FINANCIAL HEALTH FOR HEALTHCARE PROVIDERS

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1 FINANCIAL HEALTH FOR HEALTHCARE PROVIDERS

2 TABLE OF CONTENTS Toward Long-Term Sustainability And Ongoing Medical Innovation 3 Visibility And Collaboration 4 Integrating Finance Into The Healthcare Organization 4 The Benefits Of Business Discovery For Finance 6 Effective Financial And Clinical Team Collaboration 7 Improve Reimbursement Rates And Reduce Collection Costs 7 Achieve New Levels Of Financial Insight In Health Care 8 Go Deeper Using The Power Of Gray 8 Create Intelligent Financial Performance Dashboards That Keep Costs In Check 9 Empower Everyone With Mobile Healthcare Intelligence 9 Give Executive Decision-Makers The Insight And Control They Need 9 Cost-Effective, Self-Service Financial Insight That Deploys Fast 10 Simplify Healthcare And Financial Compliance Reporting 10 The Best Path Forward For Best Practices In Healthcare Finance 11 Case Study: Children s Healthcare of Atlanta 12 Case Study: ThedaCare 13 Learn More 13 2 Financial Health for Healthcare Providers

3 TOWARD LONG-TERM SUSTAINABILITY AND ONGOING MEDICAL INNOVATION Today s changing healthcare landscape demands more from the finance department than ever before. No longer a sideshow in the healthcare delivery equation, finance now plays a starring role as hospitals and healthcare providers of all kinds face the challenge of implementing the reforms of the Affordable Care Act (ACA) of The seemingly contradictory objectives of the ACA to improve quality while at the same time reduce costs put the onus on finance to work closer than ever with clinical and operational teams. While finance may once have been considered a backroom function, it is today moving beyond spreadsheets and financial formulas to take a broader look at how it can help the larger organization execute on its healthcare delivery objectives. This calls for far greater functional integration where finance is intimately involved with healthcare delivery decisions on the ground. Take, for example, value-based purchasing (VBP) a reform that links Medicare payments to improved quality and is expected to drive savings north of $200 billion over the next decade. Through a series of incentives, VBP encourages providers to improve patient outcomes and drive down costs. Another critical goal is to increase transparency wherever possible. For finance in particular, this will mean gaining visibility into the association between financial data and service delivery activities to make cost information readily available for public consumption. Closely related reforms associated with the new model for accountable care organizations (ACOs) add new levels of complexity to the mix. ACOs move providers away from the fee-for-service model toward the effective management of population pools where multiple providers work collaboratively to coordinate end-to-end care as a patient moves through the system. With ACOs come new payment models that finance must master. Bundled payment models, for instance, will require providers to share the fee for specific procedures or diseases such as kidney transplants or emphysema. Shared savings initiatives, meanwhile, reward providers by allowing them to receive a share of any savings they may achieve by increasing efficiencies and controlling costs. Financial Health for Healthcare Providers 3

4 VISIBILITY AND COLLABORATION In this context, revenue cycle management (RCM) becomes all-important for helping the finance group follow through on its core mission of ensuring sustainable growth and freeing up resources to fund ongoing innovation. New reforms come with new requirements on the information that needs to be tracked from insurance eligibility, procedure coding, and patient outcomes to claims, billing and collections data. To help manage revenues and balance competing demands in the midst of constant change and growing complexity, healthcare finance organizations everywhere are seeking ways to improve visibility into financial data and to collaborate more effectively with an ever-expanding list of stakeholders. This is where QlikView can help. Think of QlikView as a financial Business Discovery platform. It delivers true self-service financial analysis and insight to your team so that you can make the decisions that drive down costs while helping the organization improve care delivery. It also makes collaboration easier and more effective by giving you the tools you need to share information and insight with all the parties involved in end-to-end care delivery. Take, for example, the challenges involved with partial or full-risk capitation arrangements yet another reform measure associated with the ACO model. According to such arrangements, an ACO provider can assume partial or full risk not only for its own financial performance but also for those of other participants on the network. To help make this work, QlikView can give you the real-time collaborative insight you need to establish meaningful measurement and feedback mechanisms. This enables you to effectively analyze costs and risk, manage processes, negotiate contracts, properly distribute revenue, and implement improvements on a continuous basis. INTEGRATING FINANCE INTO THE HEALTHCARE ORGANIZATION This, of course, is just one of the many areas in which QlikView yields the insight you need to drive better financial performance in a complex healthcare setting. It empowers your financial group to fully explore your data to find the meaning locked inside all based on a single version of the truth that is accessible to all. And it makes it possible to work more effectively with the healthcare professionals delivering care on the front lines. This brings your finance group closer to the action which is exactly where it needs to be to help your organization as a whole succeed in a new and rapidly evolving healthcare landscape. The diagram below, gives you a more detailed overview on how you can apply QlikView to various operational areas within your healthcare organization. THE INTEGRATED HEALTHCARE ORGANIZATION 4 Financial Health for Healthcare Providers

5 Figure 1. Using QlikView for Better Financial Management and Insight in Healthcare Expense Management Travel and entertainment Telephony and mobile Supplier spend / vendor analysis Legal and contractor fees Food service Hospital & Departmental Performance Hospital profitability Physician performance Cost per patient, procedure, department Procedure assessment and comparison Departmental performance and benchmarking Financial Compliance & Reporting SOX & Financial reporting Sunshine Act cost management Aggregate spend analysis Reporting project management Audit reporting & tracking HR Optimization Labor Productivity Workforce optimization Training costs and management - CME Employees vs. contractors Vacations and involuntary time off Retirement planning P&L management Profitability analysis Margin analysis & costing Activity based costing Flash balance sheet Asset depreciation Procurement spend analysis Operational Costing Employee / contractor headcount Real estate and expansion planning Infrastructure and network Facility and equipment maintenance Operations utilization bed analysis, OR, ED Systems & data integration Revenue Cycle Management Budgeting and forecasting Accounts receivable and payable analysis Contact analysis Reimbursement analysis Cash flow comparisons Collections analysis & reporting Executive Dashboards & Scorecard CEO dashboard COO dashboard CIO & CMIO dashboard CFO dashboard CTO/CSO, CMO, etc. Financial Health for Healthcare Providers 5

6 WHAT IS BUSINESS DISCOVERY FOR FINANCE? Business Discovery for finance is based on the belief that quality financial information can transform healthcare delivery for the better and that the financial group with access to this information can play an instrumental role in that transformation. With the QlikView Financial Business Discovery platform, everyone can easily analyze data and experience that a-ha moment of discovery. Business Discovery for finance is a whole new way of doing things that puts your finance experts in control. Unlike traditional analytical solutions, where just a few people are involved in insight creation, Business Discovery enables everyone to create insight. It s about your people having access to the data they need to make the decisions that create efficiencies and drive down costs while ensuring the best possible patient outcomes. With QlikView, you can take insight to the edges of your organization, enabling every user to do their jobs smarter and faster than ever by accessing tailored insights that meet their unique needs. THE BENEFITS OF BUSINESS DISCOVERY FOR FINANCE QlikView not only improves cost visibility into critical areas like hospital or department performance, resource utilization, and revenue cycles it also provides the collaborative, analytical, and mobility tools you need to improve cost performance. Whether your healthcare organization is a small physician suite, large urban hospital, or part of a large healthcare network, understanding the nexus between costs, revenues, and patient care is more important than ever. QlikView is designed to help you make those connections, bringing together information from your own financial and clinical systems as well as the systems from partners in your healthcare networks. You can discover the root causes of claims denial, or identify procedures and service lines that not only deliver excellent patient outcomes but excellent financial performance as well. QlikView makes the latest clinical and financial data securely available to those who need it on virtually any device from the CFO s ipad to the nursing supervisor s PC. Financial and billing specialists, physicians, nurses, and every other healthcare stakeholder can interact with all relevant clinical and financial data through QlikView Apps. These apps let them securely share and exchange data and analysis on the device of their choice. They can explore all of the information contained in the app, including summary data visualized in a performance metric and then drill into underlying details behind the metric. Users can also make modifications, additions, or create new apps without requiring complex training or ramp-up time. 6 Financial Health for Healthcare Providers

7 In fact, QlikView provides clear, highly visual financial information and insight through a huge variety of charts and display options users themselves create. It is intuitive, simple to use, and visually appealing. A simple click or tap can transform clinical and financial data into fresh and clear analysis. It can help you quickly get up to speed with new models for healthcare delivery and financial performance, and even create and monitor your own innovative approaches. EFFECTIVE FINANCIAL AND CLINICAL TEAM COLLABORATION The volume of Medicare-eligible care at hospitals and other healthcare organizations is only growing, and in order to protect your razor-thin operating margins, now is the time to establish financial best practices across your organization. The challenge is to control costs and compensate for lower reimbursements that result from long revenue cycles, increased claims write-offs, and unrecoverable debt. Important for success in this context is the ability to master the new and complex payment models that are now coming into play whether it s tracking quality measures under pay-for-reporting initiatives or demonstrating quality care improvements with pay-for-performance models. Whatever the case, collaboration will play a big role. IMPROVE REIMBURSEMENT RATES AND REDUCE COLLECTION COSTS QlikView can help you turn the challenge of revenue cycle management into an opportunity to excel in the new ACA-driven reality. With QlikView, healthcare CFOs, financial analysts, and accounting professionals can make connections between specific clinical operations and their affect on critical financial performance factors such as cash flow, net cash, bad debt, denied claims, and collection costs. Not only does QlikView let you securely analyze millions of clinical and financial records instantaneously, you can work with all stakeholders in real time to solve clinical and financial performance issues. HOW DOES QLIKVIEW HELP YOU IMPROVE FINANCIAL PERFORMANCE? Effective financial and healthcare team collaboration Break barriers between financial and clinical teams to improve patient outcomes and cost performance across your organization New levels of financial insight in health care Gain deeper insights using QlikView s unique analysis engine and build powerful performance dashboards for financial monitoring and cost control Mobile healthcare intelligence Get all levels of your organization involved and invested in higher quality and more value-driven healthcare delivery Cost-effective, self-service financial insight that deploys fast Use and configure QlikView so that financial teams can quickly design the interfaces they need without a lot of ongoing involvement by IT For example, your financial and clinical teams can collaborate to identify and resolve the causes of denied claims. Even if your financial analysis and clinical specialists are located in different parts of the state or different parts of the country, they can collaborate in live, online sessions using their desktops, tablets, and other mobile devices. They can share analysis of huge volumes of EHR data, diagnostic information, and medical charts along with billing and claims records to identify patterns and root causes of denied claims. Financial Health for Healthcare Providers 7

8 In bringing clinical and financial experts together to exchange a common set of analysis, data, and insight, they can make important discoveries such as pinpointing billing code errors that are to blame for a specific clinical service. They can then quickly develop an updated billing procedure to amend previously denied claims and to ensure future claims are properly reimbursed. What s more, with annotations capabilities, collaborating parties can add their own comments to any analysis reports in order to ask questions, justify decisions made, or provide insights for putting those decisions into action. ACHIEVE NEW LEVELS OF FINANCIAL INSIGHT IN HEALTH CARE QlikView takes a very different approach from traditional healthcare analysis tools. Traditional tools rely on data that s stored and primarily processed on hard disk. This not only limits the speed of analysis, but often requires analysis of a subset of the total available data in order to return results faster. QlikView, on the other hand, maintains and analyzes all the data in active memory, enabling users to analyze the entire data set and completing that analysis much faster. QlikView not only improves the precision and accuracy of the analysis, it speeds it up giving users the ability to analyze millions of records in real time. GO DEEPER USING THE POWER OF GRAY The new paradigm of cost-conscious healthcare delivery makes it more critical than ever that financial and clinical teams uncover every hidden opportunity to improve patient outcomes and cost performance. By design, QlikView can help you uncover those hidden opportunities because it is able to make connections between data points that may not be strictly related to a particular search or query. This is known as the power of the gray and it enables teams to explore unexpected query results that may also yield unexpected opportunities to improve financial performance. For example, you can use QlikView s unique and powerful analytics capability to improve the daily efficiency of your most valuable resources the doctors, nurses, and other clinical staff that deliver patient care. A key financial challenge is to reduce reliance on excessive overtime and outside staffing agencies to assure optimum care. This is particularly difficult for large multi-hospital networks that need to analyze the huge volumes of labor data that is often distributed across multiple systems. QlikView enables you to analyze such high volumes of labor data across your entire healthcare network by region, hospital, department, team, shift, and role. You can compare productive hours with patient volumes, FTEs per occupied bed, and other metrics. By comparing labor data against different patient care indicators, QlikView can highlight unexpected variances in overtime usage for particular hospitals or departments that were never previously identified. You can then drill into the unexpected results to understand the causes and take corrective action to eliminate the overtime expenditures. 8 Financial Health for Healthcare Providers

9 CREATE INTELLIGENT FINANCIAL PERFORMANCE DASHBOARDS THAT KEEP COSTS IN CHECK To ensure the success of your evolving healthcare delivery and compensation models, constant monitoring of your financial performance is essential. QlikView lets users themselves build highly visual dashboards using financial KPIs that they also define. And with QlikView, even as the dashboard metrics are clear and meaningful, the underlying sources of data can come from a diverse and complex array of clinical and financial systems. These sources can be constantly refreshed to ensure the dashboard KPIs are absolutely current. For example, you can build a financial performance dashboard that monitors surgical costs bringing together information from ambulatory electronic medical record, EHR, surgical procurement, and OR staffing systems to determine actual OR costs against forecasts. The dashboards can employ color-coded alerts when costs exceed thresholds. And with QlikView, users can click through the metrics to view and analyze the underlying data and take action. EMPOWER EVERYONE WITH MOBILE HEALTHCARE INTELLIGENCE Physicians and other healthcare professionals are already leading the way when it comes to using mobile devices to deliver more efficient and effective patient care. QlikView takes mobile-powered collaborative health care much further, enabling everyone from the emergency room nurse to the CEO to share information and stay on track to constantly deliver outstanding and fiscally responsible care. No matter how distributed your healthcare network, everyone can stay connected on the mobile device of their choice. GIVE EXECUTIVE DECISION-MAKERS THE INSIGHT AND CONTROL THEY NEED With the growing plethora of new healthcare delivery and compensations models that are out there today, it s critical that healthcare executives stay abreast of how the organization is performing on a daily basis. With powerful QlikView apps delivering comprehensive performance dashboards and scorecards, CEOs, COOs, and CFOs can monitor real-time financial performance and healthcare metrics using their tablet computers or other mobile devices no matter where they are located. A CFO, for example, can track everything from hospital profitability and cost per patient to reimbursements and cash flow. And because QlikView can bring together both financial and clinical system data within a single QlikView app, CFOs can conduct their own ad hoc analysis to discover emerging trends that may impact revenue cycle management, operational costing, or any other critical area important for financial health. Financial Health for Healthcare Providers 9

10 COST-EFFECTIVE, SELF-SERVICE FINANCIAL INSIGHT THAT DEPLOYS FAST With traditional healthcare analysis solutions, IT has to commit significant amounts of time and cost preparing the data and then building reports for healthcare users. With QlikView, users are empowered to create their own reports, dashboards, and scorecards. Clinical teams don t have to overload IT with report requests to access the insight they need right now and given the pace of change happening in health care today, that s important. Equally important however, is the fact that QlikView keeps IT in firm control of information security and has a simplified information infrastructure that requires less resources and less cost than traditional solutions. Best of all, IT can stay more focused on its core mission of enhancing the quality and availability of information across all levels of the healthcare organization. SIMPLIFY HEALTHCARE AND FINANCIAL COMPLIANCE REPORTING When it comes to extracting and displaying critical information in charts, graphs, or standardized compliance reports such as SOX, the Sunshine Act, and others, QlikView is much simpler and faster than traditional analytical solutions. Users can create meaningful comparisons in charts, graphs, and other reports in just a few clicks. For example, your financial team can quickly generate highly visual spend and margin analysis reports that include complex calculations of aggregated data from millions of records across your healthcare network. They can also insert full explanations of the content and context for each report element to help clarify issues and provide guidance on decisions made. What s more, QlikView reports crunch the latest data and information fast, so that even the most complex, data-intensive reports can generate in seconds. 10 Financial Health for Healthcare Providers

11 CASE STUDY: CHILDREN S HEALTHCARE OF ATLANTA BACKGROUND: Children s Healthcare of Atlanta (CHOA) is one of the largest clinical care providers for children in the country. Managing more than half a million patient visits annually at three hospitals and 16 neighborhood locations, CHOA offers access to more than 30 pediatric specialties and is ranked among the top children s hospitals by Parents magazine and U.S. News & World Report. CHALLENGE: CHOA s experience with traditional business intelligence was less than positive. After years of jumping from one tool to another, the organization was left with expensive implementation schedules, scope reductions, and a dissatisfied user base. Among other issues, financial reporting was slow and the financial experts who needed the information most had to burden IT with report generation duties. SOLUTION: To address this and other business reporting issues, CHOA implemented QlikView to more than 500 employees. The implementation took less than a month much faster than with any other tool the organization worked with in the past. Almost immediately, CHOA set out to replace and improve its existing financial reporting process with QlikView as its financial business discovery platform. The hospital developed a dashboard that provides a holistic view of revenue management so that financial experts and hospital administrators can make decisions based on projections, actual performance, and trending analysis. BENEFITS: CHOA s revenue cycle management dashboard integrates records from four different data sources, all updated daily. Equivalent to the information previously available in 50 different static reports, CHOA executives, directors, and managers now have a single view of revenue billed each day. This information can be viewed according to multiple criteria such as by hospital, by each service line within a hospital, and by sub-service line. Information can also be view by targeted goals, disease codes, and acting physicians. Before QlikView, each report would have taken approximately 30 hours to build. Now, all of that detail -- and more -- is available in a single dashboard that was deployed in less than a month. Financial Health for Healthcare Providers 11

12 CASE STUDY: THEDACARE BACKGROUND: ThedaCare is the third largest healthcare employer in Wisconsin and the largest employer in the state s second largest economic market - Northeast Wisconsin. Serving 225,000 patients annually, ThedaCare is a well-established community health system with approximately 6,100 employees, five hospitals, numerous clinics, and related services. CHALLENGE: Serving a large population, ThedaCare generated an impressive volume of data but its reporting systems were not up to the task of turning that data into useful information and insight. Cumbersome and less than user-friendly, these systems required end users to coordinate with IT to develop ad hoc reports for financial insight and other needs. The process could take days to answer business and clinical questions -- a situation that only worsened as data volumes grew. SOLUTION: In less than 60 days, ThedaCare deployed QlikView to 1,200 business and clinical users. Analyzing 110 million rows of data each day from EMR, patient management, finance, call center, and time card systems, the health care provider now has greater visibility into financial performance as well as disease management, patient care, and the quality and availability of services. All of this helps the organization improve healthcare value for employer plan purchasers and patients. BENEFITS: One of the first applications that ThedaCare developed on the QlikView platform gave the organization an enterprise view of financials. Now users can quickly view KPIs that focus on charges by facility across clinics and hospitals, payer, attending provider, service line, and more all with visibility into the day, procedure, and patient level. And with QlikView s ability to answer almost any question posed, ThedaCare can also analyze payer mix and physician volumes, negotiate contracts, and control expenses. This helps the hospital remain on sound financial footing despite an extremely challenging healthcare environment. 12 Financial Health for Healthcare Providers

13 THE BEST PATH FORWARD FOR BEST PRACTICES IN HEALTHCARE FINANCE With all the pressure on the finance group to control costs, improve patient satisfaction, and help the organization succeed with complex and uncertain healthcare reform measures, it s easy to feel overwhelmed. But with QlikView you can gain the insight you need to put your best foot forward and implement best practices that will help you succeed. With QlikView, you ll be able to: Improve financial performance and the quality of care delivery with insight into cost drivers and the ability to adapt to complex new payment models Collaborate more effectively with powerful data-sharing capabilities that allow you to share insights with other financial experts and coordinate more effectively with clinical and operational teams for better performance under the new ACO model Gain insight into performance metrics and best practices with unimpeded access to financial information and the ability to freely associate with the data in a way that empowers you to make new discoveries Comply with regulations and report to stakeholders with vastly improved information transparency and the flexibility to zero in on whatever data may be relevant for existing and emerging reporting requirements LEARN MORE To find out more about how QlikView can help your finance organization drive higher levels of performance, contact us at or visit us online at Financial Health for Healthcare Providers 13

14 QLIKVIEW FOR HEALTHCARE Financial Health for Healthcare Providers. For contact details please visit: GLOBAL HEADQUARTERS Qlik Technologies, Inc. 150 N. Radnor Chester Road Suite E220 Radnor, PA Phone: +1 (888) Fax: +1 (610) QlikTech International AB. All rights reserved. QlikTech, QlikView, Qlik, Q, Simplifying Analysis for Everyone, Power of Simplicity, New Rules, The Uncontrollable Smile and other QlikTech products and services as well as their respective logos are trademarks or registered trademarks of QlikTech International AB. All other company names, products and services used herein are trademarks or registered trademarks of their respective owners. The information published herein is subject to change without notice. This publication is for informational purposes only, without representation or warranty of any kind, and QlikTech shall not be liable for errors or omissions with respect to this publication. The only warranties for QlikTech products and services are those that are set forth in the express warranty statements accompanying such products and services, if any. Nothing herein should be construed as constituting any additional warranty. qlikview.com

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