Which healthcare delivery model ties provider reimbursement to the quality and cost of care for a patient population (for example, kidney dialysis patients)?

• A. HRRP
• B. Capitation
• C. FPL
• D. Accountable Care Organizations

Answer: (D)

This item tests value-based care where payment is tied to how well a group of providers manages both quality and cost for a defined patient population. An Accountable Care Organization coordinates care across clinicians and settings for a population—such as people on kidney dialysis—and uses agreed-upon quality metrics and total-cost-of-care targets to determine reimbursement. When performance meets or exceeds benchmarks, the organization can share in savings; if targets aren’t met, there may be financial risk. This directly links how providers are paid to the overall quality and cost of care for the defined group.

Hospital readmission penalties are about reducing payments to hospitals with high readmission rates, which is a pay-for-performance mechanism at the hospital level rather than a shared-savings, population-wide model. Capitation involves a fixed per-patient payment, which controls costs but isn’t inherently tied to a population-wide quality and cost-sharing outcome. Federal Poverty Level is just a measure used for eligibility, not a care-delivery or payment model.