The New Analytics Market Planning, Operational Assessment, and Population Health

Transcription

1 The New Analytics Market Planning, Operational Assessment, and Population Health Scott W. Goodspeed, DHA, FACHE Principal and Vice President ivantage Health Analytics cell Eric T. Gommel, MBA, NHA Senior Planning Analyst University of Rochester Medical Center work *This presentation should not be construed as representative of actual operational strategy of URMC The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

2 The New Analytics Market Planning Competitive Assessment Comprehensive comparison to the competition Market, value-based and financial performance indicators Market Assessment and Strategy GIS Mapping Operational Assessment Clinical and Functional Assessment Value-Based Incentive Cultural Assessment Population Health Top 100 Hospitals Goal is increased revenue, lower expenditures, better outcomes, improved population health status, and increased value

3 Market Planning Comprehensive Comparison to the Competition The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

4 Comprehensive Comparison to the Competition Hospital Strength Index The Hospital Strength Index provides a comprehensive comparison for all U.S. general acute care hospitals using a set of market, quality, safety and financial performance indicators The Strength Index model aggregates data for over 56 indicators organized into 8 performance categories Hospitals are ranked against national peer groups using a point scale for every performance category The Index is the first national rating system built to include the 1,300+ Critical Access Hospitals

5 Comprehensive Comparison to the Competition A Strong Hospital has the following characteristics: Dominant market share with growing demand Diffuse competition Outstanding quality and safety programs Loyal, satisfied patients Efficient and appropriately priced services Strong Balance Sheet with surplus capital High margin services Market Value-Based Finance

6 Comprehensive Comparison to the Competition Correlation Matrix for 2013 Hospital Strength Index Pillars

7 Comprehensive Comparison to the Competition Hypothesis Testing of Conventional Wisdom 1. Efficiency and Quality: Conventional wisdom holds that more efficient (i.e. costeffective) hospitals achieve better clinical quality. However, using the Hospital Strength Index, this relationship is weak; in fact the correlation between the Cost & Charge Pillar and Quality Pillar is negative (-0.11). 2. Market Share and Satisfaction: Conventional wisdom holds that higher patient perception and satisfaction will contribute to greater market share. In fact the correlation between the Market Strength Pillar and the Patient Perception Pillar is negative (-0.14). 1. Market Growth and Efficiency: Conventional wisdom holds that expanding markets will contribute to operational efficiency given the high fixed-cost nature of the healthcare industry. However, this relationship is weak; in fact the correlation between the Market Size & Growth Pillar and the patient Cost & Charge is negative (-0.20).

8 Comprehensive Comparison to the Competition

9 Comprehensive Comparison to the Competition

10 Uses of the Comprehensive Comparison University of Rochester Medical Center Get to #1 in the marketplace Redefine the service area Improve market share Grow select service lines Improve quality and patient safety Improve financial performance Acquire and/or divest assets Improve system performance

11 Market Planning Market Assessment and Strategy The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

12 Source: ESRI, 2012 (Demographics), SPARCS, 2011 (Market Share) GIS Mapping: Dashboard

13 GIS Mapping: Emergency Department Visits Source: ESRI, 2012 (Demographics), SPARCS, 2011 (Market Share)

14 Source: SPARCS, 2011 GIS Mapping: Market Share

15 Uses of the Market Assessment and Strategy University of Rochester Medical Center Service area definition and map Demographics Competitor profile Patient outmigration-50% rule Service line evaluation Inpatient and outpatient demand projections Physician demand and supply

16 Operational Assessment Clinical and Functional Assessment The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

17 Facility Scorecard: Key Indicators Clinical Excess-Each DRG performing above the 65 th percentile of the target s cost per case is the savings. Cost of Off Quality- Cost per case for those cases which were targeted for an off quality indicator vs. other hospital cases that were not targeted within the same DRG. CV Blood infections Accidental puncture Pressure ulcer Functional Excess-Overall cost per adjusted admissions in the peer group FTE excess M/S nursing Utilities

18 Facility Scorecard: Cost of Off-Quality

19 Cost per Case Cost Per Case versus Margin at the Service Line Level

20 Physician Scorecard

21 Inpatient Clinical Cost Comparison: 2011

22 Inpatient Clinical Cost Trend:

23 URMC Top 10 Excess Cost DRGs (2011)

24 Operational Assessment Value-Based Incentive The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

25 Value Based Purchasing (VBP) Methodology Summary Total Performance Score 2013 VBP Program Patient Satisfaction Domain (30%) Clinical Process of Care Domain (70%) Total Performance Score is based on: YOUR scores from the performance period National scores in the baseline period YOUR scores in the baseline period

26 URMC VBP Report

27 URMC VBP Report

28 Operational Assessment Cultural Assessment The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

29 What is Organizational Culture? Culture is observable shared values, norms, and expectations that underscore how: Decisions are made; Leaders behave; People approach their work; and Colleagues interact.

30 The Three Cultural Styles We Find in Community Hospitals There are three cultural styles that we find in hospitals: 1. Constructive styles; 2. Passive/defensive styles; and 3. Aggressive/defensive styles. A constructive culture leads to better execution of strategy, improved quality, engagement, retention, satisfaction, teamwork, positive financial results and is the style that is most effective.

31 How Culture Really Works in Community Hospitals Measuring Culture What should be expected here The way things are around here The way we are expected to do things around here How we re doing here Assumptions Espoused Values Structures Individual Level Philosophy Mission Systems Goals Strategy Technology Group Level Organizational Level Skills/Qualities Focus Instrument Measuring Ideal Culture Causal Factors Current Culture Outcomes OCI Ideal OEI OCI OEI Values and Beliefs Levers for Change Norms and Expectations Effectiveness Copyright 2012 by Human Synergistics International. All rights reserved.

32 Uses of the Operational Assessment University of Rochester Medical Center Evidence based medicine comparisons Decrease functional and clinical costs 18-20% Physician peer review Credentialing Service line review Select physicians in ACO/CCO Increase value based incentive score Measure culture and improve execution of strategy

33 Population Health Assessment The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

34 County Health Rankings: % of Smokers Source: 2013 County Health Rankings, Robert Wood Johnson Foundation

35 County Health Rankings: % of Diabetics Source: 2013 County Health Rankings, Robert Wood Johnson Foundation

36 County Health Rankings: % Obese Source: 2013 County Health Rankings, Robert Wood Johnson Foundation

37 Population Health: Relation of Cost and Health Status

38 Population Health: Relation of Cost and Health Status

39 Population Health: Relation of Cost and Health Status

40 Uses of the Population Health Assessment University of Rochester Medical Center Assess baseline cost for the assumption of risk Evaluate potential for shared savings Provider Inventory Preventative Care Population Health ACO/CCO development Coordinated care index Triple Aim: Better Health, Improved Outcomes, Lower Costs

41 The Top 100 Hospitals Using the Hospital Strength Index The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

42 Top 100 Hospitals by Census Region

43 Preliminary Findings from the Top 100 Hospitals 1. They have a strategy and their intensions are known throughout the organization They speak frequently of their mission/vision/values They translate values into behavior standards They are transparent internally and externally They publish their results They tell the truth

44 Preliminary Findings from the Top 100 Hospitals 2. Focus on accelerating performance Publish financial and operational goals They meet on them every month Everyone is conversant on all data points There is accountability They fly in formation 3. They create high reliability by hardwiring performance Evidence based medicine and management Create highly reliable systems Excellence is a systematic property which means being able to remake systems in their entirety

45 Preliminary Findings from the Top 100 Hospitals 4. They compete using analytics and ask 5 key questions: Where are we today? Where should we be tomorrow? How shall we get there together? Are we getting there? Does our culture support the strategy? 5. Everyone knows the organization s financial performance

46 Preliminary Findings from the Top 100 Hospitals 6. Everyone knows the problems and priorities 7. Everyone is responsible for strategy 8. Many use outside references for benchmarks They understand the competition They set internal goals 9. Employees consistently talk about 4 things High standards in the organization We listen to patients and families Autonomy to get the job done Reframe my job so it is purposeful 10. Provider collaboration is key

47 Questions and Comments? Scott W. Goodspeed, DHA, FACHE Principal and Vice President ivantage Health Analytics cell Eric T. Gommel, MBA, NHA Senior Planning Analyst University of Rochester Medical Center work The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development