Enterprise Analytics Strategic Planning

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1 Enterprise Analytics Strategic Planning June 5,

2 "The first question a data driven organization needs to ask itself is not "what do we think?" but rather "what do we know? Big Data: The Management Revolution, HBR, October

3 Today s Reality Lowest Low Highest Highest (Source: Commonwealth Fund, reported at: ) 3

4 Affordable Care Act: Carrots & Sticks For healthcare providers, the ACA increases accountability for the quality and costs of care through risk and reward. CARROTS: Incentives to encourage desired behaviors (Voluntary) Accountable Care Organizations Patient-Centered Medical Homes Bundled Payment Pilots Value-Based Purchasing Hospital Readmission Reduction Program Payment Adjustment for Conditions Acquired in Hospitals STICKS: Penalties to discourage the wrong behaviors (Mandatory) 4

5 Reform: Increasing and Shifting Accountability Patient populations Accountable Care Organizations / Programs Care Accountability A setting (inpatient vs. outpatient) A condition An episode of care Value-Based Purchasing PCMHs Bundled payment pilots Hospital-Acq. Condition penalty Medicare Readmission Reduction Program An encounter Quality reporting Quality performance Costs Outcomes Results Accountability 5

6 Greater Accountability Requires Robust Analytics Accountability for Quality Regulatory Reporting Pay for Performance Patient management Accountability for Cost ACO/Value-based Purchasing Financial/Contracting Modeling Risk Stratification Accountability for Care Disease Management Population Management Care Coordination Data-driven decisions are better decisions. A Healthy Dose of BI and Analytics Makes for Smarter Medicine * *SAP 6

7 Care Coordination: An Ongoing Challenge Coordinating care across the continuum while increasing important remains a huge challenge for healthcare organizations. Regarding clinical quality improvement, which is the single greatest challenge for your organization? Care coordination, continuum of care Pop. health management Readmissions Care episode payment bundling Clinical quality metrics Staff buy-in Patient experience Medical home Patient safety Other 4% 2% 3% 14% 14% 12% 11% 10% 8% Strategic Imperatives for an Evolving Industry, HealthLeaders, January 2013, (n=799*) 24% 7 *respondents predominantly hospitals, health systems, and MD practices

8 Beyond the EHR: Key Capabilities Success in the new world order will require robust Heath Information Exchange, Analytics and Patient Engagement. Top IT Solutions Needed for ACOs / Initiatives to Control Costs and Improve Quality Analytics 33% HIE None Data warehouse Patient portal PHR 18% 13% 11% 8% 8% Others (none higher than 6%) 40% Unsure 18% Source: Accountable Care Providers Forge the ACO Trail, KLAS Research, August

9 The Black Hole of Data is Not Sustainable Demographics Utilization trends Debt load Rate increases from the various payers Payer mix Revenue per unit Modeling/Payment for new approaches to care delivery Co-management agreements and joint ventures Shared-risk pools between physicians, hospitals and medical homes Acuity and case mix Labor negotiations, benefit renewal expenses and vendor agreements Market trends Ownership of post-acute services Capital investment by the group in IT initiatives, care protocols and care management infrastructure 9

10 Multiple Analytic Perspectives Are Needed Ever changing patient, population and provider attributes require robust and dynamic analytics capabilities. PROVIDER POPULATION 10

11 Analytics Address Burning Questions Insurance, Employers, Personal Health Records (PHR) MATURITY PRESCRIPTIVE PREDICTIVE DESCRIPTIVE FINANCIAL OPERATIONS QUALITY CLINICAL Risk stratification by payer? Patient satisfaction scores in the new ED? Referrals Access Times? % Medicaid Reimbursement? RVU/RBRVS distribution %? A N A L Y T I C S C A P A B I L I T Y ERP Lab TAT? Median ED arrival to departure time for admitted pts? Revenue Cycle % Patients on Beta- Blockers for LVSD? % Potentially Avoidable Readmits by Dx? % CHF patients who will comply with new med regime? Labor/Acuity System % of time Pain well managed? Hospital Acquired Infections Trend? LIS Partner Hospitals, Post Acute Care, Public Health Inpatient EHR Ambulatory EHR 11

12 Analytics: Making Sense of it All Insurance, Employers, PHR MATURITY PRESCRIPTIVE PREDICTIVE DESCRIPTIVE FINANCIAL OPERATIONS QUALITY CLINICAL Value Based Purchasing Bundled Payments A N A L Y T I C S C A P A B I L I T Y ERP Risk Mgmt PQRI Patient Centered Medical Home Hospital Readmission Program Revenue Cycle Outcomes and Patient Satisfaction Joint Commission Personalized Medicine Genomics Meaningful Use Labor/Acuity System Disease Management Clinical Studies LIS Partner Hospitals, Post Acute Care, Public Health Inpatient EHR Ambulatory EHR 12

13 STRATEGIC APPROACH TO ANALYTICS 13

14 The Three Layers of Planning Strategic planning for Enterprise Analytics targets three important components. Strategic: What are the external market drivers an organization must address in order to be successful? Organizational: What are the organization s own business and clinical initiatives that the IT plan must be able to support? Foundational (Technical): What are the fundamental IT capabilities, solutions, and processes necessary to support the organization s needs? 14

15 Three Strategic Market Drivers CARE COORDINATION Greater coordination among all members of the care team including with the patient across diverse and disparate care settings Extracting actionable information from masses of complex patient data and using it to manage costs and remain competitive OUTCOMES Increasing responsibility to comply with established guidelines for quality care and greater accountability for demonstrating results FINANCIAL VIABILITY 15

16 Convergence of Strategic Market Drivers CARE COORDINATION Increasing Patient Demand & Expectations Community Physician Engagement Alignment & Meaningful Use ACO Pilots Value-Based Purchasing Re-Admission Reduction Bundled Payments Private Payer P4P Programs Medicare Penalties for HACs IMPROVED OUTCOMES FINANCIAL VIABILITY ICD-10 Staff Shortages HIPAA 16

17 Strategic Focus CARE COORDINATION OUTCOMES FINANCIAL VIABILITY 17

18 Organizational Foucs COMPETITIVE MARKET POSITION SERVICES PORTFOLIO OPERATIONAL EXCELLENCE 18

19 Foundational Focus PEOPLE PROCESS TECHNOLOGY 19

20 Key Activities to Establish Info Mgmt Plan SERVICE GOAL PHASE FOCUS ACTIVITIES* ASSESS & STRATEGIZE Where are we now and how do we compare against industry best practices? Where should we be going and how do we get there? Initiate Evaluate Vision Plan Key Healthcare Trends & Drivers Organizational Business Drivers Inventory Future Info Mgmt Requirements Organizational Business Case Current Data Mgmt Environment Future-State Info Mgmt Vision Organizational Priorities Functional and Technical Alignment Tactical Opportunities Skills and Staff Educate & Discuss Confirm Scope, Structure Collect Benchmark Survey Interview Challenge Review Redesign Plan, Select, Estimate Prioritize Architecture and Governance Model Govern How do we ensure continued success? Endorse Risk Management Organizational Ownership Ongoing IT Management Mitigate Sponsor Monitor STRATEGIC ORGANIZATIONAL FOUNDATIONAL *Not every organization will require every component 20

21 Business Priorities Drive Integrated Info Mgt Across the Continuum of Care Accountable Care Delivery Transformational Efficiency Innovative Growth Process and Product Development Care & Risk Mgmt, Quality Stds & Reporting, ehealth, New Networks Decision Support Analytics Data Management ID Mgmt, Normalization, Rules, Routing Health Information Exchange Enterprise EHR Closely Aligned Affiliates Loosely Aligned Affiliates Affiliated Care Services External Entities 21

22 (IT) Systems Capabilities Align with Organizational Analytics Maturity A N A L Y T I C S M A T U R I T Y A N A L Y T I C S C A P A B I L I T Y Optimizational - Care and Risk Management - Patient Outreach & Engagement - Population Health & Disease Management REAL-TIME Operational - Predictive Analytics - Utilization & Performance Management - Workflow Decision Support RETROSPECIVE Foundational - Enterprise Data Aggregation - (HIE) Data Integration - Data Normalization & Standardization PRESCRIPTIVE PREDICTIVE DESCRIPTIVE 22

23 Analytics Capability Building Blocks A N A L Y T I C S C A P A B I L I T Y ASSESS & STRATEGIZE Optimizational IMPLEMENT OPERATE & OPTIMIZE GOVERNANCE OPERATIONS / ORGANIZATION ANALYTIC TOOLS Business Strategies Regulatory Drivers Organization Models Current Governance Staffing/Skills Current Workflows Organization Alignment Analytics/BI Solutions Data Management Interfaces Program Sponsorship BI Strategies Needs Definitions Operational Workflow Integration Staffing and Skills (recruit/train/develop) Foundational Analytics Tools Portals & Dashboards Data Architecture Integration Services Program Oversight Performance Management Workflow Optimization BI Program Optimization Data Quality Management 23

24 EHR Analytics: Part of the Big Picture Insurance, Employers, PHR MATURITY PRESCRIPTIVE PREDICTIVE DESCRIPTIVE FINANCIAL OPERATIONS QUALITY CLINICAL A N A L Y T I C S C A P A B I L I T Y A N A L Y T I C S C A P A B I L I T Y ERP Revenue Cycle Labor/Acuity System LIS Partner Hospitals, Post Acute Care, Public Health EHR Inpatient EHR Ambulatory EHR 24

25 Analytics: Incremental Advancements Optimize Current Capabilities: EHR, ERP, Other systems Analytics Internal Data Existing Governance and Operational Structures Implement and Develop Advanced Capabilities Broader, deeper data Broader, deeper skills Internal and external data Maturing Governance and Culture Source: Epic Systems. For Representative Purposes Only 25

26 Client Example: Assess & Strategize 26

27 UnityPoint Health Background Integrated delivery network 25+ Hospitals: EHR implementation in progress 200+ Physician Clinics: alternate EMR adoption complete Strategic Drivers Accountable Care Organization Care, Disease & Population Management 27

28 ACO Analytics Program Management Identify IT requirements to support ACO strategy Determine framework for Enterprise Data Warehouse Design a Build & Buy approach Establish Analytics Governance structure 28

29 Analytics Gap Analysis 29

30 Data Flow Mapping 30

31 Vision: Stages of Enterprise Analytics 31

32 Proposed Analytics Governance 32

33 UnityPoint Health Analytics Program UnityPoint Health Analytics Program Internally developed Enterprise Data Warehouse Hadoop-based application vendor Various products to support disease and care management HIE to collect and report data across the enterprise. Data Stored External Data (i.e., CMS claims) EHR Data (inpatient/outpatient and ambulatory) Benchmarking and other sources Analytics 2.0 Expanded Framework Governance Council revamp 33

34 Strategic Planning for Enterprise Analytics 1. Initiate Education What are YOUR burning questions? 2. Evaluate Inventory Benchmark 3. Vision Desired Future State Organizational Priorities 4. Plan Prioritization Governance 5. Endorse Sponsorship On-going Operations Optimization 34

35 Impact Advisors Create a positive Impact! Contact Phone John Stanley Janice Wurz

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