Healthcare payors and delivery systems are facing disruptive changes as cost pressures are opening doorways to new business models. Healthcare payors are the organizations that pay providers for their services and include private insurers, employers, government, and individuals. Private payors need to reevaluate how to design products that are still relevant in a rapidly changing environment, build solid relationships with their members, and support providers with care management tools and reimbursement systems that encourage a higher quality of care at lower cost. To survive, healthcare delivery systems must utilize new innovations in order to contain costs while demonstrating continuous improvements in patient outcomes.
In this section, you will learn how insurance functions in the healthcare system and understand who the major payors are. You will understand how International Classification of Diseases (ICD) codes are utilized for billing and reimbursement. And lastly, you will find the answer on why does healthcare cost so much.