#HASummit14

Bobbi Brown, Vice President of Financial Engagement, Health Catalyst John Henderson, Director of Enterprise Systems, Texas Children’s Hospital

Leslie Hough Falk, Vice President, RN, Health Catalyst

Session #22Getting an ROI in Your Programs

#HASummit14 2

Learning Objectives

1. Understand the value of establishing a Goal and Aim Statements and how to develop them.

2. Learn how to determine ROI in your initiatives

Know the ROI formula

Understand the three categories of waste that will help you determine where possible gains can come from

Define and distinguish between direct and indirect benefits

3. Learn how to effectively communicate your results using an Agile ROI/communications framework

#HASummit14 3

Learning Objective # 1

Understand the value of establishing a Goal and Aim Statements and how to develop them

#HASummit14 4

Poll Question 1

Does your organization require a Goal and Aim Statements for all of its improvement initiatives?

a) Never

b) Not often

c) Sometimes

d) Frequently

e) Always

f) Unsure or not applicable

#HASummit14 5

Goal and Aim Statements

What is a Goal?

A Goal is an explicit description of your long term objective

What is an Aim Statement?

An Aim Statement is an explicit description of the individual projects that will help you achieve your Goal

Current baselines help with establishing a Goal and Aim Statements

Agile approach: Goal and iterative project Aim Statements

How will you know if you’re successful?

SMART

How do you develop Goals and Aim Statements? Think SMART.• Specific• Measurable• Attainable• Relevant • Time Based

All improvement initiatives need a Goal and Aim Statements

#HASummit14

Goal and Aim StatementsExamples

Goal: To achieve and sustain a 20 percent reduction in 30-day all cause readmission rates for patients with heart failure (HF) by (date), and sustained reduction in readmission rates through fiscal year XX, while lowering the CMS penalties by X percent.

Sample Aim Statements:

Aim #1

Aim #2

Aim #3

Aim #4

Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients by (date).

Identify high risk heart failure patients and extend the identification of these patients to a risk stratification model to predict the likelihood of all cause 30-day readmission rates by (date).

Schedule a follow-up appointment for all HF patients within 24 hours of discharge with a focus on high risk patients being seen within 48-72 hours after discharge by (date).

Establish a medication reconciliation baseline and track compliance in order to achieve 75% compliance by (date).

#HASummit14

Poll Question 2 and 3

On a scale of 1 to 5, with 5 being the highest, how would you rate this Aim Statement, “To reduce 30-day all cause readmission rates?”

1 2 3 4 5On a scale of 1 to 5, with 5 being the highest, how would rate this Aim Statement, “To establish a baseline C-Section rate and validate data by (date)?”

1 2 3 4 5

#HASummit14

Evaluating Aim Statements

To achieve and sustain a 30 percent reduction in 30-day all cause readmission rates.

To improve patient care.

To establish a baseline C-Section rate and validate data by (date).

To improve variation in outcomes, while lowering our costs.

None. Group unable to come to consensus.

8

What’s good and what could be improved?

#HASummit14 9

Goal and Aim Statement Team Exercise

Scenario: You live in California and you have decided to take your family of three persons for a visit to your grandparents in New York for seven days in June, 2015. You’ve allocated a budget of $5,000 to cover all of your expenses. After the vacation you want a thumbs up rating from your family.

Exercise:

Using SMART principles

Define your Goal Develop 3-5 project Aim Statements that will help

you achieve your Goal

#HASummit14

Goal and Aim Statement Team Exercise

Goal: To take my family of three to visit my grandparents in New York for seven days in July, 2015, within a budget of $5000, and with a thumbs up rating from my family, two days from when we return home.

Sample Aim Statements:

Aim #1

Aim #2

Aim #3

Aim #4

Talk with my grandparents and my family about possible dates that work best for them in July, 2015, by (date).

Investigate transportation options and transportation costs between California and New York — with date options determined from Aim #1 —by (date).

Review optional day trips and excursions within two to three hours from my grandparents home, including features and costs — and understand my grandparents and family’s preferences — by (date).

Establish — and gain alignment with my family — on a budget allocation, including transportation, lodging, meals, excursions, gifts and misc. items by (date).

#HASummit14 11

Learning Objective # 2

Learn how to determine ROI in your initiatives

Know the ROI formula

Understand the three

categories of waste that will

help you determine

where possible gains can come from

Define and distinguish

between direct and indirect

benefits

#HASummit14 12

Poll Questions 4 and 5

4.How often does your organization include finance as part of its multidisciplinary improvement teams?

a) Never

b) Not often

c) Sometimes

d) Frequently

e) Always

f) Unsure or not applicable

5.Does your organization currently measure ROI in its improvement initiatives?

a) Never

b) Not often

c) Sometimes

d) Frequently

e) Always

f) Unsure or not applicable

#HASummit14 13

ROI Formula

ROI 100%

(TOTAL BENEFIT)

(COST OF BENEFIT)

= x

-

COST OF BENEFIT

#HASummit14

Ordering Waste Workflow Waste Defect Waste

Ordering tests, care, substances and

supplies that do not add value

Variation in efficiency of delivering tests, care

and procedures ordered

Patient injuries incurred in delivering tests, care and procedures ordered

14

Where To Find Benefits

#HASummit14 15

Direct and Indirect Benefits

Direct BenefitsEnhanced efficiency and productivity

Examples: reductions in FTEs or less overtime; business process improvement; supply chain standardization allowing lower supply costs; increased departmental capacity; and reductions in capital expense

Clinical improvement and waste reduction

Examples: lowering LOS; reductions in uncompensated hospital readmissions; lower medication cost per case or per capita; fewer ICU days; and patient safety improvements leading to fewer complications or medical errors

Indirect BenefitsCan be more difficult to measure

Longer-term benefits

Examples: an improved medical outcome such as a reduction in future hospitalizations associated with neonatal respiratory distress syndrome (RDS), which will require long-term analysis to reveal an impact on costs; shared savings with payer associated with pre-term delivery rates; the opportunity cost of not purchasing a point solution

#HASummit14 16

Show Me the Money Exercise

Scenario:

The radiology operations team lost access to their analytics metrics for three years after they deployed their EHR. They now have an EDW and lots of metrics — including measurements like cycle times and referrals — but they didn’t start out with Aim Statements. Now they are trying to define their ROI.

… Department operations manager, IT and finance conversation

#HASummit14 17

Sample VisualizationCycle times

#HASummit14 18

Sample VisualizationResults turnaround times

#HASummit14 19

Sample VisualizationOutbound referral rates over time

#HASummit14 20

Sample VisualizationOrder Pareto

#HASummit14 21

Sample VisualizationAnesthesia utilization

#HASummit14 22

Show Me the Money

Team participation… do you have some ideas on potential benefits?

#HASummit14 23

Show Me the Money Benefit ExamplesRevenue Waste Reduction Efficiency/

Productivity SavingsOpportunity or Indirect Savings

Referral leakage Ordering: Anesthesia usage; Appropriate use of imaging technologies (e.g. Chest X-Ray for asthma patients)

Reductions associated with manual report(s) data gathering, creation and distribution

Replacement and/or not purchasing a point solution (initial layout and maintenance costs)

LOS reduction (assuming demand is an issue)—additional throughput

Workflow: Improved TAT from diagnosis surgery or treatment (better outcomes); Time to read/diagnosis/ update in EHR (e.g., ED patient)

Management gains from automated, integrated reports and ability to easily leverage the information into presentations

Improved patient satisfaction due to improved turnaround time (TAT)

Reduction in billing time/AR

Defect: Number of repeat exams due to image quality; Hospital associated infections

Reductions in overtime and contract work with appropriate resource planning

Improved employee satisfaction from using data for resource planning

Contract with payers/shared savings

#HASummit14 24

Show Me the Money Benefit ExamplesRevenue Waste Reduction Efficiency/

Productivity SavingsOpportunity or Indirect Savings

Referral leakage Ordering: Anesthesia usage; Appropriate use of imaging technologies (e.g. Chest X-Ray for asthma patients)

Reductions associated with manual report(s) data gathering, creation and distribution

Replacement and/or not purchasing a point solution (initial layout and maintenance costs)

LOS reduction (assuming demand is an issue)—additional throughput

Workflow: Improved TAT from diagnosis surgery or treatment (better outcomes); Time to read/diagnosis/ update in EHR (e.g., ED patient)

Management gains from automated, integrated reports and ability to easily leverage the information into presentations

Improved patient satisfaction due to improved turnaround time (TAT)

Reduction in billing time/AR

Defect: Number of repeat exams due to image quality; Hospital associated infections

Reductions in overtime and contract work with appropriate resource planning

Improved employee satisfaction from using data for resource planning

Contract with payers/shared savings

#HASummit14 25

Best Practice Example

Leveraging your EDW to its fullest capacity

Quality improvement includes clinical areas AND operations

Organizational transformation and governance

Establish baselines

Measure results

Maximizing the ROI of your EDW

Results

• 67% average savings on labor costs

• Average time to build reports declined from 97 hours to under 30 hours

• 1 EDW report = 10 EHR reports

• 25% faster turnaround on remaining EHR reports

#HASummit14 26

Sample Outpatient Volume Analytics

#HASummit14 27

Sample Radiology: Operational Performance Analytics

#HASummit14 28

Sample Outpatient Women’s Clinical Performance Analytics

#HASummit14

Reflection

• What did you learn about Aim Statements?

• How will you use the ROI learnings in your organization?

• What best practices do you have to share from your organization?

• …

#HASummit14 30 30Excel document

#HASummit14 31

Learning Objective # 3

Learn how to effectively communicate your results using an Agile Outcomes/ROI and communications framework

#HASummit14

Outcomes/ROI Communications

Measuring and Communicating Your Results

Sta

keh

old

er A

do

pti

on

, Lea

der

ship

Start with a core group (most enthusiastic and influential, “coalition of the believers”) Paint a vision of the future to meet objections (e.g., what is the impact to my job) Use governance bodies and management teams expand reach (“tops down”)

Efficiency or Improvement Initiatives

• Efficiency• Quick wins• High ROI

• Improvement• Core to health system mission• Most easily communicated

External Communications

• Webinars and speaking events• Authored papers• Awards• External success stories• Publications• Analysts

Platform

• Core installation and platform fools• Use agile, small wins approach• Document baselines and improvements

Internal Communications

• SharePoint• Internal success stories and presentations• Email communications• Roadshow and summit communications

Stakeholders

#HASummit14#HASummit14

Accomplishments Next Steps Issues / Help needed

Cardiovascular: Heart Failure Date: [complete] Overall Status

Risks and Uncertainties

Recruit /Train Kickoff AIM Intervention Rollout plan Results

Month Year Month Year Month Year Month Year Month Year Month/Year

Leadership teamMission, charter, roles confirmed

Review draft cohort and data

Finalize cohort Define rollout plan Review initial results

Content and Analytics Leader

Review Aim optionsData quality issues identified

Identify intervention(s)

Guidance team validation

Implementation plan adjusted

Guidance teamBest practice gathering

Direct observation Direct observationSolicit front-line plan input

Review lessons learned

Workgroup teamProfile prelim. data and cohort

Prioritize, select Aim Solicit front line input Finalize rollout plan Create Aim #2

Training workshop 2-3 Aim candidatesAdditional cohort criteria

Analytics dev & testGuidance team validation

Repeat process

Guidance team validation

Guidance team validation

Project Progress

KeyNotstarted

Inprocess

Done well

Someconcerns

Strongconcerns

GoalTo achieve and sustain a 30% reduction in the 30-day all cause readmission rates for patients with heart failure by November 2016, and sustained reduction in readmission rates through fiscal year 2018, while lowering the CMS penalties by X percent.

Sample Aim #1 Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients.

Lau

nch

/Ro

llo

ut

dat

e :

XX

Key Success and Financial Measures Target Actuals

Readmission rates: 30-day %

Balance measures: ED visits and observation stays #

Intervention compliance rates %

Project costs (e.g., resources, travel, healthcare care analytic apps …) $

Opportunity costs (e.g., not purchasing a Point Solution, no reduction in Medicare reimbursements …) $

Direct benefits: productivity (e.g., previous manual data pulls…); waste reduction (e.g., length of stay….) $

Indirect benefits (e.g., patient satisfaction…) $

Long term project ROI %

#HASummit14

Analytic Insights

AQuestions &

Answers

#HASummit14 35

Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?1) Not at all satisfied2) Somewhat satisfied3) Moderately satisfied4) Very satisfied5) Extremely satisfied

3. On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)?

1) Not at all satisfied2) Somewhat satisfied3) Moderately satisfied4) Very satisfied5) Extremely satisfied

2. What feedback or suggestions do you have?

#HASummit14 36

Upcoming Keynote Sessions2:20 PM – 3:10 PM

23. Predictive and Suggestive AnalyticsDale SandersSenior Vice President, Health Catalyst

3:25 PM – 4:25 PM

24. From The Heart: Healthcare Transformation From India To The Cayman IslandsDale SandersSenior Vice President, Health CatalystChandy Abraham, MDChief Executive Officer, Director of Medical Services Health City, Cayman IslandsGene Thompson, Health City Director, Director of Thompson Development, Ltd.

4:15 PM – 4:45 PM

25. Closing KeynoteDan Burton, Chief Executive Officer, Health Catalyst

Location

Main Ballroom