IN THIS ISSUE: Health reform is bringing added complexity to the operational decisions health leaders face every day. As payment models
change, the reimbursement stakes are higher than ever. To make informed decisions, leaders need enterprise intelligence that integrates
clinical and financial data, along with predictive modeling capabilities, to manage the chaos and complexity of reform.
Enterprise “Knowledge is Power” — Managing the
Complexity of Health Reform By Connie Moser
Vice President and Solution Line Manager
Enterprise Intelligence Solutions
McKesson Provider Technologies
The saying “knowledge is power,” credited to Sir Francis Bacon in a 1597 essay, is still considered true in 2012. Knowledge of how your organization is operating is the key to optimizing its clinical and financial performance — and protecting reimbursement in the process. Ultimately, the ability to transform your enterprise data into actionable intelligence for continuous improvement secures better care for your patients and better business health for your organization today and over the next decade.
With changes in care delivery and payment models led by health reform, organizations must broaden their view from department-based improvement to enterprise intelligence that sees the delivery system as an integrated whole across the continuum of care. With accountability for care, health leaders must evaluate and report their organization’s performance using integrated analysis of clinical and financial outcomes.
But just as leaders must look across the enterprise for improvement opportunities, they must also proactively assess how today’s action may affect tomorrow’s outcome and reimbursement. The future will require operating under multiple payment models with varied risk, so it is important to understand how process and resource changes would affect results.
Predictive modeling can assist in making the right decision today for better outcomes tomorrow. Instead of acting out trial and error improvements and then measuring the results, predictive enterprise intelligence solutions enable leaders to model choices based on how they will affect metrics and reimbursement before making the optimum selection.
A Multipronged Strategy
There are multiple strategies for addressing the complexity of health reform – all combine people, process and technology to support better care, better business and a better connected continuum of care. McKesson’s white paper, “Surviving Health Reform: Removing Chaos from Complexity,” suggests strategies in six areas.
Predict and manage financial health – With declining reimbursement, it is estimated that organizations will have to cut 3-5% per year out of their budget to maintain profitability. In addition, reform means organizations are at increased financial risk for care quality, whether from quality measures, preventable readmissions, hospital-acquired conditions or patient satisfaction surveys. In addition, value-based purchasing and bundling of payments requires the ability to do inpatient and outpatient financial modeling and having an understanding of the cost-per-patient-per-day.
Drive clinical quality and safety – The federal government is using carrots and sticks to promote clinical quality and safety delivered with efficiency. By exceeding measurement goals, healthcare organizations have the opportunity to increase their share of the healthcare payment. Failing to meet specified goals reduces reimbursement. It is important to know and optimize your organization’s performance on clinical measures – examining enterprise data for trends and the root cause of lower performance – so you can use that intelligence to drive improvement back to the point of care.
Accelerate physician alignment with strategic goals – Ongoing practitioner performance measurement enables the organization to align physicians with quality and financial metrics. It also supports shared accountability across the enterprise — in both inpatient and outpatient settings. This objective data enables benchmarking of physicians against internal and external peers. It also provides a mechanism to tie clinical process to financial outcomes.
Manage patient flow for better outcomes and throughput – A visual tracking board can provide a mechanism for better coordinated care of patients. Through shared visual cues, caregivers can track time-sensitive treatments, know when an action is due, anticipate next steps and perform tasks to meet regulatory compliance measures. By helping improve inpatient handoffs and case management, the shared view can help reduce length of stay and prevent readmissions.
Manage organizational capacity and efficiency – An appropriate level of staffing is one of the keys to patient safety and desirable outcomes. Organizations can identify an appropriate nurse-to-patient ratio by monitoring the patient census and tracking patient acuity. Analytics can take multiple historical and skill factors into consideration to model and implement appropriate nurse staffing, setting the stage for optimal patient outcomes while reducing agency use and overstaffing.
Promote a culture of accountability – Effective change requires a culture of accountability. And those who are accountable must have the information to understand their performance and how they can improve. Information – both clinical and financial – must be easily accessible and shared throughout the organization, with the opportunity to drill-down for meaningful, actionable intelligence.
Enterprise Intelligence Powers Your Organization for the Next Decade
The challenges of the next decade will require that you maximize the value of your core systems, improve financial performance and quality, and connect and coordinate care across the continuum. You also will need to manage increasingly complex payment models, from value-based purchasing to going at risk for a population. Enterprise intelligence solutions play a key role by enabling organizations to collect and aggregate the right clinical, financial and operational data so that it can be transformed into actionable information to achieve strategic objectives — within a care setting or across the continuum. With the strategic use of health IT, you will be better able to survive the complexity and volume of change, and achieve better business, better care and better connected care for your organization and your community.
Connie Moser leads the Enterprise Intelligence division within McKesson Provider Technologies and has more than 21 years experience in the healthcare industry. She served a three-year term as the public board member for the Competency and Credentialing Institute, a nonprofit organization focused on enhancing patient safety through surgical nurse certification, where she also held the roles of Secretary/Treasurer for two years. Additionally, Moser has presented on operational redesign to healthcare industry organizations, including HIMSS, HFMA and NAHAM.
change, the reimbursement stakes are higher than ever. To make informed decisions, leaders need enterprise intelligence that integrates
clinical and financial data, along with predictive modeling capabilities, to manage the chaos and complexity of reform.