Road Map Identifying Financial Opportunities Through Data Analytics

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1 Optimizing the business of healthcare ROAD MAP Road Map Identifying Financial Opportunities Through Data Analytics

2 Identifying Financial Opportunities Through Data Analytics How important is collecting, analyzing, and acting on the vast amounts of data that exist within your organization? McKinsey researchers believe big data analysis can potentially save the US healthcare industry more than $300 billion annually. 1 Thanks to rapid advances in software technology and expanded network bandwidth, healthcare organizations now have the ability to analyze a wide variety of data to drive improvements, better understand their customers needs and care histories, and otherwise make informed decisions. The migration to Electronic Health Records (EHR) and adoption of standard transaction code sets provides organizations with data that has historically been difficult to aggregate and examine. Analyzing and applying this data is a key factor in helping organizations identify improvement opportunities. According to one survey, 60% of healthcare IT professionals plan to increase investment in technology to help them increase their ability to handle complex analytics. 2 As a result, institutions today are better positioned than ever to use data to positively impact their operations. 2

3 1 The Challenges of Big Data Just possessing the data somewhere in your system isn t enough. For you to aggregate and evaluate this information and turn it into opportunities that can drive your organization forward, there are a number of challenges you have to overcome. Typically, departments within organizations work in silos - the clinical and financial teams don t typically share data or work on integrated, cross-functional reporting to find opportunities. It s difficult for senior management and the IT group to keep up with the vast amount of detailed data that is available although awareness continues to grow. The staff is familiar with the data but might not have the analytics experience to leverage it into relevant action items. Aggregate In addition, the process for senior management to request reports traditionally has not been real-time so by the time they receive requested information it s either not what they had in mind, it prompts a request for an additional report once they review, or the data is simply too dated to be useful. Finally, from a systems standpoint, not all meaningful and useful data is available electronically and even when it is, it may not be in a standardized format so is difficult to share. Evaluate Overcoming these challenges requires a strong business intelligence tool and knowledgeable analysts that not only understand the business and the data that drives it, but also know how to use the tools to identify opportunities and communicate those effectively to the rest of the organization. Identify Opportunities Drive Improvement 3

4 2 Benefits of Harnessing Big Data Obtaining and applying available data can benefit your organization in many ways including: Reducing bad debt and write-offs. Clearly defining patient financial responsibility. Improving denials management. Quickly providing actionable information to staff. Establishing targeting and segmentation models to develop effective marketing programs. As the healthcare industry continues to undergo dramatics change, these areas make effectively managing Big Data a necessity: Shift to quality-based reimbursement models such as pay-for-performance and reduction of inpatient readmissions. Increase in bundled payments where organizations need to disperse funds appropriately and negotiate contract terms. Consumer directed healthcare where patients will shop for providers based on both price and quality. Growth of Accountable Care Organizations that drive a need for data and data points to monitor care, cost, and reimbursement. 4

5 3 Develop a Data Analytics Plan Designing and implementing a comprehensive plan is critical to making data analytics an integral part of your organization s decision making process. An effective plan begins with support from senior executives and cascades throughout the organization. The steps to an effective plan include: Establish a core group that understands the data and the importance of using it to drive business initiatives. Set up a strong data governance protocol. Determine who is responsible for maintaining data, who has access, which data is to be integrated and how it will be accomplished. Institute a process that enables constant QA of your data. Conduct audits and user surveys to ensure the selected data is meeting end user requirements. Empower cross-functional teams to review data and plan for future needs, making sure of alignment with executive organizational goals. Define the key metrics for every initiative. That s the only way to appropriately manage improvement ESTABLISH CORE GROUP DATA GOVERNANCE QA PROCESS AUDITS AND USER SURVEYS CROSS-FUNCTIONAL TEAMS KEY METRICS MEASURE AND MANAGE 5

6 4 Collaborate With IT to Discover Opportunities Uncovering valuable insights from your data requires a close working relationship among managers, analysts and IT Ops personnel. The IT team has the system knowledge to help gather and organize the information you need to guide you in making meaningful decisions. These steps provide a path to an effective collaboration between operations and IT to optimize your data analytics program: Set up a data management team committee of business owners and IT staff to govern the process. Include analysts with in-depth knowledge of the business and the data, along with strong analytical and research skills. Establish consensus on the goals and initiatives of the program. Determine top priority organizational goals and determine what data sources are required to help drive decisions Ensure your data is standardized and design an appropriate repository to house it. Outline an inventory of current reports and determine which ones are still being used. Suspend existing reports not currently used (but do not eliminate in case they may be needed later.) Ask business users what they need to better manage their departments. Agree on appropriate new reports and design real time analytics dashboards. Establish regular reporting schedules. Set up periodic meetings with operations/business owners and the IT group to review progress, discuss future goals, and establish plans to achieve them. Using this collaborative approach will not only help identify opportunities but will also expedite the process of fulfilling business needs. Growing economic pressures clearly demonstrate that the healthcare industry must focus more closely on business realities. This means adopting business rules, tools, and technology to operate more efficiently and productively. As margins decrease, providers must use every tool at their disposal to maintain viability and thrive in a difficult economy. Leveraging Big Data plays a growing part in helping organizations reach that goal. 6

7 Sources 1 Big Data: The next frontier for innovation, competition, and productivity, McKinsey & Company. May Web. April Big Data Driving Analytics Investments, Healthcare IT News, March

8 Once you ve established a baseline, the next step is to make improvements by initiating a corrective action program that addresses your people, process, and technology. Hayes Management Consulting Hayes Management Consulting is a leading, national healthcare consulting firm focused on healthcare operations. This includes strategic planning, interim leadership, revenue cycle optimization, clinical optimization, project management, IT consulting, and preparation for federal initiatives such as ICD-10, Meaningful Use, and HIPAA compliance. Hayes also provides software such as MDaudit and other proprietary tools to ensure clients are operationally efficient. To learn how Hayes Management Consulting can help you with your revenue cycle transformation, call or Optimizing the business of healthcare 1320 Centre Street, Suite 402 Newton Center, MA Phone: Fax: People Focus on training and education so everyone in the organization understands the depth and impact of the problem and what their role in solving it should be. Specific actions to take include: Establish accountability and self-reporting by root cause owner and process owner Set a zero to low tolerance for finger pointing and excuses Recognize improvement and determine consequences for unacceptable outcomes Workflow A thorough process review will help highlight redundancies and time-wasting tasks and will quantify the outcome or performance expectation for each task. The most effective way to improve the workflow process is to eliminate errors that could result in a denial Key points to include: Develop robust pre-visit/visit management process

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