#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
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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
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Learning Objective # 1
Understand the value of establishing a Goal and Aim Statements and how to develop them
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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
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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
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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).
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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
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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.
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What’s good and what could be improved?
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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
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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).
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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
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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
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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
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Where To Find Benefits
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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
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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
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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
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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
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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
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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?
• …
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Learning Objective # 3
Learn how to effectively communicate your results using an Agile Outcomes/ROI and communications framework
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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
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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 %
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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?
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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
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