team building
  • Outcome requirements
  • Ability to improve client satisfaction

The workforce selection emphasis should be on:

  • Matching workers with client needs
  • Resourcefulness, tenacity, unflappability

The presenters also note that "both Fee-For-Service and Capitated models focused on cultivating a workforce that had the ability to connect with people and improve Client satisfaction."