Performance Data, Dashboards, & Metrics-Based Management

Transcription

1 Performance Data, Dashboards, & Metrics-Based Management The NYAPRS Collective in Collaboration with the Managed Care Technical Assistance Center (MCTAC) Monica E. Oss, Chief Executive Officer, OPEN MINDS December 11, :15pm 2:30pm York Street, Gettysburg, PA Phone: info@openminds.com

2 Agenda Performance Data, Dashboards, & Metrics-Based Management I. Performance Matters II. Using Big Data III. Using Your EHR Dataset To Support Executive Decision Making IV. Questions & Discussion 2014 OPEN MINDS. All rights reserved. 2

5 Many Kinds Of Performance Measures In The Field Can Seem Confusing 1. Organizational or program sales or revenue 2. Organizational or program cost 3. Organizational or program profit/margin 4. Program market share 5. Cash flow 6. Consumer clinical outcomes 7. Consumer functional outcomes 8. Consumer satisfaction 9. Community tenure 10. Emergency room use 11. Readmission rates hospital, residential facility, jail 12. Reunification with family 13. Payer satisfaction 14. Cost per consumer care episode 15. Annual cost per consumer 16. Contract compliance 17. Productivity of clinical team members 18. Yield (occupancy) of facilitybased care 19. Staff retention and turnover 20. Service volume 2014 OPEN MINDS. All rights reserved. 5

6 Guideline: Where You Focus Performance Improvement Investment Depends On Strategy For Competitive Advantage Organizational Performance Communication Market Positioning & Competitive Advantage 2014 OPEN MINDS. All rights reserved. 6

7 When Does Organizational Performance Not Matter? In a monopoly market, where there is no competition In a commodity market, where all products or services are viewed as identical Otherwise, performance matters 2014 OPEN MINDS. All rights reserved. 7

8 The Challenge Previous relationships with payer changing Role of mission-based, tax-exempt organizations evolving More competition Technological substitution reducing price point on rates Specialist organizations need strategic repositioning to maintain competitive advantage To win, create what is scarce 2014 OPEN MINDS. All rights reserved. 8

9 Strategic Advantage & Market Positioning Performance Matters! Payer Performance Expectations Contract Performance Consumer Performance Expectations Accreditation & Licensure Performance Metrics-Based Management Strategic Management & Business Process Management Strategy Evolution Operational Execution Strategy Development Market Intelligence Customer, Competitor, Regulatory, Legal 2014 OPEN MINDS. All rights reserved. 9

11 Big Data Is The Silver Bullet Of Executive Decision-making Large pools of data (and getting larger each year) that can be captured, communicated, aggregated, stored, and analyzed Big Data defined by Velocity: speed of data creation, how much data is recorded each minute of each day Variety: many stakeholders recording different types of data from different sections of industry Volume: natural consequence of velocity and variety, pushes existing storage infrastructure to its limits 2014 OPEN MINDS. All rights reserved. 11

13 The Evolution Of Analytics The Past The Present The Future Analytics 1.0: Business Intelligence For Management Teams Analytics 2.0: Big Data For Management Teams Analytics 3.0: Data-Enriched Services For Consumers & Front-line Staff 2014 OPEN MINDS. All rights reserved. 13

14 The Evolution Of Analytics The Past The Present The Future Analytics 1.0: Business Intelligence For Management Teams Analytics 2.0: Big Data For Management Teams Analytics 3.0: Data-Enriched Services For Consumers & Front-line Staff We re not here yet This is a few years off 2014 OPEN MINDS. All rights reserved. 14

15 What Is Business Intelligence? Tools enabling analysis of organizational information to optimize management decisions and performance. BI technologies provide historical, current and predictive views of business operations. Retrospective What Happened Directive What Is Happening & Where Are We Headed Predictive What Will Happen 2014 OPEN MINDS. All rights reserved. 15

16 Where Are We With Business Intelligence Among Payers & Care Management Organizations? Elemental data available for decision making State data sets highly variable and few are connected outside of departments Health insurers traditionally focused only on claims management, and not on health system or outcomes management 2014 OPEN MINDS. All rights reserved. 16

17 Where Are We With Business Intelligence In Service Provider Organizations? The percent of physicians using EHR system was just 17 percent in 2008 now more than 50 percent 45 percent with EHRs say they routinely access clinical data from outside their own organization For hospitals, just nine percent had adopted EHRs in 2008 now more than 80 percent have demonstrated meaningful use of EHRs 17% of hospitals using comprehensive functionality Non-profit health/human service organizations other than hospitals far behind the EHR adoption curve 8 Core EHR Functions 1. Health information and data 2. Result management 3. Order management 4. Decision support 5. Electronic communication and connectivity 6. Patient support 7. Administrative processes and reporting 8. Reporting and population health 2014 OPEN MINDS. All rights reserved. 17

18 Big Data Is The Goal For Interoperable EHRs But Is Far From Here EMRs & EMR Data (National Health Information Network of the future) Clinical Data From New Diagnostics & Neurotech Bioconnectivity Single Real-Time Clinical, Admin, & Cost Data Set Clinical Metrics From Telehealth Connection Of & Access To All Data Sets Via Web Tools - For Consumers, Professionals, Health Systems 2014 OPEN MINDS. All rights reserved. 18

19 Anatomy Of Big Data In Health & Human Services Inputs Billing, personal health records, electronic health records, registries, meaningful use requirements, etc. Exchange Health information exchanges (HIE) Database BIG DATA Tools Dashboards and decision support 2014 OPEN MINDS. All rights reserved. 19

20 Management Teams Are Waiting For "Big Data" To Arrive & Be Perfect! Postponing the cultural changes involved in metrics-based management and some hard decisions... The challenges of the evolving health and human service market are not waiting for big data to arrive Organizations need to manage both strategy and business processes with the information that they have The KPI of strategic management The KPI of business process management Neither a wise man nor a brave man lies down on the tracks of history to wait for the train of the future to run over him. - Dwight D. Eisenhower 2014 OPEN MINDS. All rights reserved. 20

21 Bioconnectivity Roadmap For U.S. Health & Human Service System Clinical Data From New Diagnostics & Emerging Neurotech EMRs & EMR Data (NHIN of the future) Bioconnectivity Single Real-Time Clinical, Admin, & Cost Data Set Clinical Metrics From E-Health & Remote Consumer Monitoring Connection of All Data Sets Via Web Tools (With Consumer & Professional Access) 2014 OPEN MINDS. All rights reserved. 21

22 The Challenge is to Get Maximum Leverage Of Your Investment in Bioconnectivity Requirements Strategic Decisionmaking Informatics -- Analysis of data gathered through bioconnectivity with tools to support decisions Bioconnectivity -- Comprehensive, web accessible data set of all health and human services activities 2014 OPEN MINDS. All rights reserved. 22

23 Using Tools Is the Differentiator Ability to use tools separates man from animals (theoretically, at least) Ability to use data separates the thriving from the surviving in current health and human service environment 2014 OPEN MINDS. All rights reserved. 23

24 The Failure To Get Leverage Investment in electronic health recordkeeping system As a compliance cost (cost only) As a process or efficiency improvement model (operations ROI) As a source of strategic decision support tool (priceless) 2014 OPEN MINDS. All rights reserved. 24

25 Key Strategic & Market Information You Need To Make Critical Business Decisions 1. Development of organizational strategy using data to assess internal resources against external environment 2. Design of operating unit plans to support strategy implementation using data to conduct operational business unit gap analysis and set performance standards 3. Management of performance using data to manage the organization s operations to the performance metrics required for success 4. Evolution of market positioning using data to compare organizational performance against competitors to gain competitive advantage 5. Participation in performance-based contract arrangements using data to prospectively estimate (and manage) performance 2014 OPEN MINDS. All rights reserved. 25

26 Metrics Needed For Optimal Strategic Planning 1. Income/revenue, by source and service line 2. Allocated charitable income/revenue, by service line Profit/loss by service line without charitable allocation (if NFP) 3. Total profit/loss by service line 4. Total number of consumers served, by service line and payer 5. Total number of service units delivered, by service unit type, by service line and by payer 6. Staff/facility productivity or yield, by service line and/or operating units 7. Total direct cost per service unit, by service unit type Total indirect cost per service unit 8. Total cost per service unit Profit/loss per service unit 9. Consumer satisfaction and performance, by service line 10. Charity/subsidy as % of total unit cost (if NFP) 2014 OPEN MINDS. All rights reserved. 26

27 Strategic Decisions Supported By These Service Line Metrics Service line/portfolio management decisions Markets to pursue and service lines to offer Revenue and return required for each service line Target costing decisions Assessment of organizational competencies required for success in specific scenarios 2014 OPEN MINDS. All rights reserved. 27

28 #2. Plans For Each Business Unit Or Program Tie to objectives and strategies in organizational plan and assign accountabilities Have quantitative metrics that define success of unit operations: Turnover Productivity Claims paid Process measure Revenue Cash flow 2014 OPEN MINDS. All rights reserved. 28

29 #3. Building Metrics-Based Management Competency 1. Establish performance standards for each operating unit 2. Develop standard reporting of performance (dashboards, etc.) appropriate to each operating unit 3. Modify management and supervision approach to integrate metrics-based approach 4. Use internal and external benchmarks, where possible, to identify best practices and improve operating processes 5. Within each operating unit, link performance appraisal (and compensation, if possible) to performance 2014 OPEN MINDS. All rights reserved. 29

30 #4. Market Positioning Requires Metrics Comparing Your Organization To Your Competitors The relationship of a service, or an organization, to the competition in a specific market Positioning is Comparative to competitors Defined in terms of perception of customer Limited positioning options Price Performance attributes Ease of use 2014 OPEN MINDS. All rights reserved. 30

31 #5. Participating In Emerging Risk-Based, Pay-For- Performance, & Value-Based Purchasing Initiatives Application of EBP and comparative effectiveness models to service delivery Move from FFS to bundled case rates and global payment models More Medicaid managed care particularly for consumers with disabilities Medicaid plans adding value-based purchasing initiatives CMS Value-Based Purchasing program National Quality Forum measures 2014 OPEN MINDS. All rights reserved. 31

33 Data Elements Linked Via Your EHR Consumer service and clinical history data Customer relationship management (CRM) data Outcome and performance measurement data Employee activity data Personnel data Financial data Revenue (billing, collections, etc.) Costs (productivity, salary, units, etc.) 2014 OPEN MINDS. All rights reserved. 33

34 Purpose of Creating Key Performance Indicators Is to Leverage Value of Existing Data Data: raw symbols with no significance beyond its existence Information: data that are processed to be useful and provides answers to "who", "what", "where", and "when" questions; given meaning by way of relational connection Knowledge: application of data and information that answers "how" questions; the collection of information with the intent to be useful. Wisdom: an understanding of "why 2014 OPEN MINDS. All rights reserved. 34

36 What is A Dashboard? A computer interface that organizes key performance indicators in an easy to read format, displaying the information that executives need to run an organization OPEN MINDS. All rights reserved. 36

37 Features Of An Effective Executive Dashboard 1. An intuitive graphical display that is thoughtfully laid-out and easy to navigate 2. A logical structure that makes information easily accessible 3. Little or no user training is required 4. Data displays that can be customized and categorized to meet the specific needs of each user. 5. Regular and frequent updates of dashboard information for accuracy and relevance to current conditions 6. Information from multiple sources, departments, or markets can be viewed simultaneously 2014 OPEN MINDS. All rights reserved. 37

38 Framework For Executive Team Performance Management Dashboards 1. Determine critical performance outcomes for success of organizational strategy (starts with the strategic plan) 2. Distill from these performance outcomes the specific measures (leading and lagging) that would best enable the management or measurement of success 3. Determine which of the data to create these measures are available in current data systems and identify proxy data and measures where not available 4. Design dashboard based on available measures For each measure, create an appropriate display and measurement and reporting specifications 5. For long-term planning, identify data not currently available in system for necessary measures and conduct ROI of costs to gather data 2014 OPEN MINDS. All rights reserved. 38

39 Five Step Process To Creating The Dashboards Needed To Maximize Organizational Performance 1. Identify and quantify what performance means for your organization 2. Create an overarching organizational strategic dashboard for the board and executive team based on strategic vision, mission, and objectives 3. Develop an executive team dashboard of leading indicators of organizational success 4. Design a dashboard at the business unit/program level that provides managers with the tools to measure and maximize unit performance 5. Leverage operational performance within programs with functional dashboards 2014 OPEN MINDS. All rights reserved. 39

40 Step #1: Identify & Quantify What Performance Means For Your Organization Mission, vision, and objectives of your strategic plan Customer (consumer and payer) measures of value and performance Regulatory or legal performance measures Industry financial or operational metrics 2014 OPEN MINDS. All rights reserved. 40

41 Step #2: Create An Overarching Organizational Strategic Dashboard For use of the board and executive team Based on strategic vision, mission, and objectives Minimalist approach with focus on key board responsibilities and strategic objectives 2014 OPEN MINDS. All rights reserved. 41

42 Step #3: Develop An Executive Team Dashboard Of Leading Indicators Of Organizational Success Real time organizational performance metrics to allow strategic navigation Based on the board s strategic dashboard Facilitates management through management by exception 2014 OPEN MINDS. All rights reserved. 42

44 Strategic Intent: The leader in translating research into effective practice solutions. Stakeholder Financial S1. HFA s system of care produces positive outcomes F1. Diversify revenue streams S2. Local communities experience a sense of ownership of Hillside F2. Develop a stronger system of care through growth. Customer Operational Excellence C1. EB practices achieve effective outcomes C2. Create customer solutions. Innovation C3. Preferred provider of services Partnerships W3.EB s practices are delivered according to design W7. Service growth includes research grants. W10. We understand Strategic Partners needs. W1. Efficient standard work processes drive productivity. Internal Work Processes W2. User-friendly systems provide accurate data W5. Service models are based on research. W6. We infuse innovation across our value chain. W4. Hillside has research partnerships. W9. Strong parent and youth advocacy W8. Communication exceeds customer expectations. L1. IT systems add value and ease complexity L3. Research infrastructure supports HFA system of care. L4. Hillside is a destination for diverse talent. Learning and Growth L2. Organized system shares knowledge and learning OPEN MINDS. All rights reserved. L5. Behaviors consistent with COI values. HFA BSC FY0809, rev

47 Step #4: Design Dashboards At The Business Unit/Program Level Provides managers with the information needed to measure and maximize unit performance Focus on leading indicators that allow management intervention early in performance challenges 2014 OPEN MINDS. All rights reserved. 47

48 Step #5: Leverage Operational Performance With Functional Dashboards Tracks the performance of specific functions Can automate and improve efficiency of specific tasks Allows early identification of operational fail points Basis for performance assessment of individual teams and team members 2014 OPEN MINDS. All rights reserved. 48

55 Create KPI Dashboards Appropriate to Level of Organization Organization Strategic Plan & Objectives Organization-Wide Performance Indicators Operating Unit Plan & Objectives Operating Unit Performance Indicators Program Plan & Objectives Program-Specific Performance Indicators Overall Agency Performance 2014 OPEN MINDS. All rights reserved. 55

56 Dashboard Development Rules 1. Agreement on performance is the starting point 2. Brevity is key 3. Only automated data is allowed (no hand tallies) 4. Leading indicators preferred but lagging indicators essential in some areas 5. Perfect data is not always available use of proxy indicator data is the solution 6. Dashboard display design must be done with the users 7. Where data not currently available, ROI on data collection costs is recommended 2014 OPEN MINDS. All rights reserved. 56

57 Some Thoughts About Benchmarking & Performance Targets Using benchmarks and performance targets to challenge and drive continuous improvement in service quality and operations Allow your organization to Compare with other firms in your industry Develop cross-industry comparisons Develop points of reference or standards of practice Make best-in-class determinations Develop best practices 2014 OPEN MINDS. All rights reserved. 57

58 Benchmarking Process A Collaborative Approach Purchase or Acquire Benchmark Data Develop group of organizations to initiate benchmarking process Agreement of organizations about process, goals, and measures to benchmark Collect data and analyze Create data collection instrument Reality check and refinement Publish benchmarks Compare it to your organization s measures 2014 OPEN MINDS. All rights reserved. 58

59 Metrics In Supervision & HR Functions Benchmark program and individual performance with other programs and individuals Make performance reporting a key part of managerial and clinical supervision Use dashboards as a means to keep your staff s eyes on the performance targets Use performance-based job descriptions and evaluation processes 2014 OPEN MINDS. All rights reserved. 59

60 #1. Think deliberately about how to combine and use the information you have now what data, what data management options, etc. Keys To Performance Management Success OPEN MINDS. All rights reserved. 60

61 #2. Create an executive team that accepts the fact that the analytics of the future don't belong to "IT" and it s not network management create cross-disciplinary teams for managing and using data Keys To Performance Management Success OPEN MINDS. All rights reserved. 61

62 #3. Build tools to bring data to managers and front-line staff imbed analytics into services, systems, and processes which makes it harder for decision makers to avoid metrics-based management Keys To Performance Management Success OPEN MINDS. All rights reserved. 62

63 #4. Prepare for the human resource issues that come with a new way of managing organizational performance Big brother is watching technology reports on activities of front-line staff and consumers immediately Decisions pushed to consumers & front-line staff Decisions are frequent & fast real-time service line changes with real-time management adjustments "reading the digital smoke signals Keys To Performance Management Success OPEN MINDS. All rights reserved. 63

64 Keys To Performance Management Success... Why competitive advantage? It is what differentiates you from your competition and makes consumers/payers select your organization. A superiority gained by an organization when it can provide the same value as its competitors but at a lower price or can charge a higher prices by providing greater value through differentiation. Without planning, prioritization of investments of time and resources (and identification of performance requirements) not possible OPEN MINDS. All rights reserved. 64

66 Metrics-based management sounds easy Organizing processes and systems, teams, and resources to achieve metrics required by the market is hard work and a huge culture change The new role of supervision The new executive team responsibility Keys To Performance Management Success OPEN MINDS. All rights reserved. 66

67 "Data are becoming the new raw material of business. - Craig Mundie, Head Of Research And Strategy, Microsoft "Data is the new oil!" - Clive Humby, ANA Senior Marketer's Summit, 2006 "Information is the oil of the 21st century, and analytics is the combustion engine." - Peter Sondergaard, Senior Vice President At Gartner 2014 OPEN MINDS. All rights reserved. 67