scorecards & dashboards - aachc a scorecard/dashboard system to ... " patient payor source...

Scorecards & Dashboards:“If you can measure it, you can manage it”

The 15th Annual Region IX Management Training ConferenceFireSky Resort and SpaScottsdale, Arizona 85251

Greg BrandenburgChief Executive Officer

Columbia Basin Health Association

14th Ave Medical Center

Wahluke Family Clinic

Othello Family Clinic

Connell Family Dental Clinic

Who We Are…Founded in 1973, CBHA’s mission and purpose is to provide equal access to

quality health care to all persons regardless of age, sex, color, ethnicity, national origin, or the ability to pay.

2008 was the fourth time CBHA has placed in the top five Not-for-Profit Companies to Work For.

CBHA won the first ever HIMSS Davies Community Health Award of Excellence.

CBHA has been accredited by the Joint Commission since 2002.

In 2007, CBHA won the William O. Robertson Patient Safety Award for the Medication Reconciliation & Consultation Program

Course Objectives

! Understand How You Can Develop and Implement a Scorecard/Dashboard System to Improve Your Organization Performance

! Identify Performance Measures to Track! Identify Sources of Data for Reporting! Identify Benchmarks

What Are Scorecards & Dashboards?

! A Set of Documents That Use Technologies and Processes That Gather Data to Understand and Analyze Business Performance.

! If You Want To Develop a Scorecard/Dashboard System, a Quick & Painless Journey Cannot Be Promised.

Steps To Implementation

! Software Applications! Technology! Mine The Data! Develop Processes! Metrics! Incentives! Culture! Sponsorship

Why Use Scorecards/Dashboards?! Organizations That Want To Be Competitive

Must Have Some Attribute At Which They Are Better Than Their Competition

! As A Tool To Measure Organizational Performance

! As A Tool To Communicate And Provide Feedback To All Stakeholders

! As A Strategic Management Tool To Outline Measures Important To Your Leadership Team

! As A Goal-Setting Tool

What Should We Measure?! Things that are important to:

" Board: How can we maximize the value and effectiveness of our mission?

" Leadership & Supervisor Teams: How can we improve our processes to deliver our services better, faster, and more cost effective?

" Employees: How can we support our processes through improved knowledge, skills, and technology?

" Patients: How well do our products and services meet the needs of our patients?

What Should We Measure?

! Look For Common, Repeating Program Elements" Overtime (%)" FTEs" Attendance (CBHA “exception points”)" Cycle Times" Patient Complaints" Encounters

How Should We Measure?! Organization Wide

" Billable Patient Visits" Patient Payor Source" Patient Wait and Cycle Times" Complaints by Department" Managed Care Enrollment by Program" Average Days in A/R" FTE’s Compared to Budget" Overtime as % of Worked Hours Compared to

Budget

Encounters – Organization Wide

Billable Patient Visits

-1,0002,0003,0004,0005,0006,0007,0008,0009,000

10,00011,00012,00013,00014,000

FY2006

FY2007

Apr-0

8

May-0

8

Jun-0

8Ju

l-08

Aug-08

Sep-08

Total

M edical

Dental

Vision

M SS/M CM

OtherProfessional

'08 Budget > 11,500/Month

Patient Complaints – Organization Wide

Patient Complaints

-2468

10121416182022

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

OtherLabEyeCareNursingPatient ServicesAdministrationDentalMedicalPharmacy

< 9 Complaints

How Should We Measure?

! ClinicsOthello Family ClinicWahluke Family Clinic14th Avenue Medical Center

Othello Family Dental ClinicWahluke Family Dental ClinicConnell Family Dental Clinic

Othello EyeCare

Encounters – Nursing Department

-2468

101214161820

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Othello

Mattaw a

14th Avenue

Visits/FTE/Day'08 Budget > 10 visits

Encounters – Othello Family Clinic

-369

1215182124

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Patient Service

Nursing

Medical Visits/FTE/Day'08 Budget PS >17 / Nursing > 10

How Should We Measure?

Programs/DepartmentsBilling WICCall Center Patient BenefitsHuman Resources ITSupport Services Case ManagementLab Medical ProvidersNursing Dental ProvidersPharmacy Chronic Disease Mgmt

Encounters – Medical Providers

Encounters / Provider Hours

0

1

2

3

4

5

6

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

'08 Budget = 3

UDS Grantee Comparison Report - MedicalGrantee

Grantee WA National Rural Large 25th Median 75th PercentileCY 2005U3.21 Family Practice Productivity 5,006 3,687 3,963 4,027 4,075 3,146 3,781 4,448 88%U3.23 Internal Medicine Productivity 3,474 3,205 3,881 4,045 3,941 3,109 3,790 4,483 37%U3.24 OB/GYN Productivity 6,174 3,808 3,636 3,727 3,649 2,617 3,720 4,595 93%U3.25 Pediatric Productivity 7,610 3,352 3,985 4,201 4,068 2,923 3,697 4,387 99%U3.26 Overall Physician Productivity (excl. spec. phys.) 5,208 3,608 3,928 4,045 4,015 3,160 3,726 4,292 94%U3.27 NP/PA/CNM Productivity 3,985 3,016 2,850 3,041 2,969 2,211 2,787 3,316 92%U3.272 PA Productivity 3,985 3,179 3,042 3,162 3,176 2,247 2,935 3,579 84%U3.28 Medical Team Productivity 5,907 4,213 4,312 4,482 4,403 3,657 4,255 4,808 96%

CY 2006U3.21 Family Practice Productivity 5,059 3,371 3,858 3,961 3,971 3,086 3,703 4,348 90%U3.24 OB/GYN Productivity 6,285 3,281 3,596 3,673 3,625 2,634 3,558 4,585 92%U3.25 Pediatric Productivity 7,844 3,310 3,935 4,129 4,025 2,963 3,669 4,455 100%U3.26 Overall Physician Productivity (excl. spec. phys.) 5,349 3,349 3,846 3,969 3,937 3,080 3,676 4,261 96%U3.27 NP/PA/CNM Productivity 4,233 2,929 2,879 3,076 3,001 2,262 2,810 3,356 95%U3.272 PA Productivity 4,233 3,135 3,072 3,232 3,189 2,305 2,923 3,668 90%U3.28 Medical Team Productivity 6,107 3,933 4,256 4,464 4,338 3,635 4,207 4,796 96%

CY 2007U3.21 Family Practice Productivity 5,220 3,574 3,830 3,881 3,943 2,979 3,682 4,289 91%U3.23 Internal Medicine Productivity 1,932 2,818 3,755 3,944 3,850 2,843 3,605 4,287 6%U3.24 OB/GYN Productivity 6,769 3,529 3,616 3,776 3,642 2,566 3,429 4,546 93%U3.25 Pediatric Productivity 7,230 3,356 3,937 4,206 4,019 2,927 3,678 4,363 99%U3.26 Overall Physician Productivity (excl. spec. phys.) 5,300 3,467 3,826 3,953 3,921 3,039 3,638 4,208 94%U3.27 NP/PA/CNM Productivity 4,513 3,030 2,868 3,071 2,998 2,223 2,775 3,380 97%U3.272 PA Productivity 4,513 3,244 3,062 3,198 3,224 2,190 2,860 3,646 95%U3.28 Medical Team Productivity 6,161 4,072 4,248 4,463 4,336 3,568 4,205 4,737 96%

Averages National PercentilesUNIVERSAL

UDS Grantee Comparison Report - Dental

GranteeGrantee WA National Rural Large 25th Median 75th Percentile

CY 2005U3.31 Dentist Productivity 4,438 2,893 2,720 2,773 2,805 2,005 2,467 3,088 97%U3.32 Dental Hygenist Productivity 2,378 1,000 1,298 1,239 1,332 861 1,291 1,623 95%U3.33 Dental Team Productivity 4,486 2,803 2,700 2,722 2,784 2,035 2,463 3,066 97%



Averages National PercentilesUNIVERSAL

Encounters – Billing Department

Encounters/Billing FTE

-200400600800

1,0001,2001,4001,6001,800

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Enc/FTE

Target

'08 Budget = 1200

Encounters – Lab Department

0%10%20%30%40%50%60%70%80%90%

100%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

% Receiving Lab Services

Othello

Mattaw a

14th Ave

Encounters - Support Services

Visits

-200400600800

1,0001,2001,4001,6001,8002,000

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Non-Billable

Outreach

In Clinic

Behavioral Health

Computer Status - IT

Computer Status

100130160190220250280310340370400430460490

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

For Sale

Pending

Storage

WIP

Disposed

Active

Encounters – Patient Benefits

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

% Self Pay Visits

% Othello% Mattaw a

%14th Avenue

< 3%

All Providers - Dental

All Providers-Dental

Enco

unte

rs

No

Cha

rge

Wal

k in

s

Cen

ter C

ance

ls

Wai

t tim

es

Prov

ider

tim

e

No

Show

s

Cha

rges

Rec

eipt

s

RVU

's

Day

s in

clin

ic

Clin

ic d

ays

PL B

alan

ce

Cha

rges

per

Enco

unte

r

Rec

eipt

s pe

rEn

coun

ter

RVU

per

Enco

unte

r

Enc

per

days

in c

linic

Dec-07 2,323 15 165 39 17 38 174 388,467$ 162,145$ 8,093 12 20 1,626 167.23$ 69.80$ 3.48 188.4 Jan-08 2,597 12 186 74 17 38 189 450,326$ 210,592$ 9,399 13 22 1,420 173.40 81.09 3.62 194.8 Feb-08 2,548 17 193 81 18 38 154 465,409$ 175,669$ 9,563 15 21 1,582 182.66 68.94 3.75 172.7 Mar-08 2,505 7 220 88 18 40 114 454,408$ 190,180$ 9,295 15 21 1,705 181.40 75.92 3.71 171.3 Apr-08 2,611 13 193 135 15 38 131 434,125$ 195,275$ 8,605 14 22 1,738 166.27 74.79 3.30 189.9

May-08 2,488 13 192 148 13 38 135 428,099$ 184,334$ 8,558 14 21 1,724 172.07 74.09 3.44 176.1 Jun-08 2,598 14 195 122 13 36 140 481,162$ 162,120$ 9,344 14 21 1,707 185.20 62.40 3.60 185.6 Jul-08 2,623 7 216 124 14 38 106 452,164$ 208,236$ 8,905 14 22 1,680 172.38 79.39 3.40 185.7

Aug-08 2,733 14 179 146 13 37 121 503,002$ 195,134$ 9,810 15 21 1,725 184.05 71.40 3.59 185.3 Sep-08 2,531 6 144 108 13 37 175 458,912$ 164,029$ 8,508 14 21 1,783 181.32 64.81 3.36 180.8 Oct-08 - - - - - -$ -$ - - Nov-08 - - - - - -$ -$ - -

YTD 25,557 118 1,883 1,065 15 38 1,439 4,516,074 1,847,714 90,080 140 212 176.71$ 72.30$ 3.52 182.8 Annualized 30,668 142 2,260 1,278 1,727 5,419,289$ 2,217,257$ 108,096 168

%'s 0% 7% 4% 5% 41% 66% 41%

All Providers - Medical

All Providers-Medical

Enco

unte

rs

No

Cha

rge

Wal

k in

s

Cen

ter C

ance

ls

Wai

t tim

es

Prov

ider

tim

e

No

Show

s

Cha

rges

Rec

eipt

s

RVU

's

Day

s in

clin

ic

Clin

ic d

ays

PL B

alan

ce

Cha

rges

per

Enco

unte

r

Rec

eipt

s pe

rEn

coun

ter

RVU

per

Enco

unte

r

Enc

per

Day

s in

clin

ic

Dec-07 6,906 52 652 186 17 46 371 1,084,858$ 494,242$ 8,537 17 20 4,799 157.09$ 71.57$ 1.24 397.6 Jan-08 8,123 66 681 206 14 43 362 1,280,278$ 531,150$ 10,343 20 22 4,896 157.61 65.39 1.27 403.1 Feb-08 8,254 69 797 191 16 44 406 1,353,047$ 504,529$ 10,412 19 21 5,167 163.93 61.13 1.26 428.8 Mar-08 8,463 72 880 199 15 43 395 1,409,581$ 594,193$ 10,964 20 21 5,388 166.56 70.21 1.30 430.7 Apr-08 8,777 65 820 207 16 45 441 1,432,462$ 599,094$ 11,028 20 22 5,531 163.21 68.26 1.26 434.5

May-08 8,062 62 765 224 15 43 407 1,334,048$ 562,643$ 10,141 19 21 5,812 165.47 69.79 1.26 427.7 Jun-08 7,921 77 854 183 15 43 443 1,367,090$ 604,434$ 10,473 18 21 5,703 172.59 76.31 1.32 436.4 Jul-08 8,526 83 876 229 15 42 460 1,527,463$ 565,624$ 11,457 20 22 5,457 179.15 66.34 1.34 431.7

Aug-08 8,187 60 933 216 15 45 512 1,391,739$ 552,502$ 10,337 18 21 4,994 169.99 67.49 1.26 447.0 Sep-08 8,604 87 1,226 178 14 43 555 1,426,876$ 620,499$ 10,691 19 21 5,118 165.84 72.12 1.24 447.9 Oct-08 - - - - - -$ -$ - - Nov-08 - - - - - -$ -$ - -

YTD 81,823 693 8,484 2,019 15 44 4,352 13,607,442 5,628,910 104,382 191 212 166.30$ 68.79$ 1.28 428.6 Annualized 98,188 832 10,181 2,423 5,222 16,328,931$ 6,754,692$ 125,258 229

%'s 1% 10% 2% 5% 41% 90% 41%

Data Particulars…

! Show Progress At A Glance" Running 6-months" 2 prior fiscal year averages" More Elements Than You Can Fit On A Graph?" Include data sheets for supervisors & leadership

! Show targets where appropriate

Call Center Scorecard

Shift to Call Volume Overlay

0.00%2.00%4.00%6.00%8.00%

10.00%12.00%14.00%16.00%

7:00 A

M

9:00 A

M

11:00

AM

1:00 P

M

3:00 P

M

5:00 P

M

7:00 P

M

Hours Worked

Incoming Calls

Number of Abandoned

0.00%1.00%2.00%3.00%4.00%5.00%6.00%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Equal or less than 3%

Appointment Source

02,0004,0006,0008,000

10,00012,00014,00016,000

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

All Depts

Call Center

Walk-in appointments are not includedAvg Calls/Day

0

400

800

1200

1600

2000

2400

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Service Factor

0%10%20%30%40%50%60%70%80%90%

100%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

% TSF

Goal

Greater than 90% in 30

Overtime Hours

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

% Ovt

Budget

OT < 5%

Employee Utilization

0%10%20%30%40%50%60%70%80%90%

100%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

% Logged

% Phone

Logged in 85% of Worked Hrs

Occurrences Per FTE/Yr

048

121620242832

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

< 12 per FTE/Yr

Full Time Equivalents

-1.002.003.004.005.006.007.008.009.00

10.0011.0012.00

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Non-Worked

Worked

'08 Budget = 11

Call Center – Detail SummaryFY2006 FY2007 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08

Clinic Days 21 21 19 23 20 20 22 21 21 22 21 21 22 21 21Overtime Hours

Regular 1,607 1,608 1,523 1,840 1,619 1,504 1,744 1,632 1,816 1,912 1,776 1,808 1,869 1,617 1,716 PL 161 140 156 186 127 164 207 300 193 152 63 145 166 251 163 Overtime 40 32 20 31 42 53 54 101 40 50 26 22 12 58 27 Total 1,808 1,780 1,699 2,058 1,788 1,722 2,005 2,034 2,049 2,114 1,865 1,975 2,047 1,926 1,907 % Ovt 2.21% 1.82% 1.18% 1.53% 2.34% 3.09% 2.70% 4.99% 1.94% 2.37% 1.38% 1.12% 0.59% 3.02% 1.44%Budget 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

Full Time EquivalentsWorked 9.80 9.77 10.15 10.17 10.38 9.74 10.21 10.32 11.05 11.15 10.73 10.90 10.69 9.97 10.38 Non-Worked 0.96 0.83 1.03 1.01 0.79 1.03 1.18 1.79 1.15 0.86 0.38 0.86 0.94 1.49 0.97 Total FTE's 10.76 10.60 11.18 11.18 11.18 10.76 11.39 12.10 12.20 12.01 11.10 11.76 11.63 11.47 11.35 FTE Budget 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00

Occurrences per FTE/YrOccurrences 10 12 11 11 12 12 10 9 9 9 8 8 9 10 10

Number of Abandoned% Calls 2.08% 3.20% 3.75% 3.64% 5.34% 4.23% 2.47% 2.18% 2.57% 2.32% 1.98% 1.79% 2.47% 3.58% 2.59%

Employee UtilizationWorked 1,647 1,641 1,543 1,872 1,661 1,558 1,798 1,734 1,856 1,962 1,802 1,830 1,881 1,675 1,744 Logged in 1,407 1,392 1,345 1,576 1,395 1,372 1,614 1,543 1,627 1,669 1,523 1,612 1,616 1,439 1,475 % Logged 85.43% 84.86% 87.14% 84.21% 84.00% 88.07% 89.78% 88.99% 87.66% 85.09% 84.51% 88.11% 85.92% 85.88% 84.59%On Phone 597 694 664 817 777 698 777 761 738 723 621 750 750 773 748 % Phone 36.25% 42.32% 43.00% 43.65% 46.80% 44.79% 43.20% 43.88% 39.77% 36.87% 34.46% 40.97% 39.86% 46.14% 42.89%Total 3,652 3,728 3,551 4,266 3,834 3,628 4,189 4,038 4,221 4,355 3,946 4,192 4,247 3,886 3,967

Service Factor% TSF 91% 85% 84% 83% 76% 79% 86% 88% 84% 86% 87% 89% 86% 80% 85%Goal 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Shift to Call Volume TotalsShift Time 1,606.95 1,571.03 1,506.13 1,782.48 1,624.21 1,542.92 1,543.92 1,688.63 1,767.44 1,776.83 1,731.31 1,808.04 1,817.13 1,610.30 1,687.09 Calls Offered 31,029 31,780 30,291 35,636 34,530 31,494 37,155 36,458 37,087 38,967 34,617 35,761 38,402 38,300 37,786

Average Calls per DayCalls Offered 1478 1513 1,594 1,549 1,727 1,575 1,689 1,736 1,766 1,771 1,648 1,703 1,746 1,824 1,799

Appointment SourceAll Depts 10,255 11,977 10,666 12,916 12,893 11,115 13,307 12,981 13,595 13,802 13,134 12,659 13,702 13,520 13,426 Call Center 6,577 6,778 5,918 6,924 7,519 6,169 7,222 8,106 8,324 7,940 6,906 6,690 8,446 8,503 8,098

~ 13 Month Trend ~

Benchmark Sources! In-House Budget

" Building Blocks of Budget! UDS Data

" Nation and State-Wide Statistics" UDS Managerial Training

! Surveys" Milliman" MGMA" NACHC

Getting the Job Done! Leadership Support & Commitment

" Roll-Out Timeline! Dedicated & Knowledgeable Personnel! Accountability

" Praise" Performance Improvement Committee" Performance Evaluation Goals

Reliable Monthly Cycles" Due Dates

! New Supervisor Training on Scorecards

Prominent Placement

The Ties that Bind: Nursing! Linking the Scorecard to the Incentive Plan! Patient Complaints! PHQ Screens! Attendance! Immunizations! Wait Times

Patient Complaints

-2468

10121416182022

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

OtherLabEyeCareNursingPatient ServicesAdministrationDentalMedicalPharmacy

< 9 Complaints

80%82%84%86%88%90%92%94%96%98%

100%

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Immunization Compliance

OthelloMattaw a

14th Avenue

> 95%

Occurrences Per FTE/Yr

048

121620242832

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

< 12 per FTE/YrMedical Cycle Times

-10203040506070

FY2006

FY2007

Apr-08

May-08

Jun-0

8Ju

l-08

Aug-08

Sep-08

Combined

Provider

Wait

Wait Time < 15 Minutes

PHQ Screening

30.5%34.2%

59.5%67.0%

87.1%93.0%94.3%93.5%

60.7%

0%10%20%30%40%50%60%70%80%90%

100%

Jan-

08

Feb-

08

Mar

-08

Apr-

08

May

-08

Jun-

08

Jul-0

8

Aug-

08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

85% PHQ-9 Screening Completed for Chronic Care

Useful Tools

! Introduction to The Balanced Scorecard: Nine Steps To Successby the Balanced Scorecard Institute and the Strategy Management Group, Inc.

Useful Tools

! Competing on Analytics by Thomas H. Davenport and Jeanne G. Harris

Questions?

! Best wishes to your organization as you implement a Scorecard/Dashboard System of your own.

! Visit us at: www.cbha.org