Strategies to increase profitability in Hospitals

Transcription

1 .. Strategies to increase profitability in Hospitals Dipl. Betriebswirt Heinz Jörg Schwarz, MS IS Global Business Development Director Regional Health, AGFA HealthCare, Mortsel, Belgium Sr. Adjunct Professor, Ageno School of Business, Golden Gate University, San Francisco, CA 1

2 Agenda Focus on Continuum of Care What is it Why it will change Hospital business models How to thrive in the new paradigm Manage new Service Lines to increase market share The glass is half full, not half empty Outsourcing Services IT Infrastructure as a managed Service Specialist services cost efficiency Reduce Supply costs The model of shared risk and reward 2

3 Agenda Focus on Continuum of Care What is it Why it will change Hospital business models How to thrive in the new paradigm Manage new Service Lines to increase market share The glass is half full, not half empty Outsourcing Services IT Infrastructure as a managed Service Specialist services cost efficiency Reduce Supply costs The model of shared risk and reward 3

4 Integrated Care is here to stay Care Coordination shows results Initial results of accountable care organizations show double digit cost reduction and quality improvement Shift from acute care to preventive care More prevention saves cost Less revenue for Hospitals (fewer acute care episodes), more revenue for GPs and Specialists (more preventive care) The end of the fee for service era? 4

5 Outcomes based payments require integrated care Source: McKinsey 5

6 The Dilemma Payer View More Quality = Lower Cost! Why? Shift to low-cost preventative care saves high-cost acute care Hospital View More Quality = Lower Revenue? Why? Loss of revenue from ICU, interventional medicine 6

7 The Solution Build business model for a care continuum Deliver episodes of care, not fragmented services Become a partner that delivers patient specific health & wellness management Information Technology is key Integrated information flow within Care team General Practitioner Specialists (Cardiologists, Radiologist) Wellness consultants (Nutrition, Exercise, Mental Health) Analytics and clinical Business Intelligence Descriptive Analytics (identify high risk patients) Predictive Analytics & Clinical Decision support (care path ways) 7

8 March of Progress Level 1 - Messaging Level 3 - EHR Level 5 Smart Care Level 2 - Sharing Level 4 - Analytics Level 6 Integrated Care 8

9 AGFA Maturity Model Integrated Care Maturity Level Objectives Characteristics 9 1 Messaging Simple pnt-to-pnt messaging (e.g. ) to send orders and to receive results(push only the data is stored in the edge systems) 2 Sharing Query and retrieve results, stored at different locations (push-pull model, central / federated data storage ). Example XDS Data is structured and non-structured with various levels of data quality Tracking of orders / referrals (status monitoring, task management) 3 EHR Use semantics (e.g. NLP, master data, tagging) and data qualitymanagement mechanisms (e.g. validation, normalization) to ensure that the data is structuredand of guaranteed data quality (complete, consistent and correct) Provide longitudinal view on clinical results of patients (virtual patient record), stored at different locations Support secure electronic communication (e.g. chat, secure ) among different members of care team Access to clinical guidelines in applications Provide patient level alerting 4 Analytics Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level Search and navigate through the data in interactive way Support secondary data usage for clinical trials 5 Smart Care Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism (e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning Generate knowledge from information (e.g. using predictive analytics, community authoring) Integrate high variety of data sources, including sensors, genomics 6 Integrated Care Support clinical pathways (process workflow) for disease / health management Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums, social media, Provide population level alerting

10 Agenda Focus on Continuum of Care What is it Why it will change Hospital business models How to thrive in the new paradigm Manage new Service Lines to increase market share The glass is half full, not half empty Outsourcing Services IT Infrastructure as a managed Service Specialist services cost efficiency Reduce Supply costs The model of shared risk and reward 10

11 Manage new Service Lines The Glass is half full, Not half empty 11

12 Source: Maffei, Burciago, Dunn, (2009) Determining Business Models for Financial Sustainability in Regional Health Information Organizations (RHIOs): A Review, Population Health Management, 12 (5) 2009, 12

13 Integrated information for Outpatient Care Portal RIS/PACS Specialty Domain i.e. Radiology, Cardiology, Pathology DICOM Archive DICOM Viewer Clinical Documents Regional Community Image Enabled HIEs -Provide Clinical Information to Radiologists -Provide Ordering and Results Delivery to Physicians -Provide an integrated clinical community view (Maturity level 2) 13

14 Integration of clinical documents & imaging HYDMedia as IHE document consumer HYDMedia as IHE document consumer + ICIS View 14

15 Pre- and post- acute coordination Portal (Orion or AGFA OEM) HIS XDS-I Archive DICOM Viewer DCM Hospital Domain Regional Community Extend Hospital EMR to Community -Provide Clinical Information to Hospital (pre acute) -Provide Clinical Information and Results to Community Physicians (post acute) -Provide an integrated clinical community view 15

16 Patient activation and involvement Patient Portal Provider Portal RIS/PACS Radiology or Cardiology Domain ICIS XDS-I.b ICIS VIEW REM+ HYDMedia Regional Community Information Flow Value Proposition -Patient Activation & enpowerment -Regulatory Requirement or condition (such as Meaningful Use) 16

17 Post acute integration Provider Portal ORBIS / HIS Hospital Domain HYDMedia Regional Community Information Flow Extend Hospital EMR to Community -Provide Clinical Information and Results to Community Physicians (post acute) -Provide an integrated clinical community view -Prevent early readmissions 17

18 Pre- and post acute integration Provider Portal ORBIS / HIS Hospital Domain HYDMedia Regional Community Information Flow Extend Hospital EMR to Community -Provides Clinical Information to Hospital (pre acute) -Provides Clinical Information and Results to Community Physicians (post acute) -Clinical improvements in acute care and early-readmission prevention -Provides an integrated clinical community view (Maturity level 2) 18

19 Clinical and Imaging integration Provider Portal ORBIS ICIS XDS-I.b ICIS VIEW HYDMedia Hospital Domain Regional Community Information Flow Extend Hospital EMR to Community -Provides Clinical Information to Hospital (pre acute) -Provides Clinical Information, Images and Results to Community Physicians (post acute) -Clinical improvements in acute care and early-readmission prevention -Provides an integrated clinical community view (Maturity level 2) 19

20 Patient activation Patient Portal Provider Portal ORBIS ICIS XDS-I.b ICIS VIEW HYDMedia Hospital Domain Regional Community Information Flow Extend Hospital EMR to Community -Provides Clinical Information to Hospital (pre acute) -Provides Clinical Information, Images and Results to Community Physicians (post acute) -Clinical improvements in acute care and early-readmission prevention -Provides an integrated clinical community view (Maturity level 2) 20

21 AGFA Maturity Model Integrated Care Maturity Level Objectives Characteristics 1 Messaging Simple pnt-to-pnt messaging (e.g. ) to send orders and to receive results(push only the data is stored in the edge systems) 2 Sharing Query and retrieve results, stored at different locations (push-pull model, central / federated data storage ). Example XDS Data is structured and non-structured with various levels of data quality Tracking of orders / referrals (status monitoring, task management) 3 EHR Use semantics (e.g. NLP, master data, tagging) and data qualitymanagement mechanisms (e.g. validation, normalization) to ensure that the data is structuredand of guaranteed data quality (complete, consistent and correct) Provide longitudinal view on clinical results of patients (virtual patient record), stored at different locations Support secure electronic communication (e.g. chat, secure ) among different members of care team Access to clinical guidelines in applications Provide patient level alerting 4 Analytics Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level Search and navigate through the data in interactive way Support secondary data usage for clinical trials 5 Smart Care Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism (e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning Generate knowledge from information (e.g. using predictive analytics, community authoring) Integrate high variety of data sources, including sensors, genomics 6 Integrated Care 21 Support clinical pathways (process workflow) for disease / health management Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums, social media, Provide population level alerting

22 AGFA Maturity Model Integrated Care Maturity Level Objectives Characteristics 1 Messaging Simple pnt-to-pnt messaging (e.g. ) to send orders and to receive results(push only the data is stored in the edge systems) 2 Sharing Query and retrieve results, stored at different locations (push-pull model, central / federated data storage ). Example XDS Data is structured and non-structured with various levels of data quality Tracking of orders / referrals (status monitoring, task management) 3 EHR Use semantics (e.g. NLP, master data, tagging) and data qualitymanagement mechanisms (e.g. validation, normalization) to ensure that the data is structuredand of guaranteed data quality (complete, consistent and correct) Provide longitudinal view on clinical results of patients (virtual patient record), stored at different locations Support secure electronic communication (e.g. chat, secure ) among different members of care team Access to clinical guidelines in applications Provide patient level alerting 4 Analytics Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level Search and navigate through the data in interactive way Support secondary data usage for clinical trials 5 Smart Care Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism (e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning Generate knowledge from information (e.g. using predictive analytics, community authoring) Integrate high variety of data sources, including sensors, genomics 6 Integrated Care 22 Support clinical pathways (process workflow) for disease / health management Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums, social media, Provide population level alerting

23 New Services Summary Integration of Information is possible at different levels Legacy Systems can be integrated Paper, HL7, IHE Different integration levels and efforts Value creation at every level Level 2 solutions offer already great benefits Vertical Integration = Revenue opportunity Hospitals expand care delivery instead of waiting for patients to show up Integration can be organized virtually using Information Systems Not necessarily rip-and-replace of systems Not necessary to replicate existing services 23

24 Agenda Focus on Continuum of Care What is it Why it will change Hospital business models How to thrive in the new paradigm Manage new Service Lines to increase market share The glass is half full, not half empty Outsourcing Services IT Infrastructure as a managed Service Specialist services cost efficiency Reduce Supply costs The model of shared risk and reward 24

25 Outsourcing Services = IT & Clinical IT Infrastructure Leverage Standards such as DICOM, XDS, and IHE Define SLAs Response times Up-times Security / Privacy Imaging as-a-service VNA Distributed Reading Shared Workflows Pay per study HIE Services Regional Provider Portal Integration of Paper based processes and documents Alerts, Reminders Leverage Economy of Scale Clinical Services Leverage IT Infrastructure to source specialist services, i.e. Pathology Primary Reading Consultations / 2 nd opinion Low frequency hours Sparsely populated areas Focus on things you do really well High frequency usually allows better training Lower cost Partner for things others do better and cheaper New Supply chain paradigm If you do it only once a month, maybe someone else can do it better? Leverage Economy of Scale IT and Regional Health is an enabler for better cost structure sourcing! 25

26 Agenda Focus on Continuum of Care What is it Why it will change Hospital business models How to thrive in the new paradigm Manage new Service Lines to increase market share The glass is half full, not half empty Outsourcing Services IT Infrastructure as a managed Service Specialist services cost efficiency Reduce Supply costs The model of shared risk and reward 26

27 Reduce Supply cost 1. Identify Areas of excellence 1. Usually requires Business intelligence data 2. Quality Metrics (Clinical outcomes) 3. Cost Metrics (i.e. DRG costs) 2. Identify Areas of lower performance 1. BI data 2. Quality metrics (Clinical outcomes) 3. Cost metrics (i.e. DRG cost) 3. Provide Services beyond hospital in areas of excellence 1. Leverage quality and cost advantage 2. Leverage ehealth Infrastructure to integrate with other providers and payers (compare slide 12, sustainable business models) to provide integrated care as an outsourced service 4. Contract Services into hospital in areas of lower performance 1. Leverage other providers superior cost and quality for your patients 2. Leverage ehealth Infrastructure to integrate. 27

28 The New Supply chain within an Integrated care continuum Referring Service Provider In-Sourced Specialist Referring GPS Core Clinical Services In-Sourced Service Referring Specialist ehealth IT Infrastructure For integrated Care Delivery, Bundled Payments, Shared Risk/Reward = New Business Model for sustainable growth 28

29 Don t ask if you can afford to invest in ehealth. Ask if you can afford not to invest in ehealth Technologies! 29

30 30 Heinz Jörg Schwarz