Since accountable care took the healthcare industry by a storm in 2010, health systems have had to move from their predictable revenue streams based on volume to a model that includes quality measures. While the switch will ultimately improve both quality and cost outcomes, health systems now need the capability of tracking and analyzing the data from both clinical and financial systems. A late-binding enterprise data warehouse provides the flexible architecture that makes it possible to liberate both kinds of data to link it together to provide a full picture of trends and opportunities.
Financial Alignment & ROI
By committing to transforming healthcare analytics, organizations can eventually save hundreds of millions of dollars (depending on their size) and achieve comprehensive outcomes improvement. The transformation helps organizations achieve the analytics efficiency needed to navigate the complex healthcare landscape of technology, regulatory, and financial challenges and the challenges of value-based care.
To achieve analytics transformation and ROI within a short timeframe, organizations can follow five phases to become data driven:
Establish a data-driven culture.
Acquire and access data.
Establish data stewardship.
Establish data quality.
Spread data use.
Healthcare organizations have long relied on traditional benchmarking to compare their performance to others and determine where they can do better; however, to identify the highest ROI improvement opportunities and understand how to take action, organizations need more comprehensive data.
Next-generation opportunity analysis tools, such as Health Catalyst® Touchstone™, use machine learning to identify projects with the greatest need for improvement and the greatest potential ROI. Because Touchstone determines prioritization with data from across the continuum of care, users can drive improvement decisions with information appropriate to their patient population and the domains they’re addressing.
Besides improving your information systems and educating your staff on the ins and outs of managing revenue, there are many more opportunities for improvement. Here are five suggestions to help health systems improve their revenue cycle management:
Trend and benchmark your healthcare data.
Use DOS to Mine Your Healthcare Data.
Constantly ask frontline staff for suggestions.
Monitor all payer contracts.
Maintain convenient and caring touch points with patients.
Outdated technology and antiquated costing methodologies have left health system CFOs unable to see the true cost of the services they provide and impacts on patient outcomes. The move from fee-for-service to value-based contracts, however, means that CFOs need this information more than ever. Health Catalyst® has partnered with industry-leading health systems to develop a next-generation costing system: the CORUS™ Suite. Two integrated products comprise the suite:
Activity-Based Costing delivers accurate and actionable data from across the continuum of care in a scalable and maintainable tool.
Cost Insights analyzes and delivers early insights through a customizable dashboard powered by embedded logic and access to the most granular level of activity and costing data.
CORUS leverages Health Catalyst’s analytics platform and best-of-breed activity-based costing models to help users manage the true cost of care.
When it comes to transitioning to value-based reimbursement, health systems consistently ask two questions:
Why should I invest in reducing utilization when 90+ percent of my business is still fee-for-service (FFS)?
Where do I start?
This value-based reimbursement road map can help systems transition from barely surviving to successfully arriving (while respecting both shared-risk and FFS worlds):
Stop #1: Surviving— If you don’t get paid for the risk you take on, then you can’t survive long term.
Stop #2: Sustaining—Numerous clinical interventions occur in hospitals that systems can focus on to help improve the bottom line.
Stop #3: Succeeding—Build out competencies on a smaller population with aligned incentives so you can negotiate deeper alignment with key payers.
Stop #4: Arriving— The ultimate destination, where the lines between traditional healthcare delivery and public health are blurred.
Although healthcare is far from arriving at the value-based reimbursement destination, it can use this road map’s pragmatic strategies for heading down the right road.
When it comes to maximizing analytics ROI in a healthcare organization, the more domains, the merrier. Texas Children’s Hospital started their outcomes improvement journey by using an EDW and analytics to improve a single process of care. It quickly realized the potential for more savings and improvement by applying analytics to additional domains, including:
Organization-wide clinical improvement
The competencies required to launch and sustain such an organizational sea change are all part of a single, defining characteristic: the data-driven culture. This allows fulfillment of the analytics strategy, ensures data quality and governance, encourages data and analytics literacy, standardizes data definitions, and opens access to data from multiple sources.
This article highlights the specifics of how Texas Children’s has evolved into an outcomes improvement leader, with stories about its successes in multiple domains.
These past few years have seen a lot of coverage on healthcare costs. But a majority of these articles just confuse the issue. Some of the reasons healthcare costs are elusive do not include: 1. Hospitals are hiding something. Or 2. There isn’t enough data. Instead, the real reasons behind the difficulty are: 1. Healthcare is complex. 2. Fragmentation. And, most importantly and pervasively, 3. Data governance. Until data governance becomes a priority, healthcare organizations will not be able to get clear answers for their healthcare costs.
If all goes according to plan, the first performance period for the new Medicare Access and Chip Reauthorization Act (MACRA) is just around the calendar corner. It’s a complicated reimbursement structure with multiple tracks that are guaranteed to reward with bonuses or inflict pain through penalties in CMS’s new zero sum game. To the physicians and practices that adopt this new program early and position themselves for the best fiscal outcomes, go the spoils. But for many smaller practices and those that consistently underperform, the outlook may be glum regardless. Here are some highlights of the new program and the financial impact it will have on clinicians and practices.
The hospital finance department typically acts as administrator and controller over hospital operations, at least in the eyes of frontline clinicians. Additionally, finance is burdened with the day-today tasks of balancing the books. And all too often, finance thinks they know what their customers want, but customers think that finance is isolated, secretive, and bureaucratic. The hospital finance department needs a makeover. To transition into the role of valued business partner and financial expert, finance needs to reinvent itself by:
Simplifying the flow of, and expand access to, information
Repositioning financial analysts as experts
Understanding what customers value
Learn how these straightforward business practices can support operations in their outcomes improvement efforts, and ultimately benefit the entire healthcare organization.
The shift to value-based payments and a greater focus outcomes and cost reduction has hospital leaders seeking new ways to work more efficiently and improve patient satisfaction. Monitoring and analyzing productivity more effectively is crucial to ensure healthcare organizations are aligned with this goal. Getting overtime and labor productivity under control isn’t an easy task, but it’s not impossible. A few best practices can shorten the learning curve. These include 1) secure leadership commitment, 2) implement data governance, 3) ensure financial targets are defined, 4) create transparency, and 5) keep productivity metric balanced with quality goals.
IT project development usually proceeds down one of two development paths: Agile or Waterfall. But those involved with developing process improvement and project management understand that taking a more pragmatic approach is required when determining which path is best. It’s not a single-path environment where Agile has replaced Waterfall, nor is Waterfall the one-and-only legacy option. Depending on the project, both may be viable at different points along the timeline. The speed to value of Agile is attractive to organizations seeking quicker returns on the work in progress. It also minimizes documentation. Waterfall is valuable when risks must be minimized and when the development path and end product are familiar. Sometimes, a blending of Agile and Waterfall is appropriate for different stages in the development process. Ultimately, organizations should remain open regarding both approaches and apply the one that will work best for any given circumstance.
When deciding to prioritize your clinical improvement or cost reduction efforts, it’s helpful to use clinical program costs as a key input. The idea is to start with the first three or four in the first year, then work down the list. Most health systems prioritize using inpatient costs because they do not have access to outpatient data. However as accountable care and population health efforts increase, looking at costs in silos will not be sufficient. Under the leadership of Dr. Burton, our Health Catalyst team has been collecting, analyzing, and compiling a macro, industry-level view of inpatient and outpatient costs to serve as a guide for healthcare organizations who lack access to either of those views. The following ranking is the first of its kind, combining months of detailed analysis of several California health systems to show a combined total of both outpatient and inpatient costs. The results are surprising. Adding outpatient costs significantly changes the cost rankings of many of the traditional top health system care processes.
A consolidated EDW is not a replacement or threat to the individual financial systems and reporting tools employed for general ledger, billing, payroll, or supply management. On the contrary, each of those systems is designed with sophisticated functionality that drives organizational efficiency. But alone, these systems realize only a portion of their true return on investment for the enterprise. As a consolidated data resource, these systems provide untold potential to address the underlying challenges to efficient, cost-effective health care.
Healthcare organizations are looking to analytics applications that will help them identify and prioritize the best areas for improvement projects. Even once they choose an analytics solution, though, it’s difficult to know where to start because of all of the data health systems have stored. Two solutions will help eliminate the guesswork: a healthcare enterprise data warehouse and sophisticated analytics applications, such as the Key Process Analysis (KPA) Application. The KPA application uses the Pareto principle to find areas with highest variation and highest resource consumption. This valuable information gives health systems a starting point as they begin their journey to improve the delivery of care and reduce costs.
My three-day summary of the HFMA conference in Las Vegas established this year’s theme of: “This is BIG.” And it’s true. Healthcare is facing a number of BIG issues in healthcare transformation, including: regulatory impact of reform and business intelligence/analytics capabilities. Different keynote addresses and presentations examined each of these issues, and I took away some key messages.
Hospitals and healthcare systems need a systematic approach and tools to demonstrate ROI from their healthcare improvement projects. Bobbi Brown, VP of Financial Engagement, shares a four-step process for demonstrating ROI: 1) define the project and business need, 2) begin to quantify ROI, 3) recruit, train and plan, and 4) evaluate costs, revenue and direct benefits. Download the Health Catalyst Clinical Improvement Financial and Executive Communications tools for estimating, calculating and communicating your ROI results.
I spent many years of my career as a healthcare finance executive in the state of California, where I had the opportunity to participate in several groundbreaking pay-for-performance (P4P) initiatives. However today, things have grown much more complex and intimidating. Health systems have to report on Medicare quality measures that determine important incentives and penalties. Add to this the host of private payers who have established their own value-based programs, all of which require different metrics. In this post, I discuss 4 lessons learned for success in VBP: 1) assessing your performance 2) education programs, 3) your analytics strategy, and identifying areas for clinical quality and cost improvement.
Texas Children’s Hospital, a client of mine, found they needed an immediate solution to address their labor and productivity challenges….The Health Catalyst Labor Productivity Advanced Application delivered a view of staffing levels, volume and productivity across Texas Children’s various cost centers. The application enables the business and unit managers to track and manage their resources. It delivers information into the hands of decision makers to help them manage their business. Managers can track performance as often as daily to see exactly how well labor is being allocated and make rapid modifications to counter scheduling problems. In the event that labor utilization outpaces volume, managers can drill further into labor data to understand utilization at the job code level.
One of the major contributing factors to escalating hospital costs is patient variation and waste associated with the delivery of care. Hospitals have begun to address waste through a variety of methods such as Six Sigma, LEAN and other healthcare quality process improvement techniques. While these methods are effective at dealing with administrative costs, a much greater return can be gained by concentrating on the clinical or patient care costs. Clinical work teams coupled with data and healthcare analytics reduce costs by helping your organization reduce variation, leading to lowering cost trends as the revenue trend flattens. To fully understand your costs and identify areas of waste, you need good data.
In April 2013, Health Catalyst partnered with North Memorial to develop the Health Catalyst Professional Billing Advanced Application built on our Late-binding™ Data Warehouse platform. The application automates data capture previously done manually by the coding staff. The development process was completed in six weeks. The solution is a perfect marriage of technology supporting workflow processes to become a natural part of billing. The results to date include: 1) 6% increase in notes that had sufficient clinical data for billing, 2) 25% improvement in professional coder efficiency, and 3) a potential to reclaim more than $5.7 million over the next three years. Read our success story to find more details.
CEOs and CIOs of health systems often ask me how much a healthcare enterprise data warehouse will cost them. As I delve into the topic with them, it becomes clear that what they are really concerned about is their return on investment. These executives are aware that many data warehousing projects require significant upfront investment but may not deliver a return for years, if ever. That feels very high risk to them—and to me as well. I’d like to share what I believe is the lowest-risk, most economical plan for investing in a healthcare enterprise data warehouse.
Surviving Value-Based Purchasing in Healthcare: Connecting Your Clinical and Financial Data for the Best ROI
Reducing healthcare costs is a major driving force in bundled payments, home-centered medical care, and accountable care organizations. But each new delivery model is built on the premise of reducing revenue per patient. So how can a health system win? Find out what you can do financially survive in today’s environment.