(And How You Can Survive It It) A Complimentary Webinar From - - PowerPoint PPT Presentation

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Th The St State of f Analyt ytics (And How You Can Survive It It)

A Complimentary Webinar From healthsystemCIO.com Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You!

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Housekeeping

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Agenda — Approximately 40 Minutes

• 35 minutes: Gene Thomas, VP/CIO, Memorial Hospital and Memorial

Physician Clinics at Gulfport

• 10 minutes: Q&A w/Gene Thomas

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By Gene Thomas Memorial Hospital and Physician Clinics Gulfport, MS

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XXXX

 XXXX  XXXX  XXXX

The State of Analytics and How You Can Survive It

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Memorial Hospital and Physician Clinics

• Not-for-profit community safety net provider
• Established in 1946
• 445 Beds
• ~ 3,200 employees
• ~ 450 Medical Staff / Half Employed
• 85+ Owned Memorial Clinics
• Achieved Stage 1 in 2011 – I/P and EP
• High Medicare / Medicaid / Un-insured Mix ~ 65+%

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Memorial Hospital and Physician Clinics

 Level 2 Trauma Center  Annual Volume:

 450,000 clinic visits  180,000 outpatient procedures  75,000 ED visits  16,000 admissions High volume of “un-managed manageable conditions”…….. Or so we believe

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Where we have come from… What Happened to Us

• Surrounded by for-profit
• Only Behavior Health on Gulf Coast
• Never closed our doors during

Hurricane Katrina

• Operated as both a hospital and place
• f refuge
• Founded 1946

August 29, 2005

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The “System” Katrina Built

“The storm” wiped out most medical practices in the area. The buildings were gone, patients were gone, doctors were gone or leaving.

–Memorial stepped in & offered

employment to all medical staff.

–By 2009, Memorial owned 46 clinics. –Today, there are 85, tomorrow…

100+

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Realities & Predictions

 Be accountable

 “We’re already accountable”

 Prepare for clinical integration and/or - use our footprint now for CI  Develop and Use Analytics to Enable – Pouring the foundation

 Real targeted measurable quality initiatives  Population Health Management  Revenue Cycle Analytic Capabilities  Financial Decision Support Capabilities  Managing Fee for Service Transition to……?

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Where we came from…

3 Clinical Areas Live Ancillary’s Automated Limited Integration

• 10 years of e-nursing

documentation

• High Portal adoption
• Mixed paper & electronic

environment

• Some Ancillary’s Automation

2009 ED Automated June 2011

• Installed Enterprise

Practice Management & EMR in 53 clinics 2010-2011

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• Integrated Core System

– One patient, one longitudinal view – Comprehensive analytics – Speed, performance, reliability and security – Extensible and scalable – Common ancillary and support systems

What We Wanted

Data Driven:

• Decisions
• Care
• Negotiations
• Clinical

Improvements

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Two Key Decisions

Key Decision # 1 Key Decision # 2

 Integrated EMR  EMR Vendor / Partner  Comprehensive EDW  Analytics Vendor / Partner

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Staying Focused on the Goal…

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Staying Focused on the Goals…

16

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CIO Role

 Infrastructure

Foundational

 EHR

Table Stakes

 Patient Portal

Table Stakes

 Data Submission

Regulatory

 MU

Regulatory

 Positioning

Critical

 Supporting C’s

A Must

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CIO’s Topics Stream of Consciousness – Supporting the Organization

• Shared Risk
• Narrow Network
• Clinical Integration
• CMI
• Breakage / Leakage
• Capture CC’s & MCC’s
• Commercial Contracts
• LOS reporting & analysis
• Cost per Case
• Transformation
• Exchanges
• Fee-for-Service
• Bundled Payments
• Quality / Outcomes
• Revenue Cycle
• DNFC / DNFB
• A/R Days
• Commercial Volume
• Reimbursement Environment
• Readmission Topics
• Unnecessary Tests
• Variability
• Regulatory Reporting

But Really – CIO’s / CAO’s provide data & analytics supporting decisions for:  How to maintain or increase margin while decreasing I/P volume  Demonstrating ability to bend cost curve  Eliminate waste – target medicare cost structure??  Long List - And on and on…….…………. Serious Topics But…..,

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Disclaimer

The opinions expressed herein represent my personal opinions and not necessarily those of Memorial Hospital at Gulfport.

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Why Analytics and Why Now?

1.

Now is almost to late

2.

Get ready for the real game by pouring your foundation

3.

Can you measure outcomes and cost?

4.

PROFITABILITY Assuming obvious costs cut, can you cut your way out of margin pressure forever?

National Trend: Bond Rating Downgrades

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Fallacy

 Inability to reconcile numbers in different applications, so

difficult to plan margin improvement and quality improvement.

 Silos of data = Lack of coordination between quality and cost,

between quality and finance.

 “Magical Thinking” – If we put in an EHR we got this

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Role Of Analytics

Aids in answering important questions - Will we improve our margin by:

1) Reducing waste - Getting some shared savings or bonuses 2) Reducing out of network leakage to offset reductions in per capita in patient utilization 4) Help us model

• If we can actually make NET savings after we pay for all of this

new IT and case managers and bonus the doctors?

• How long until will we experience the law of diminishing returns

as the benchmark is ratcheted down

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Typical baseline scenario for community hospital analytics

 Finance uses legacy applications to look at cost by service line,

by DRG and by cost center; as well as little to no risk adjustment, drill down, and modeling capabilities.

 Quality uses service that provides last year‘s risk adjusted

benchmarked service line and DRG based performance, especially quality and some cost. Cannot model margin, contribution margin, or easily identify cost outliers.

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Thoughts…

 Identify all data to move into EDW while you…  Interfaces, Interfaces, Interfaces – lots of source marts  Mapping, Mapping, Mapping  Upgrade Hell  Needs & Resources  How to justify to leadership??

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The Set Up

 Many traditional administrators don't believe ACO’s

• r ACO type models are the solution

 Many don't understand but accept inevitability  Some don't want any change and don’t want to believe.

 Most are not clinically integrated  Don't have risk contracts  Some are not committed mantra wise to the triple aim

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We are “Doing” Analytics in a Big Way!

 Seeming contradiction on the surface  On closer inspection is not only wise.  Is necessary!  Individual markets are different but drivers are the same,

just weighted differently.

 Ask yourself, are we like these folks in Anywhere USA?

Yes, the largest payer is moving away from FFS

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Usual Facts

 Market dominance  Largely employed  Medical staff on new integrated EMR - having primary care

integrated is key !!

 I/P Volume high and not declining yet, but expect it will -reality  Keeping an eye margin, but no longer just “Volume & Mix”  They say it's our payer mix  Maybe it's our cost structure?

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Not So Unusual Facts

 Rapid acquisition of primary care and primary specialists  Many use RVU metrics (kind of a blind eye to quality)  Some have some cost data on their practices (our P&L),

• verhead allocation complicates comps

 Some don't know yet, if their physicians look efficient or

expensive as well as how good or poor quality looks to private payers or CMS

 Many don’t have robust quality data on ambulatory  Is that you?

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Baseline Status

 Flying Triple Blind  Not starting CI/ACO  Passed on engaging in CI with other

MS health systems for now

Note: Many providers traditionally care for population at unknown cost, quality and patient satisfaction

Can’t see the details..

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If Not Ready for FFV Triple Aim Today…. Consider The Quadruple Increment*

1.

Maximize FFS revenue in new ways using analytics

2.

Reduce Costs embedded in Clinical Variation using analytic

3.

Measure and improve quality and overall utilization in primary care for 1 year and simulate FFV contract performance using analytics

4.

When you can show you have moved quality and cost needles, go to commercial payers armed with your own analytics and move to no-risk, shared savings with quality bonuses

*(Source: Richard Ferrans MD, ScM)

USE ANALYTICS TO PREPARE FOR INEVITABLE

“You Can’t Improve What You Don’t Measure”

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The Quintuple Increment: STRATEGIC PREPARATION

 Whereas Value Based Purchasing is forced toe dipping…  Quintuple Increment- voluntary both feet moving slowly

• ff FFS shore into ankle deep FFV water.

 Based on theory of some organizations in some markets

are better off maintaining FFS until economic advantage indicate certain trigger points, then convert to FFV

 FFV resistant organizations are typically dominant still

profitable no volume declines. Lack burning motivation.

Many say that will change – I’m one of them

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• Stay in FFS but prepare for FFV using four analytics-

powered incremental steps to improve your future "Triple Aim aim"

• Use analytics to simulate FFV contract performance so

you can learn how with "Monopoly money"

• Use analytics to identify variation, root cause analysis,

build QI programs that improve quality and reduce cost in 1-3 year time horizon

• Measure results and go for new contract before you

move the needle a ton.

The Quintuple Increment:

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What is this approach?

 Simulation!  Like all simulation and modeling, designed to teach

you skills so you are proficient before the real world exercise begins!

 Only way to accomplish this is to have a preseason!  Moving later to FFV requires rapid ascent of

learning curve to catch early moving competitors

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Cost

 This part is real  Obvious targets some or most address

 Benefits  Staffing to volume  Variation  Services lines  Supplies

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The Costs are Not Where Typically Believed to be

 Not in service lines  They are embedded in variation  Identify and move to reduce  This is the lean or lean type approach  Starts with insight into cost variation of treating

conditions and process mapping of variation

 It's about margin on direct costs for DRGs and

waste within overhead.

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Revenue Max

 Revenue Cycle Optimization is about lean analysis

process mapping redesign and iterative improvements to understand revenue per case – allows discussion with data

 So many hands touch it, so much exception handling  Starts with analytics…  Goal is - going from where you are now to best  “ No Outcome, No Income” (formerly no margin no mission)

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Summarize Quadruple Step

• Ambulatory quality/cost/ utilization PMPM
• Revenue cycle and resulting discussion with MD’s
• Lean type focus on cost and optimization
• Move needle, go to commercial payer for shared saving or

bonuses

• ALL START WITH ANALYTICS

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Examples

• Readmissions broken out from home and from post-acute-

different root causes, different programs.

• Uninsured and Medicaid primary care in ED and readmissions

contributes to our lowering margin.

• COPD not on optimal therapy increases utilization
• HgA1C >9 increases utilization
• Post d/c visits and adherence reduces readmits

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Typical Baseline Scenario for Community Hospital Analytics

 Finance uses legacy application to look at cost by service

line and by DRG and by cost center. Little to no risk adjustment, drill down, and modeling capabilities.

 Quality uses service that provides last year's risk adjusted

benchmarked service line and DRG based performance, especially quality and some cost. Cannot model margin, contribution margin, or easily identify cost outlier.

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Understanding Causality of Variance- Analytics

• Ultimate Goal- Capture and analyze claims, clinical data, utilization, adherence,

and social determinant data.

• Understand causality so solutions can be tailored to patients
• If a patient has poor control of diabetes…

– Did they go to the PCP – Did the PCP test for correct things and prescribe correct medications – Did the PCP escalate therapy appropriately – Did the patient fill the prescriptions – If not, (financial, educational, side effect concern, mental health) issues? – Does patient self manage? – Does patient fundamentally understand disease process?

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The Elephant in the Room

 If we start taking risk or at risk:

 Will improved quality reduce ambulatory sensitive

admissions and readmissions.

 Are they negative margin or positive margin cases we are

removing?

 If we improve population health, will we reduce inpatient

utilization and low acuity ED utilization.

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An Example…or Though…

 If you use analytics to avoid readmission and or VBP

penalties, (risk adjust readmissions)

 The benefit is to payers  You could be cannibalizing revenue  Why should only the payer benefit?  Look at the observed vs. the expected  What is the mean?

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Summary

 "We are in Fee for Service"- the party line  Quadruple step powered by Analytics  Analyze - react - simulate - improve  Strike when ready and have an unfair performance

advantage day 1

 Analyze the present to prepare for the future

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End Game…

 ANSWER-

 Buy some analytics and develop a real plan.  Need to know where you can improve, how much you can

improve in quality and cost, and how to prepare for risk, VBP and when to do so…..

 Engage the right set of stakeholders – starts with leadership,

expands rapidly to most every area of the system

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Our Path to Analytics….

 Our approach  What we did  How we did it  Result

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Build Consensus for Analytics -

• Talk to Everyone About Value of:

– Integrated Clinical & Financial System – True EDW – Analytic Capabilities – Data Visualization

• Mind Set of:

– C-Suite

Bench

– Board

Clinicians

– Staff

• Get Stranded out of town with your Chief of Staff

– Include the need for Med Staff to understand their role in Data, Rev

Cycle, Variation….. “You’ll of course fail if their not engaged” (G. Thomas)

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Analytics - Organizational Alignment What we did

• Define Analytics
• Approach – no analytics = risky future (no future?)
• Communicate Value
• Define Data Governance
• Define Data Integrity
• Engagement

–Assess –Obtain –Maintain Talk about Continuum /Plans/Variation vs. “Treat and Release” (G. Thomas)

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Communicate & Explain….. Already the Norm

 “Analytics” Outside of HealthCare  Share of Wallet  CRM  Life Time Value of “customer” – LTV of a Baby/Beneficiary  Apple, Google, Wal-Mart, Sony, Groceries Store, Amazon…….

(you are the product)

 Manufacturing, Logistics, UPS, FedEx  Behavior Modification – Consumer (CMS Patients)

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Then show a bunch of slides like this……

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And like this……

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More Consensus / Engagement

• Get Specific
• Real World Examples
• Encourage Scenario's - (via assignment if needed)
• Engage Clinicians, Bench, Broad Staff, End User
• Not Normally in these Strategy / Discussion

Blend “people worried about future with people worried about today”

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Build It and They Will Come??

 Maybe, Maybe Not  Tease them and they will engage  Show them and they become hungry  Be careful

 Feeding the Beast  Why can’t we see, compare, have..…… attitude  Expectations become high – that’s a good thing  Becomes a pillar for future  Supports the real must have need for dedicated BI Team

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Our Path to Engagement

• SCENARIO # 1 – HYPERTENSION PATIENTS WITH NO PRIMARY CARE IN 12

MONTHS

• SCENARIO # 2 – PATIENTS WHO NEED A SPECIFIC TREATMENT
• SCENARIO # 3 – DIABETIC PATIENTS WITHOUT SPECIFIC LAB TEST
• SCENARIO # 4 – BLOOD ANALYSIS
• SCENARIO # 5 – PERCENT READMIT PATIENTS WITH VTE OR PE
• SCENARIO # 6 – PROCEDURE VOLUMES BY PROVIDER
• SCENARIO # 7 – LOS & COST/CASE BY SPECIALTY
• SCENARIO # 8 – FALLS ANALYSIS
• SCENARIO # 9 – PAYOR PERFORMANCE ANALYSIS
• SCENARIO # 10 – REFERRALS TO OUT-OF-NETWORK FACILITIES
• SCENARIO # 11 – PROVIDER COMPARISON ACROSS MULTIPLE METRICS
• SCENARIO # 12 – SCHEDULING PATTERN EFFECTIVENESS

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SCENARIO # 4 – BLOOD ANALYSIS

 Compare volume of blood transfused with an external

• benchmark. Show percent blood transfused by Hgb level

(what percent occurred at Hgb 7 – 9 mg/dl). Drill down to individual encounters and show Hgb level at time of transfusion and reason for transfusion

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SCENARIO # 5 – PERCENT READMIT PATIENTS WITH VTE OR PE

• Calculate the percent patients admitted with a primary or secondary

diagnosis of VTE or PE that had a prior inpatient encounter within the last 30 days.

– Numerator: number of patients admitted with a DVT or PE who had a

prior inpatient encounter within the last 30 days.

– Denominator: Number of patients with an admission in the last 30 days

that were not admitted with a DVT or PE on the initial admission.

– Patient: Inpatient admissions age 18 or older. Exclude Rehab and Psych

cases

– DVT or PE: ICD-9 codes 453.40-453.42, 453.80-453.89, 415.11,

415.19

– Admitted with: POA = Y

• Using the same criteria, calculate the number of patients with hospital

acquired VTE per 1000 inpatient days.

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The Result

1)

Fully Integrated EHR



Captures clinical data



Captures cost



System wide data and reporting

2)

EDW in place and populated daily

3)

Analytics applications in place

4)

Education and skills of the humans taking place

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Disclaimer - Again

The opinions expressed herein represent my personal opinions and not necessarily those of Memorial Hospital at Gulfport.

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Lots of Data

Premier Rev Cycle I/P Clinical Data Clinic EHR Data HIM Stats Press Ganney CEP Data Clinic PM Claims Rx Payer Mix Core Measures Data Data Aggregation Data Manipulation Bye Bye Excel Claims Data Registries Sorry to show this….

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Houston We Have a Problem

Provider Patient Payer

The Tax Payer Has a Problem Much Like Lawyer/Client Relationship

Industry Vendors

Data Data Data Data

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Continuum of Healthcare

NFP Provider

EHR/HIT Vendors Consulting /Staffing Firms Pharma

Device Mfg’s Payers ………, “n”

Guess the average margin for each of the above??

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Final Thoughts…

Without analytics you live in a world where -

 In the absence of your own data you can only rely on

and are “forces” to accept and defend the data of the payer

 Analytics prepares you to present your validated data

leading to a more realistic picture of your performance

 Without analytics your PI efforts are diluted compared

to PI with analytics…….

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Final Recommendations…

 If you need to push forward for Triple Aim, get analytics

up and running ASAP or fly blind. Put tools and processes in now. Don’t shoot, ready, Triple Aim like most

• thers who start without infrastructure, processes, and

practice!

 If you are not ready, take Quadruple Steps forward with

analytics, then Triple ready aim shoot when timing is

• ptimal and your preseason shows you are ready to

execute.

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The Road To Success

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Q&A

Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”

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Thank You!

• Thanks to our featured speaker: Gene Thomas!
• You will receive an email when our archive recording is ready. (Separate

registration is required)

• CHIME CHCIO Credits – Attending our Webinars = 1 CEU
• Sponsorship opportunities: Nancy Wilcox nwilcox@healthsystemCIO.com
• Questions/Comments: Anthony Guerra aguerra@healthsystemCIO.com

Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see the last 12 months of archived events.