Sustaining a financially vibrant
Healthcare Organization
By: Chandler Ewing, CPA, FACHE
Date: June 5, 2013
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Sustaining a financially vibrant
Healthcare Organization
Healthcare Background – 12 years
• Academic
• Community
• Specialty
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Sustaining a financially vibrant
Healthcare Organization
• How do hospitals maintain their financial
viability in the face of the revolution and
evolution of payment for hospital care
and health care?
– Good question????
– If you know the answer = BIG $$$$$
– Where are you in the “GAP” in the transition of
the payment model?
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Sustaining a financially vibrant
Healthcare Organization
Talking points
• Background (AHA white papers)
– Hospitals and Cares Systems of the Future
– Metrics for the Second Curve of Health Care
• Metrics overview
• Where you are in the “GAP”?
• What can you do right now?
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Sustaining a financially vibrant
Healthcare Organization
• In 2011 AHA published,
Hospitals and Cares
Systems of the Future
– Move from First Curve
to Second Curve
– Recommendations
• Four groups
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Sustaining a financially vibrant
Healthcare Organization
• First Curve to the Second Curve
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Sustaining a financially vibrant
Healthcare Organization
• Recommendations – four groups
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3
2
4
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Sustaining a financially vibrant
Healthcare Organization
• In 2013 AHA
published, Metrics for
the Second Curve of
Health Care
– Identifies metrics for
the 10 “must do”
strategies
– “Tool box” for
assessing the GAP to
the Second Curve
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Second curve evaluation metrics
“Tool Box”
4 out of the 10 “must do” strategies are considered
“imperative”, these strategies are:
1.
2.
3.
4.
Aligning hospitals, physicians and other clinical
providers across the Continuum of Care
Utilizing evidence-based practices to improve
quality and patient safety
Improving efficiency through productivity and
financial management
Developing integrated information systems
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Second curve evaluation metrics
“Tool Box”
1. Aligning hospitals, physicians and other clinical providers
across the Continuum of Care
– Percentage of aligned and engaged physicians
• Aligned across all dimensions (structural/cultural)
• Engaged/collaborate/participate in strategic initiatives
• Engagement survey data - analyzed w/ improvement actions
implemented
• Recruiting/contracting include an assessment of cultural fit
– Percentage of clinical provider contracts containing
performance and efficiency incentives aligned with ACOtype incentives
• Reimbursement risk associated with new payment models
• Participating in an ACO/PCMH model across a significant
population, utilizing a value-based incentives
• Payment contracts, payment and compensation models are linked
to performance results
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Second curve evaluation metrics
“Tool Box”
1. Aligning hospitals, physicians and other clinical providers
across the Continuum of Care (cont.)
– Availability of non-acute services
• Full spectrum of health care services available to patients in
continuum
– Distribution of shared savings/performance
bonuses/gains to aligned physicians and
clinicians
• All clinicians' performance is measured and they receive
benchmark data on performance against peers
• Most clinicians share financial risk and rewards linked to
performance, and may have received distributions of shared
savings or performance bonuses
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Second curve evaluation metrics
“Tool Box”
1. Aligning hospitals, physicians and other clinical providers
across the Continuum of Care (cont.)
– Number of covered lives accountable for
population health (ACO/patient-centered medical
homes)
•
•
Active participation in a population health management
initiative for a defined population
Able to measure the attributable population for health
management initiatives and a sizable population is enrolled
– Percentage of clinicians in leadership
•
•
Active clinical representation at leadership or governance
level (30% or above)
Physicians and nurse executives are leading development of
strategic transformation initiatives
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Second curve evaluation metrics
“Tool Box”
2. Utilizing evidence-based practices to improve quality and
patient safety
– Effective measurement and management of care
transitions
• Fully implement clinical integration strategy across the entire
continuum of care
• Fully implement use of multidisciplinary teams, case
managers, health coaches and nurse care coordinators for
chronic disease cases and follow up care after transitions
• Measurement of all care transition data elements. Data is
used to implement and evaluate interventions that improve
transitions
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Second curve evaluation metrics
“Tool Box”
2. Utilizing evidence-based practices to improve quality and
patient safety (cont.)
– Management of utilization variation
• Regular measurement and analysis of utilization variances,
steps employed to address variation and intervention
effectiveness analyzed on a regular basis
• Providing completely transparent, physician-specific reports
on utilization variation
• Regular use of evidence-based care pathways and/or
standardized clinical protocols
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Second curve evaluation metrics
“Tool Box”
2. Utilizing evidence-based practices to improve quality and
patient safety (cont.)
– Reducing preventable admissions, readmissions,
ED visits, complications and mortality
• Regular tracking and reporting on all relevant patient safety and
quality measures
• Data commonly used to improve patient safety and quality, with
positive results observed
– Active patient engagement in design and
improvement
• Regular use of patient-engagement strategies such as shared
decision-making aids, shift-change reports at the bedside, patient
and family advisory councils and health and wellness programs
• Regular measurement or reporting on patient and family
engagement, with positive results
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Second curve evaluation metrics
“Tool Box”
3. Improving efficiency through productivity and financial
management
– Expense-per-episode of care
• Tracking expense per episode data across every care setting
and a broad range of episodes to understand the true cost of
care for each episode of care
– Shared savings, financial gains or risk-bearing
arrangements from performance-based contracts
• Measuring, managing, modeling and predicting risk using a
broad set of historical data across multiple data sources
(clinical and cost metrics, acute and non-acute settings)
• Implementing a financial risk-bearing arrangement for a
specific population (either as a payer or in partnership with a
payer)
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Second curve evaluation metrics
“Tool Box”
3. Improving efficiency through productivity and financial
management (cont.)
– Targeted cost-reduction and risk-management
goals
• Implemented targeted cost-reduction or risk management
goals for the organization
• Instituted process re-engineering and/or continuous qualityimprovement initiatives broadly across the organization and
demonstrated measurable results
– Management to Medicare payment levels
• Projected financial impact of managing of future Medicare
payment levels for the entire organization, cost cuts to
successfully manage at the payment level for all patients
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Second curve evaluation metrics
“Tool Box”
4. Developing integrated information systems
– Integrated data warehouse
• Fully integrated and interoperable data warehouse,
incorporating multiple data types for all care settings (clinical,
financial, demographic, patient experience, participating and
non-participating providers)
– Real-time information exchange
• Full participation in a health information exchange and
utilizing the data for quality improvement, population health
interventions and results measurement
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Second curve evaluation metrics
“Tool Box”
4. Developing integrated information systems (cont.)
– Lag time between analysis and availability of
results
• Real time availability for all data and reports through an easyto-use interface, based on user needs
• Advanced data-mining capabilities with the ability to provide
real-time insights to support clinical and business decision
across the population
• Advanced capabilities for prospective and predictive
modeling to support clinical and business decision across the
population
• Ability to measure and demonstrate value and results, based
on comprehensive data across the care continuum (both
acute and non acute care)
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Second curve evaluation metrics
“Tool Box”
4. Developing integrated information systems (cont.)
– Understanding of population disease patterns
• Robust data warehouse, including disease registries and
population disease patterns to identify high-risk patients and
determine intervention opportunities
• Thorough population data warehouse that measures the
impact of population health interventions
– Use of electronic health information across the
continuum of care and community
• Fully integrated data warehouse with advanced data mining
capabilities that provides real-time information in order to
identify effective health interventions and the impact on the
population
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Second curve evaluation metrics
“Tool Box”
Application – Where are you in the “GAP”?
• Academic
• Community
• Specialty
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Second curve evaluation metrics
“Tool Box”
“GAP” Analysis:
LTAC – Select Specialty Hospital (SSH) Jackson
– Primary services
•
•
•
•
Pulmonary (Vent weaning)
Medical
Rehab
Wound healing
– 53 beds (ICU/Medsurg)
– Hospitalist 24/7
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Second curve evaluation metrics
“GAP” Analysis
LTAC – SSH Jackson
1. Aligning hospitals, physicians and other clinical providers
across the Continuum of Care
– Percentage of aligned and engaged physicians - ALL
– Percentage of clinical provider contracts containing performance
and efficiency incentives aligned with ACO-type incentives - TBD
– Availability of non-acute services – FULL SPECTRUM
– Distribution of shared savings/performance bonuses/gains to
aligned physicians and other clinicians - TBD
– Number of covered lives accountable for population health
(ACO/patient-centered medical homes) - TBD
– Percentage of clinicians in leadership - ACTIVE
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Second curve evaluation metrics
“GAP” Analysis
LTAC – SSH Jackson
2. Utilizing evidence-based practices to improve
quality and patient safety
– Effective measurement and management of care
transitions – MODERATE
– Management of utilization variation –
COMPLETE/LIMITED
– Reducing preventable admissions, readmissions, ED
visits, complications and mortality - REGULAR
– Active patient engagement in design and
improvement – IN DEPTH ANALYSIS/ VARIOUS
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Second curve evaluation metrics
“GAP” Analysis
LTAC – SSH Jackson, MS
3. Improving efficiency through productivity and
financial management
– Expense-per-episode of care – SELECTED
– Shared savings, financial/risk-bearing arrangements
from performance-based contracts - TBD
– Targeted cost-reduction and risk-management goals INITIATED
– Management to Medicare payment levels –
PROJECTED WITH LIMITED SCOPE
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Second curve evaluation metrics
“GAP” Analysis
LTAC – SSH Jackson, MS
4. Developing integrated information systems
– Integrated data warehouse – LIMITED
– Lag time between analysis and availability of results LIMITED
– Understanding of population disease patterns THOROUGH
– Use of electronic health information across the
continuum of care and community - TBD
– Real-time information exchange - TBD
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Results of “GAP” Analysis
LTAC – SSH Jackson
1. Aligning hospitals, physicians and other clinical
providers across the Continuum of Care
– Continue to grow partnerships
– Educate referring physicians
– Assist referring hospitals in the reduction of
unpaid days/avoidable costs
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Results of “GAP” Analysis
LTAC – SSH Jackson
1. Aligning hospitals, physicians and other clinical
providers across the Continuum of Care (cont.)
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Results of “GAP” Analysis
LTAC – SSH Jackson
2. Utilizing evidence-based practices to improve
quality and patient safety
– Physician to physician hand off in care
transition
– Sharing quality data and practice standards
with referring providers
– Working with referring administrators to assist
re-admission reductions
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Results of “GAP” Analysis
LTAC – SSH Jackson
3. Improving efficiency through productivity and
financial management
– Improve through put from referring providers
– Identify LTAC appropriate patients quicker at
the referring provider
– Enter into purchase service agreements with
referring providers
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Results of “GAP” Analysis
LTAC – SSH Jackson
4. Developing integrated information systems
– Work with referring providers for access to
computer system
– Work with referring providers to understand
LTAC appropriate population disease patterns
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Sustaining a financially vibrant
Healthcare Organization
• Recap
• Background
– Hospitals and Cares Systems of the Future
– Metrics for the Second Curve of Health Care
• Metrics overview
• Where you are in the “GAP”?
• What can you do right now?
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Sustaining a financially vibrant
Healthcare Organization
Questions?
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