the application of healthcare intelligence
TRANSCRIPT
9/10/2014
1
The Application of Healthcare IntelligenceData Analysis for the Improvement of Operations and Adapting to the Changing Health Care EnvironmentLeadingAge NY Financial Managers Conference
Presented byKent Godwin
Corporate VP of ApplicationsSalient Management Company
September 16, 2014
Background• Corporate Vice President of Applications, Salient Management Company
• Salient is a World Class system for data discovery, visual data mining and value determination, creation and growth. We provide the exact accounting of value creation for any type of enterprise, especially healthcare
• Responsible for the comprehensive development of application solutions for both our Government/ Healthcare and commercial areas
• Data and Financial consulting, Profitability Consulting• The Bonadio Group• Extensive Healthcare experience
• Turnaround, Financial and data, leadership, operations• Hospitals, LTC, Insurers, pharmaceuticals
• The intersection of Finance and Data• Packaged Goods and manufacturing
• Pepsi Bottling Group, Heinz NA, Westinghouse Electric• Apply commercial, packaged goods concepts to healthcare
• Education• MBA, Finance, St. Joseph’s University, Philadelphia PA• BSBA, Accounting, West Virginia University
2
9/10/2014
2
Data’s Lifecycle
Slide courtesy of Michael Budzich – GEMKO/ The Bonadio Group
Data Analysis• Analysis of Data – the end goal of the data continuum
• Mining Data to produce usable information• Mining Data to produce required information (Compliance)
• Reporting for External and Internal needs
• The value lies in using data analysis to improve
• Profitability
• Operations
• Leveraging of the different types of data available and integrating them enhances the value
• Data Analysis Done Well -• Improves operations• Reduces costs and increases profitability• Strengthens and enhances patient care
4
9/10/2014
3
Levers
5
Data Analysis should address the levers of the organization. These are the elements that any organization has to create and improve profitability
• Volume• Increase, right size• Market Share• Activities that increase reimbursement while improving patient service
• Revenue Rate• Billing – reducing leakage, increasing recovery• Mix• Reimbursement Rates• Other Funding
• Cost• Reduce Costs, properly Right Size• Per Bed, Patient, shift• Benchmarking to Others• Regulatory levels
Targeting Investment/ Action
6
• What do We Want to Grow?• Consider the Levers
• Is there adequate volume to be had• Market Share• Potential Reimbursement• Marginal Profitability
• Each incremental delivers $X• Revenue Rate with Cost
• Can we execute?• External Factors
9/10/2014
4
Compliance Reporting
7
Compliance Reporting is the 4th element of data analysis in addition to the 3 levers of profitability
• Compliance• Cost Reports• Audits• Tax Returns• Industry/ Trade Group• Government – State and Federal
• Is ultimately the source of benchmarking data – the benefit of “what you have to do”
• May be your most significant immediate need
Conceptual Frameworks
8
When performing data analysis or setting up a program of planning and analysis it is helpful to set up a few conceptual frameworks to establish goals and move in the most valuable direction. The two following concepts impact both the Levers and compliance reporting analysis, and are useful in the healthcare setting:
•Standard Economics vs. “Rule Based Economics”
•The Power of the “Per”
9/10/2014
5
Economics
9
Standard Economics can best be considered as the economic principals like supply and demand, diminishing returns etc. It is closer to free market economics
• These are the factors that react in standard ways -
• Market price for labor• Commodity costs• Supply costs• Patient Volume• Respond to marketing
• Most impact on the Volume and Cost Levers
Rule Based Economics can best be considered as the incentives and disincentives created by law, regulation, policy. The best example of rule based economics are the decisions and actions done in response to the tax code
• These are the factors that react in rule based ways -
• Reimbursement• Regulation based ratios• Grants and other funding
(DSRIP)• Post audits, payer denials• The carrots, sticks and
reporting required• Most impact on the Revenue rate
Lever and Compliance
Economics
10
Standard Economics and Rule Based Economics can be conceptualized as a continuum. Different industries fall on different points of the continuum.
• Industries like retail stores and distribution companies are closer to the Standard Economics side of the continuum
• Construction and Real Estate would be in the middle• Healthcare (and LTC in particular) are far on the Rule Based side of the
continuum• Is an important consideration in the development of a data analysis
program• What you have to work with• What your most important metrics are• Targeting what you can affect
StandardEconomics
“Rule Based”Economics
RetailDistribution
Construction Real Estate
HealthcareLTC
9/10/2014
6
The Power of the “Per”
11
The nature of LTC facilities lends itself to analysis per unit. Because all facilities differ in size, census, staffing, etc., actual values for comparison are less important than the per unit metric which equalizes between facilities and eliminates the variability with internal data
• Metric construction is Actual Value / Unit Quantity• Example – Total Food Costs / Patient days = Food Cost per Patient Day
• Food costs alone aren’t meaningful – $50K - $54K change in 1 month – why? More days in month, increase in census, or more spend?
• One facility spends $50K on Food, another $40K – per patient day allows you to compare different sized facilities
• Typical denominators (the Per) – Patient Day, Medicaid (and other classification) Patient Count, Staff Count, Bed Count, Days, Shift, Weekend, etc.
• When benchmarking additional value and insight is obtained by setting the scope you are comparing to – Ownership type, region, relative size, etc.
Healthcare Data AvailabilityThe Good News:There is a tremendous amount of data available to your organization for operations, marketing, compliance, reporting
• Internal – EMR, Billing/ ERP system, Additional specific systems like NH, PT
• External – NYS DOH (SPARCS, Other), Census, Medicare, Cost Report data, Other. External data can be paid resources or free
The Bad News:It will require some investment to get it, and/ or make it useful
• Personnel – the internal resources to acquire, extract, manipulate, program, present, interpret, analyze
• Expert Help – The external resources to augment or replace internal capability, or provide the data and expertise in specific areas
• Systems – Modules, analysis systems, basic tools, new capabilities, purchased access
9/10/2014
7
Assessment of Current Environment
13
• Most organizations have basic reporting from their management systems
• Financial• Patient Management System• Generally Limited and does not meet needs• Generally does not facilitate robust analysis
• Systems are not integrated – Limited connections between Financial, Patient Management, Therapy, staffing/ payroll systems
• Larger organizations may have more access, but delays and dependent on others to provide
• Small organizations may have significant barriers• Not utilizing External data sources for benchmarking
How to Address
14
• Business Intelligence (BI) type system• Internal ad hoc system
• Access• Excel• Interacts with existing systems, may require modules• Requires personnel
• Purchased data• Purchased Expertise• Be sure to project plan
• Identify your Goals• Identify needed outcomes
• Levers• Compliance
9/10/2014
8
Benchmark Example
15
• Public sourced data – Cost Report File from NYS• Over 1.5 Million Records each year• Process data in Access• Modify and Deliver in Excel• Tag with other meaningful data attributes – Facility Number, Region,
Ownership, etc.• Expertise needed
• Purchased Expertise• Purchased Data
Raw Cost Report Data
1.7 Million Lines!
9/10/2014
9
Benchmark Result
BI and External Purchased Data
18
• BI to provide better flexible access to data – the internal fix• Data warehouse• SQL, Access, report writers are more basic options• Requires Expertise• Full Scale tools – such as Salient
• Purchased data scenarios• Others process and deliver with BI
• Example – HANYS and SPARCS Data• Salient and Medicaid data
9/10/2014
10
Salient’s NYS Medicaid System
Quality Data
Paid Claims Data
Recipient Enrollment Data
Global Cap Projections
Salient Computing Platform
Managed Care Encounter Data
Salient’s Evolution in Healthcare
9/10/2014
11
Salient Healthcare 2014• Accountable Care Organizations (ACO)
• Measure outcomes, quality metrics, survey results and performance, PPR
• Dashboard and analysis tools for improvement of metrics
• Providers• Meaningful Use metrics analysis and tracking• Patient data based operational and financial solutions
• Health Home and DSRIP Support• Outgrowth of our State Medicaid system• Same data used to manage the NYS Medicaid Program
being accessed by the provider community
21
Example Dashboards
9/10/2014
12
Example Dashboards
DSRIP• Delivery System Reform Incentive Payment (DSRIP)
• 6.8 Billion for DSRIP• 1.1 Billion for other Medicaid Redesign including LTC
• Create networks to do projects to reduce hospital admissions• LTC’s Role?
24
9/10/2014
13
DSRIP Announcement
http://www.health.ny.gov/health_care/medicaid/redesign/dsrip_performance_data/
Performance Data
http://dsripdashboards.health.ny.gov/
Dashboards
http://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm
Main Site
Interactive Exploration
of Public Data
