NANO Medical HUB

Provider-to-payer transactions on one exchange, in a standard form

What is a NANO Medical Hub?

NANO HUB is the exchange that carries transactions between healthcare providers and payers — eligibility, e-prescription verification, pre-authorisation and claim submission — securely, and in a standard form both sides already understand. The portal is built around the workflows that actually connect the two, using international coding standards rather than each party's own format.

That plumbing is what value-based payment depends on. A payer cannot reward outcomes it cannot see, and a provider cannot be measured on quality if eligibility and authorisation decisions arrive by phone. The sections below set out what value-based care asks for; the HUB is how the transactions behind it move.

Transactional Requests and Responses

Eligibility checked on every claim submitted through the portal

Verifying the electronic prescriptions to ensure the medications prescribed by the healthcare provider is meeting the norms of value based healthcare system

Pre-authorization requests and approvals

Claim submissions

Volume-Based Healthcare

Fee for service
Providers are reimbursed for the interventions they perform
Incentive to perform more interventions to increase reimbursement
Siloed, specialty-driven approach
Individual patient episode
No reward for quality
No incentive to invest in IT

Value-Based Healthcare

Quality and performance-based service
Providers are reimbursed for health outcomes
Incentive to keep patients well and avoid unnecessary interventions
Team-based, across the whole continuum of care
Outcomes measured across a disease and a patient, not one visit
Incentives and penalties tied to quality metrics
IT is a core part of the strategy

Value Based Payments

Value-based payment is the arrangement in which healthcare regulators (government, employers and consumers) and payers, public and private, hold providers — physicians, other clinicians and hospitals — accountable for both the quality and the cost of care delivered at national scale.

Value here means paying for high-quality service at a reasonable cost, rather than paying for the number of things done.

Most commonly used value based payment models:

Pay for performance : drives outcomes, spreads best practice and improves patient satisfaction through timely intervention. Of the models here, this is the one that most favours providers.

Bundled payments : one comprehensive payment covers an entire episode of care, which forces care integration and tends to reduce total cost.

Shared savings : providers are rewarded against the quality and experience of the care given, so improvement in the care is what produces the saving.

Shared risk : payer and provider both carry risk, which raises the attention paid to quality and cost on both sides.

Capitation : billing follows the quality of service rather than its quantity, which changes what the whole system optimises for.

Value Based Healthcare

Value based healthcare is a reimbursement program that benefits healthcare providers with incentives based on the quality of care they provide to the patients.

Essentially, value based healthcare models always revolve around the patient’s treatment and how well the care team can improve patient outcomes based on certain metrics, such as reducing hospital readmissions, improving preventative care, providing quality care, and using particular kinds of certified health technology.

Value Based Care vs Fee-For-Service Care (Volume Based Care) :

Fee-for-service is the more traditional & also a good program for healthcare reimbursement model, based on the kind of services a healthcare provider performed. This system incentivizes providers to order more laboratory tests and procedures thereby increasing the cost and total number of patients in order to bring in more money.

This is the key difference with value based care vs. fee-for-service care. The former provides incentives and feel proud of their approach for quality, while the latter stresses more on quantity.