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Value- Based Healthcar e PAYMENTS & REIMBURSEMENTS ELIJAH B. BANKSTON, ACCOUNTING INTERN

Value Based Healthcare

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Page 1: Value Based Healthcare

Value-Based HealthcarePAYMENTS & REIMBURSEMENTSELIJAH B. BANKSTON, ACCOUNTING INTERN

Page 2: Value Based Healthcare

▪Initiative that is established to increase quality by simultaneously decreasing cost

Value Based Healthcare (VBS)

Pay For Performance

Page 3: Value Based Healthcare

Pay For Performance (P4P)Po

pula

tion

Heal

th Rewarding Providers for improvement over a previous

years performance level

Incentivize the attainment of a

specific benchmark, paying incentives to

providers that achieve the target In

divi

dual

Hea

lth

Per-event incentive to reward providers for specific activities

Page 4: Value Based Healthcare

Health Financial Managers Association

▪CEO Power Panel▪ 55 members▪ Represent 23 Hospital Systems and integrated delivery networks▪ Combined 85,000 bed▪ Representing 14 medical professional and trade association▪ 4 insurers▪ Cover 87 million lives (combined with integrated delivery

networks)

Research by Modern Healthcare

Page 5: Value Based Healthcare

CEO Power Panel ResultsWhen asked, “Which statement best describes your attitude towards value based reimbursement models?”

78% selected the choice: “Value-based reimbursement models should play the dominant role in healthcare reimbursements with fee-for- service medicine playing a declining and minor role”

“We should be compensated for results, not just for doing something,” said Chris Van Gorder, CEO of Scripps Health in San Diego.

“it will change the whole economics of the value chain about how we think about healthcare and the financing of healthcare, which is still predominantly on a fee-for-service basis or pay-for-volume.” said Bernard Tyson, CEO of Kaiser Permanente in Oakland, Calif.

“I'm encouraged by the early pay-for-value work,” said Dr. Gary Kaplan, chairman and CEO of Virginia Mason Health System in Seattle

Garnering Comments such as:

Research by Modern Healthcare

Page 6: Value Based Healthcare

VBS: Financially▪ Accountants Perspective▪ Purpose of accounting is to accumulate and report financial

information about the performance, financial position, and cash flow of a business. The information is then used to reach decisions about how to manage the business.

How/why is this relevant?Healthcare CEOs are divided over whether the shift to

performance-based pay will improve their organizations' top and bottom lines.

Page 7: Value Based Healthcare

CEO Power Panel PollUsing revenue as the measure:

Majority (52%) of executives indicated value-based reimbursement will increase revenue

“somewhat” (43%)“substantially” (9%).

Minority (27%) indicated they expect value-based reimbursement will decrease revenue to their organization

“lose a little” (19%) “lose a lot” (8%).

Another 21% said they will “not be affected one way or another.”

Research by Modern Healthcare

Page 8: Value Based Healthcare

CEO Power Panel PollUsing profit margin as the measure assessing the switch:

Narrow majority (45%) of executives indicated value-based Profit Margins will increase

“somewhat” (39%) “substantially” (6%)

But a significant minority (33%) indicated they expect value-based reimbursement will decrease revenue to their organization

“lose a little” (31%) “lose a lot” (2%).

Research by Modern Healthcare

Page 9: Value Based Healthcare

Dr. Ram Raju, president of the New York City Health and Hospitals is among those who worry value-based pay will affect top-line revenue “a lot,” since many programs tie reimbursement rates to patient-satisfaction score. Saying, “Changing patient-satisfaction scores is a very heavy lifting.”

Page 10: Value Based Healthcare

0%20%40%60%80%

Hospital Rating: Customer Satisfaction Results

Emory Univery Hospital State Average Grady DeKalb Medical

Data From Network of Care

Page 11: Value Based Healthcare

Patient satisfaction carries the promise ofbig rewards and the risk of big penalties.The most commonly used measureof patient satisfaction is the HospitalConsumer Assessment of HealthcareProviders and Systems.

Page 12: Value Based Healthcare

What is the fundamental problem

of Healthcare? How do we address the problem?

“It’s a sick care system that comes down to

profits”….. a “sick care capitalist marketing campaign”

Page 13: Value Based Healthcare

How do we Define Success?

What Is The Goal of Healthcare (system)?

Page 14: Value Based Healthcare

Value a Function of Cost

and Outcom

es 𝑉𝑎𝑙𝑢𝑒=

𝑂𝑢𝑡𝑐𝑜𝑚𝑒𝐶𝑜𝑠𝑡

Page 15: Value Based Healthcare

How do we create a High Value Delivery

System?

Page 16: Value Based Healthcare

Leveraging Data to Deliver Value

Data

Value Information

Page 17: Value Based Healthcare

Data▪facts and statistics collected together for reference or analysis to gather information.

Reorganize Integrate Measure

Page 18: Value Based Healthcare

… Outcomes that matterMeasuring … Information

Reorganize

Integrate Measure

Health Status

QUESTION OF: • Health Status

• Population Health• Recovery & Sustainability

Page 19: Value Based Healthcare

… Around the patients condition

Re-Organizing …

QUESTIONS OF: • Structure

• Demographics & Specialty

• Volume• Fragmentation & Duplications

• Processes• Mapping & Costing

Informatio

n

Reorganize

Structure

Volume

Process

Integrate Measuring

Page 20: Value Based Healthcare

DiabetesAsa G Yancey Health Center

East Point Health CenterNorth DeKalb Health Center

Data From Network of Care

Asa G Yancey Health CenterEast Point Health CenterGrady Memorial Hospital Lindberg Health Center

North DeKalb Health CenterNorth Fulton Health Center

Ponce De Leon Center

HIV

Page 21: Value Based Healthcare

… the entire health cycleIntegrating … Information

Reorganize Integrate

Response

Measuring QUESTION OF:

• Response• Co-occurring conditions

Page 22: Value Based Healthcare

GHS Zip Code Level Data

45 & Under 46 & Older Female

Hispanic Asian Black

Male

DiabetesAsthmaHIVLow-Birth WeightObesityStroke

30318, 30344, 30303, 30317, 30324, 30341, 30350, 30308 Data From Network of

Care

Page 23: Value Based Healthcare

Materializations

Page 24: Value Based Healthcare

How Does this apply to The Fulton DeKalb

Hospital Authority?