Value-Based HealthcarePAYMENTS & REIMBURSEMENTSELIJAH B. BANKSTON, ACCOUNTING INTERN
▪Initiative that is established to increase quality by simultaneously decreasing cost
Value Based Healthcare (VBS)
Pay For Performance
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
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
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
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.
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
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
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.”
0%20%40%60%80%
Hospital Rating: Customer Satisfaction Results
Emory Univery Hospital State Average Grady DeKalb Medical
Data From Network of Care
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.
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”
How do we Define Success?
What Is The Goal of Healthcare (system)?
Value a Function of Cost
and Outcom
es 𝑉𝑎𝑙𝑢𝑒=
𝑂𝑢𝑡𝑐𝑜𝑚𝑒𝐶𝑜𝑠𝑡
How do we create a High Value Delivery
System?
Leveraging Data to Deliver Value
Data
Value Information
Data▪facts and statistics collected together for reference or analysis to gather information.
Reorganize Integrate Measure
… Outcomes that matterMeasuring … Information
Reorganize
Integrate Measure
Health Status
QUESTION OF: • Health Status
• Population Health• Recovery & Sustainability
… 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
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
… the entire health cycleIntegrating … Information
Reorganize Integrate
Response
Measuring QUESTION OF:
• Response• Co-occurring conditions
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
Materializations
How Does this apply to The Fulton DeKalb
Hospital Authority?
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