Transcript Slide 1

Leading the Change
Solutions for Today’s
Healthcare Challenges
Melinda S. Hancock, FHFMA, CPA
Partner, Dixon Hughes Goodman LLP and
2014-15 Chair-Elect, HFMA
Women in Healthcare: Lead #likeagirl
November 14, 2014
"If your actions inspire others to dream more,
learn more, do more, and become more, you are
a leader.” – John Quincy Adams
Presentation Overview
• Organizational Performance
– Cost Reductions
– Business Analytics
– Payment Reform & Value-Based Purchasing
– Population Health & the Care Continuum
– Capital Access
– Revenue Cycle
• Leadership … What does it really mean?
3
Cost Reduction
The need for rigorous cost management is clear. Accelerated
by unsustainable growth in national healthcare costs, the
emerging value-based business model and healthcare reform
will push hospitals and health systems to improve quality,
access, and outcomes, while reducing expenses.
From hfm, March 2012, Kaufman Hall
4
AMA’s Cost Reduction Strategies
The American Medical Association identified
four broad strategies to contain healthcare
costs and get the most for our dollars:
1. Reduce the burden of preventable
disease
2. Make healthcare delivery more efficient
3. Reduce nonclinical health system costs
that do not contribute to patient care
4. Promote value-based decision making at
all levels.
Source: “Getting the most for our health care dollars”, AMA.
5
Cost of
Chronic
Care
2003-2023
Source: http://www.good.is/posts/the-cost-of-treating-chronic-disease
6
Are We Efficient? U.S. Ranks Last
7
7
8
Deloitte’s “Radical Cost Reduction”
Basic Premise:
“By many estimates the reduction must reach
20%-30% of total cost structure by 2015 to be able
to confront a lean, health-reformed environment.”
Why?
Reductions from government payers, pressures
from lower commercial rates, pricing transparency,
narrow networks… all equate to shrinking revenue
base.
Source:
http://www.deloitte.com/assets/DcomSingapore/Local%20Assets/Documents/Industries/2012/Life%20Sciences%20and%20Health%20Care/Health%20Care/Radical%20Cost%20Reduction.pdf
9
Operational vs. Strategic Approach
Operational
Strategic
1. Top down
1. Bottom up
2. Changes underlying
delivery and profit
model
2. Looks to drive
incremental change
3. Derives value from
making organization
better than peers
3. Derives value from
making the organization
different
Source:
http://www.deloitte.com/assets/DcomSingapore/Local%20Assets/Documents/Industries/2012/Life%20Sciences%20and%20Health%20Care/Health%20Care/Radical%20Cost%20Reduction.pdf
10
How Much Is Enough?
• Capital needs and related
shortfalls
• Medicare breakeven analysis
• Current and desired bond rating
• Market dynamics
• Current negotiations and at-risk
contracts
• The impact of transparency and
benefit design
11
Tool For Readiness Assessment
Source: A Guide to Strategic Cost Transformation in Hospitals and Health Systems, March 2012
12
How to Approach Cost Management
Understand
readiness
Supplement with
other data
analytics
Streamline
overhead
functions
Define goals
based on capital
shortfall
Focus on key
drivers of staffing
& productivity
problems
Ensure targets
are integrated
with plans &
budgets
Use benchmarks
to identify
sources of
savings
Drill down on
staffing methods
http://www.beckershospitalreview.com/racs-/icd-9-/icd-10/8-strategies-for-hospitals-to-approach-cost-management
Bob Herman, June 14, 2012
13
Business Analytics
“We developed the concepts in this work from the data we gathered,
building a framework from the ground up. We followed an iterative
approach, generating ideas inspired by the data, testing those ideas
against the evidence, watching them bend and buckle under the weight
of evidence, replacing them with new ideas, revising, testing, revising
yet again, until all the concepts squared the evidence.”
From Great by Choice, Jim Collins 2011
14
Business Analytics Needs
in an Era of Change
Source: Building Value-Driving Capabilities: Business Intelligence. An HFMA Value Project report.
2012. www.hfma.org/valueproject
15
Untapped Potential of Business
Analytics in Health Care
Analytics are available but few are measuring…and even fewer are
managing to the metrics.
• Costs of
adverse events
• Margin impact
of readmissions
44%
Not measuring
36%
Measuring
20%
• Cost of waste in
care processes
Source: HFMA Value Project, June 2011
16
Managing
How to Apply Data Mining to
Everyday Clinical Practice
Content
System
• Standardizes knowledge work
• Systematically applies evidence-based best
practices to care delivery
Deployment
System
• Drives change through new organizational
structures, especially teams
• Requires true organizational change to
drive adoption of best practices throughout
an organization
Enterprise
Data
Warehouse
• Aggregates clinical, patient satisfaction, and
other data
• Enables analysts to identify patterns that can
inform decisions
(Analytic System)
17
Harnessing Data to Improve
Physician Performance
Source: “Moving Toward Population Health.” Leadership . Spring
2014. Available at hfma.org/leadership.
Payment Reform &
Value Based Purchasing
Payment reform is changing health care, bringing with it the
need for new competencies for success. Healthcare leaders
need innovative strategies to integrate with physicians,
manage risk, reduce cost and price bundled services, and
enhance quality while lowering cost. Business as usual is not
an option.
Healthcare Payment Reform – Accelerating Success, HFMA
19
Goals of Payment Reform
Source: http://www.rand.org/pubs/periodicals/health-quarterly/issues/v1/n1/03.html
20
Estimated Gains from ACA: $64B
Amounts in Billions
$15.5
Ind Pmt Advisory Bd
$32.0
Excise Tax on High Cost Ins Plans
$1.4
HAC Penalties
$2.2
Pt Centered Outcomes Research
$7.1
Readmission Penalties
$1.3
CMMI
$4.9
ACOs
$0
$10
21
$20
$30
$40
How CMS Views The Programs
Source: Health Care Advisory Board, 2012
22
The Continuum of Risk
Source: http://www.athenahealth.com/knowledge-hub/ACO/accountablecare-organizations.php
Source: Hancock, M., Hannah, B. “Determining Your
Organization’s Risk Capability”, hfm, May 2014.
23
The Mandatory Programs under ACA
VBP
Payment Type
% of Medicare
Inpatient $s
Description of
Metrics
Bonus/Penalty
1%
1.25%
1.5%
1.75%
2%
2013
2014
2015
2016
2017+
Addition of
domains through
2015 with
dynamic metrics
every year
1%
2%
3%
RRP
HAC
Penalty
All or None
Penalty
2013
2014
2015+
Three core
diagnoses with
additional 2 in
2015 and more to
be added in later
years
24
1%
2015+
Two domains:
Safety and
Infections with
infections
weighted higher
and additional
infections added
Maximizing & Protecting
25
VBP Shifting of Domain Weights
FY 2014
FY 2013
FY 2015
20%
30%
30%
FY 2016
30%
10%
25%
45%
25%
20%
70%
25%
30%
• Patient Experience
• Outcomes
40%
• Core Measures
• Efficiency (MSPB)
26
New NQS Based Domains for FY 2017
Clinical Care Process = 5%
HCAHPS = 25%
Clinical Care Outcomes = 25%
Safety = 20%
MSPB = 25%
27
Readmission Reduction Program
• 3 Performance periods in play at a time
– 3% penalty of Medicare Reimbursement at risk each program year
– Measured Populations 30 days from DISCHARGE
•
AMI, HF, PN, COPD, THA & TKA
•
CABG is added in FY 2017 which is in play now
•
Performance Periods: 3 Year Rolling Program
– FY’15: July 1, 2010 – June 30, 2013 – 3%
– FY’16: July 1, 2011 – June 30, 2014 – 3%
– FY’17: July 1, 2012 – June 30, 2015 – 3%
– FY’18: July 1, 2013 – June 30, 2016 – 3%
– FY’19: July 1, 2014 – June 30, 2017 – 3%
28
Currently participating
in 3 performance
periods simultaneously
Hospital Acquired Conditions: FY 2017
First Domain: PSIs
Second Domain: CDC
Pressure Ulcer Rate
CLABSI
Foreign Object Left in Body
CAUTI
Iatrogenic Pneumothorax Rate
SSI Following Colon Surgery (FY 2016)
Postoperative Physiologic and
Metabolic Derangement Rate
SSI Following Abdominal Hysterectomy
(FY 2016)
Postoperative Pulmonary Embolism and Methicillin-Resistant Staphylococcus
Deep Vein Thrombosis Rate
Aureus (MRSA) Bacteremia (FY 2017)
Accidental Puncture and Laceration
Rate
Clostridium Difficile (FY 2017)
Where Are the First Cohort of Bundles?
41%
36%
16%
7%
Model 1
Model 2
Model 3
Model 4
Source: Centers for Medicare and Medicaid Services; Health Care Advisory Board
interviews and analysis.
30
Early Results of BPCI Cohort 2
•
Tremendous increase in the
number of applications in the
most recent open enrollment
in April 2014: Nearly Triple!
•
Models 2,3,4 were open for
enrollment
•
Currently in the Phase 1
period which is the non risk,
decision making period.
Phase 2 is when the Episode
Initiator starts to accept risk
Where Are the MSSPs?
As of January 2014, there
are 23 Pioneer ACOs and
351 Shared Savings ACOs.
Source: The Advisory Board
32
Geographical Dispersion of MSSPs
Represents Assigned Patient Population for 2012-2014 Cohorts
Source: MLN Webinar 4/8/14 www.cms.gov/NPC
33
Early Results
Pioneer ACOs: 32 Participants
 All participants met quality goals
 25 of the 32 reduced readmission rates
 >1/3 reduced costs, over $87M
 2 providers lost money, $4M
 13 providers or 40% getting distributions
2012 MSSP Cohort: 114 Participants
 54 (47%) reduced spending with 29 (25%) sharing in savings
 $126M in distribution to the 29 providers
 60 were not able to reduce spending: 2 of which were 2-sided model
 109 reported quality measures satisfactorily: 2 of the 5 who did not were eligible for $
34
Revenue
How to Manage to the Tipping Point
Time
•
•
•
•
How do local market conditions impact timing considerations?
Can market-changing events create an urgent paradigm shift?
What is my step-change business model risk?
Do I have the financial tools to adequately analyze relevant states?
35
Source: DHG Healthcare
The Changing Healthcare Landscape
Source: Leavitt Partners, LLC
36
What Is Accountable Care?
• Improve the individual experience of care
• Improve population health
• Reduce the cost of health care for populations
Outcomes
•
•
•
Oversee the provision of clinical care
Coordinate the provision of care across the continuum of health services
Invest in and learn to use appropriate IT to manage population health
Processes
•
•
Bear financial risk for the measured health of a population
Align incentives to encourage the production of high-quality health outcomes
Structure
Source: Leavitt Partners, LLC
37
Partnering for Success
Under Value-Based Payment
Who
Collaborated
 Aetna
 Consultants in Medical Oncology and
Hematology, a 9-physician practice in
Southeastern Pennsylvania
What They Did
 Collaborated on a patient-centered medical
home model for oncology
 Used a common medical home approach:
management fee plus shared savings
Results They
Achieved
 71% fewer ED visits and 51% fewer
hospitalizations for chemotherapy patients in
2012, compared to national benchmarks
Source: “Partnering Around Value-Based Payment,” Leadership, Summer
2014, available at hfma.org/leadership
38
Population Health
The Care Continuum
Improving the heath of populations is one of
three dimensions that make up the
Institute of Healthcare Improvement’s
Triple Aim.
39
Advancing Population Health
Management
Best Health, Best Care, Best Experience
Care Delivery Models
Care Coordination
Patient Engagement
Information Technology and Analytics
Alignment of Incentives
Source: Sharp Healthcare, San Diego, CA
40
Care Management Programs
Hospital Care
Management
Skilled Nursing
Care
Management
Disease
Management
Complex Case
Management
End-of-Life
Care
Management
Source: Sharp Healthcare, San Diego, CA
41
Out-of-Network
Care
Management
Transitions Program
Pre Transitions*
During Transitions
71
33
Hospitalizations, n
Hospitalizations per patient,
mean (SD)
Hospitalization rate
ED visits, n
ED visits per patient, mean (SD)
ED visit rate
Total Cost of Care, (SD)
.46
p
(.84)
.21
(.55)
< 0.01
32%
157
1.01
57%
(26)
< 0.01
(1.3)
(88)
17%
67
.43
31%
(.78)
< 0.01
< 0.01
$73,025
($109,708)
$46,588
*Transitions LOS is unique for each patient: pre-Transitions LOS = During-Transitions LOS
Source: Sharp Healthcare, San Diego, CA
42
($81,616) < 0.01
Who Is Eligible?
Health & Wellness
Disease Management
Promotion of knowledge,
healthy attitudes, and
practices to help our
patients achieve their
personal best health.
• Healthier LivingChronic Disease Self
Management
• Weight Management
• Dietician Consultation
• Heart Failure
• Healthy Hearts
• Asthma
• Stress Management
• Strength Training
• Smoking Cessation
Education and support customized to the
patient’s level of health, allowing them to
self-manage their chronic medical condition,
promote wellness and prevent
complications.
Disease Managers/Coordinators
• Diabetes
• Asthma
• CAD
• Obesity/Sleep Apnea
• Heart Failure
• COPD
Pharmacy
Focus on medication therapy management
and improved patient adherence.
• Lipid Clinic
• Refill Clinic
• Medication Reconciliation
Chronic Care Nurses
Provide patient support in the Primary Care
Offices. The RN supports and reinforces the
treatment plan prescribed by the physician.
Source: Sharp Rees-Stealy, Sharp • 5 or more chronic medical conditions
• 4 or more ER visits in the last 12 months
Healthcare, San Diego, CA
• 4 or more hospital admissions in the last
12 months
43
Complex Case
Management
Coordination and
assessment of care and
services for members who
have experienced a critical
event or diagnosis that
requires the extensive use
of resources and system
navigation in order to
facilitate appropriate
delivery of care & services.
What Do Patients Receive?
Disease Management
(Ongoing)
Health &
Wellness
(Ongoing)
•
•
•
Group Classes
1 on 1 Evaluation
Telephonic/Web
Education
Source: Sharp Rees-Stealy,
Sharp Healthcare, San Diego,
CA
• Evidence based targeted educational
mailings
• Personalized Face to Face and Telephonic
Assessments with collaborative Goal Setting
• Regular telephone consultations and followup with a registered nurse
• Provision of self-management tools and
support
• Referral, care coordination and
communication with Healthcare providers
Pharmacy (Ongoing)
• Physician/Patient support
• Medication Therapy Management
• Personalized Telephonic Assessments
• Resource Care Coordination
Chronic Care Nursing (30-90 days)
• Personalized Face to Face Assessments
with collaborative Goal Setting
• Regular office and telephone consultations
and follow-up with a registered nurse
• Provision of self-management tools,
education and support
• Attend Senior post Hospital discharge and
post Emergency Department follow-up visits
44
Complex Case
Management
(3-6 months)
• Evidence based targeted
education
• Personalized Telephonic
Assessments with plan of
care and collaborative
Goal Setting
• Frequent telephone
consultations and followup with a registered
nurse
• Provision of authorization
and coordination of
services
• Referral, care
coordination and
communication with
healthcare providers
Capital Access
In an era of healthcare reform, with declining payment, concerns
about reducing costs, and exploration of new organizational
structures to improve accountability for population health,
uncertainty abounds among healthcare providers. Considerable
investment and reinvestments are critical to the profitability and
survival of hospitals and health systems today.
Bond Financing in Volatile Times, HFMA,
March 3, 2014, Gould & Blanda
45
Healthcare Issuance Down in 2013
Source: John Hanley, Managing Director, Head of Healthcare, Ziegler, “Is Capital Available?”
Presentation at HFMA’s Capital Conference, April 10, 2014.
46
Source: Martin Arrick, Managing Director, Standard & Poor’s Not-for-Profit Health Group. “U.S.
Not-for-Profit Health Care Sector Outlook.” Presentation at HFMA Capital Conference, April 10,
2014.
47
Revenue Cycle
The revenue cycle presents unique opportunities for bottomline improvement. As payment continues to decline, hospitals
should take a renewed interest in improving their financial
performance through the revenue cycle.
HFMA
48
Revenue Cycle
The New Norm - Basic Expectations
• Efficient – Low cost work flows…..
 Exception based processing
 Automation through EDI
 Patient Self Service Options
• Accurate – Get it right the first time!

Right Insurance, Right Authorization

Right Patient Responsibility at Time of Service

Mandate Real Time Concurrent Review, Open EMR
• Timely – Introduce expectations early in cycle
 Patient and payers timely payment expectations
49
Revenue Cycle… More Than
Efficiency – It’s an Experience!
Revenue Cycle Leaders Should Consider the
“Service Differentiation”…..
– Employee Satisfaction
 Why will the “best and the brightest” want to work for
you?
 Efficiency
 How is your Revenue Cycle team creating intuitively
accurate processes?
How does the Revenue Cycle team create patient
loyalty?
‒ Patient Satisfaction
50
Embrace the Insurance Exchanges
• Assist with
Securing Coverage
• Certified
Enrollment
Counselors
• Patient Advocates
51
It’s a “New Era” in Revenue Cycle
• Price Transparency, New Payment Methodologies
and Patient Liabilities
• Cost Based Chargemasters
• Self Pay Initiatives
• Bundled Payments
52
Leveraging Technology
– Work from Home
– Expanding EDI
– Patient Self Service
– Payer Interfaces with Hospital Systems
– Front end solutions to guide patients through the
Exchange and Medicaid options
– “Priceline” Price Quotes
– Game Industry Productivity Monitoring Tools
– Patient Preference Lists
– Facetime Chat with a Customer Service Rep
53
HFMA Resources
My goal each year is to introduce promising young
professionals and colleagues to HFMA and help integrate
them within the organization. The HFMA network enhances
their careers, strengthens our chapter, and allows us to follow
their success. My chapter leaders did it for me, and I want to
pass it on. It's a win- win!
Debbie Teesdale
Executive Director of Corporate Development
Paragon Hospital Services, LLC
54
Improve the Billing and Payment
Experience for Patients
hfma.org/dollars
55
Discover Revenue Cycle Strategies
That Work
• Strategies used by MAP award
winners and other highperforming organizations
• Innovative practices designed to
drive revenue cycle performance
• Nov. 2-4, Las Vegas
hfma.org/mapevent
56
Take Advantage of Other Educational &
Career Development Opportunities
• Certification
• ANI: HFMA National
Institute
• Virtual Conferences
• Seminars
• Webinars
• eLearning
• HFMA onsite programs
57
Stay Up to Date with Online Resources
• hfma.org
• Daily and weekly
online news
• Social media
– Facebook
– LinkedIn
– Twitter
• HFMA Forums
58
Add HFMA Publications to Your
Reading List
• hfm magazine
– The #1 publication for healthcare CFOs
• Leadership publication
– Reaches all levels of the
C-suite
• Newsletters
– Revenue Cycle Strategist
– Healthcare Cost Containment
– Strategic Financial Planning
59 59
Earn CPEs by Reading Newsletter Articles
60 60
Leadership…
What does it really mean?
“Leadership has nothing to do with titles;
it has everything to do with,
“Do you inspire other people?
Do they want to follow you?
Do they want to be with you?”
-Tom Atchison, author of
Followership: A Practical Guide to
Aligning Leaders and Followers
61
Community banks
and residents
bought 38% of the
$45M in bonds that a
rural Nebraska
critical access
hospital
used to fund
construction of a
replacement facility.
PAYER & PROVIDER
A California
healthcare system
created core
revenue cycle teams
with representatives
from 10 departments
across all system
hospitals.
Improvement:
$9.4 M
HOSPITAL & COMMUNITY
WITHIN A HEALTHCARE SYSTEM
Collaboration
Success Stories
A payer funded an
initiative to make a
Minnesota
healthcare system’s
primary care clinics
more efficient and
patient-centered.
Physicians, nurses
and other clinicians
provided the ideas.
Source: HFMA’s Leadership e-Bulletin, available at www.hfma.org/leadership. “Transforming Revenue Cycle”
(Providence Health & Services CA region): Oct. 2010 issue. “Funding a Capital Project” (Beatrice Community
Hospital/NE) : Dec. 2010 issue. “Redesigning Primary Care” (Fairview Health Services.MN): Nov. 2010 issue.
.
62 62
62
Anchor Change in Corporate Culture
“Company cultures are
like country cultures.
Never try to change one. Try,
instead, to work with what you’ve
got.”
-Peter Drucker
63 63
63
“The people who really succeed in this
field have a vision. They have a high
degree of motivation, and they are out
to make things better—to do good and
to change the world on whatever scale
they can. They work hard, they have
an end in mind, and they will acquire
whatever skills and training and
knowledge they need to get there. ”
Mary Stefl, professor and chair of the department
of healthcare administration, Trinity University,
San Antonio, Texas, and a consultant for the
Healthcare Leadership Alliance Competency
Model
64 64
64
Create Short-Term Wins
“A journey of a
thousand miles
begins with a single
step.”
- Lao-tzu,
Ancient Chinese
philosopher
“Don’t be afraid to
start small.”
- Marty Manning,
Advocate Physician
Partners
65 65
65
“. . . a leader needs to k
You cannot lead without knowing the
needs of your people—what drives
them, what makes them do what they
do of the psychology of that, then you
can give them opportunities to succeed
based on their own psychology of
success.”
Kerry Gillespie, FHFMA, vice president,
operations, Community Health System, Inc.,
Brentwood, TN, and a member of HFMA’s
Tennessee Chapter
66
66
Everyone Is a Leader….
Everyone in this room is a leader. I’m asking each of you to
renew your commitment to leading our industry forward, to
ensuring its long term viability and quality.
Together, we CAN improve health care. Together, we can
and we must
• Mentor young professionals as we have been mentored,
• Rise above the uncertainty and frustration of today, and
• Work in partnership with our colleagues throughout the
industry to lead the change.
Kari Cornicelli
HFMA National Chair
2014/2015
67
68