1. Value-Based
Healthcare
PAYMENTS & REIMBURSEMENTS
ELIJAH B. BANKSTON, ACCOUNTING INTERN

2. ▪Initiative that is established to
increase quality by simultaneously
decreasing cost
Value Based Healthcare (VBS)
Pay For Performance

3. Pay For Performance (P4P)PopulationHealth
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
IndividualHealth
Per-event incentive to
reward providers for
specific activities

4. 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

5. CEO Power Panel Results
When 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

6. 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.
Healthcare CEOs are divided over whether the shift to performance-based
pay will improve their organizations' top and bottom lines.

7. CEO Power Panel Poll
Using 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

8. CEO Power Panel Poll
Using 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

10. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
PERCENT OF PATIENTS WHO
GAVE THEIR HOSPITAL A
RATING OF 9 OR 10 ON A
SCALE FROM 0 (LOWEST) TO
10 (HIGHEST)
PERCENT OF PATIENTS WHO
REPORTED YES,THEY WOULD
DEFINITELY RECOMMEND THE
HOSPITAL
PERCENT OF PATIENTS WHO
REPORTED THAT YES,THEY
WERE GIVEN INFORMATION
ABOUT WHAT TO DO DURING
THEIR RECOVERY AT HOME
PERCENT OF PATIENTS WHO
REPORTED THAT THEY
ALWAYS RECEIVED HELP AS
SOON AS THEY WANTED
Hospital Rating: Customer Satisfaction Results
Emory Univery Hospital State Average Grady DeKalb Medical
Data From Network of Care

11. Patient satisfaction
carries the promise of
big rewards and the risk
of big penalties.
The most commonly
used measure
of patient satisfaction is
the Hospital
Consumer Assessment
of Healthcare
Providers and Systems.

12. 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”

13. How do we Define Success?
What Is The Goal of
Healthcare (system)?

14. Value a
Function
of Cost
and
Outcomes
𝑉𝑎𝑙𝑢𝑒 =
𝑂𝑢𝑡𝑐𝑜𝑚𝑒
𝐶𝑜𝑠𝑡

15. How do we create a High
Value Delivery System?

16. Leveraging Data to Deliver Value
Data
Value

17. Data
▪facts and statistics collected
together for reference or analysis to
gather information.
Reorganize Integrate Measure

18. Measuring …
Information
Reorganize Integrate Measure
Health Status
QUESTION OF:
• Health Status
• Population Health
• Recovery & Sustainability

19. Re-Organizing …
QUESTIONS OF:
• Structure
• Demographics & Specialty
• Volume
• Fragmentation & Duplications
• Processes
• Mapping & Costing
Information
Reorganize
Structure
Volume
Process
Integrate Measuring

20. Data From Network of Care

21. Integrating …
Information
Reorganize Integrate
Response
Measuring
QUESTION OF:
• Response
• Co-occurring conditions

22. GHS Zip Code Level Data
45 & Under 46 & Older Female
Hispanic Asian Black
Male
Diabetes
Asthma
HIV
Low-Birth Weight
Obesity
Stroke
30318, 30344, 30303, 30317, 30324, 30341, 30350, 30308
Data From Network of Care

23. Materializations

24. How Does this apply to
The Fulton DeKalb Hospital
Authority?