TECHNOLOGY STRATEGY. EMR and Beyond. Building a Comprehensive Roadmap. Trenor Williams, MD. Managing Partner

Transcription

1 TECHNOLOGY STRATEGY EMR and Beyond Building a Comprehensive Roadmap Trenor Williams, MD Managing Partner

2 Road Map Market Insights Starting Point Building an IT Roadmap 4 5 Tactical Process Organizational Optimization 2015 The Advisory Board Company advisory.com

3 Changing Demands of the Healthcare Landscape (Pre-Read) 3 Drivers of HIT Adoption Several factors influence HIT adoption among healthcare providers: Patient-to- Consumer Shift Patients are beginning to expect certain technologies from providers 78% of consumers want option of consultations 72% of consumers want access to online scheduling Provider Demographics Characteristics associated with higher adoption rates: Larger practices ( 11 physicians) Physicians <50 years of age Practices owned by an HMO or community or academic health center Surgical specialty least likely HITECH Act Enacted to promote adoption of use of HIT Established meaningful use requirements Provides additional incentives / grants outside of MU for HIT initiatives Meaningful Use Using certified EHR technology to promote quality, safety, and efficiency Sets specific requirements that providers must achieve to qualify for incentive payments Value-Based Payments Shift from fee-forservice (FFS) to valuebased payments Incentive payments for quality reporting and performance, efficiency, and eventually value Facilitated by HIT investments

4 Pfizer Customer Assessment and Prioritization Strategies 4 HIMSS EMR Adoption Model (EMRAM) Greatest Level of HIT Adoptio n Inpatient Providers Stage 7 Inpatient EMRAM Capabilities Medical record fully electronic Continuity of Care Document (CCD) transactions to share data Data warehousing Data continuity with Emergency Department (ED), Ambulatory, Outpatient (OP) 2015 Q1 Adoption Rates Q2 Adoption Rates 2 3.7% 3.7% 6 Physician documentation (structured templates) Full Clinical Decision Support System (CDSS) Full Radiology Picture Archiving and Communication System (PACS) R-PACS 22.2% 23.6% 5 Closed loop medication administration 30.8% 32.3% Computerized Physician Order Entry (CPOE) Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets) CDSS (error checking) PACS available outside Radiology Clinical Data Repository (CDR) Controlled Medical Vocabulary Clinical Decision Support May have Document Imaging Health Information Exchange (HIE) capable 13.6% 13.2% 19.7% 18.2% 4.3% 3.6% 1 Ancillaries modules (Lab, Radiology, Pharmacy) all installed 2.2% 1.9% 0 All three Ancillaries modules (Lab, Radiology, Pharmacy) not installed 3.5% 3.3% 1) N = 5,462 2) N= 5,464 3) Individual hospitals within listed IDNs are given HIMSS certification and were mapped against the Pfizer Vaccines ACIP 65+ implementation tracker (September 2015) Source: HIMSS

5 2014 IT Costs & Performance Management Survey Survey of CIO and CFO level executives from top IDNs and Hospitals 5 Executives often struggle to find budget for new initiatives. Future state goals can take a back seat to present needs

6 6 CFOs Recognize the Need for New IT Investment Percentage of At-Risk Patients is Growing at Most Health Systems % Patient Population Under Some Form of Risk Contract n = 214 CFOs 15%-30% 30%-50% 5%-30% 12% 12% >50% 22% 5% 49% <5% 12% 5% High Priority Placed on New IT Enabled Care Management Initiatives % Identifying Among Top 2 Investments to Prepare for Risk-Based Contracts Investing in care management programs Reducing inpatient costs Investing in analytics to monitor performance Building a clinically integrated network Stratifying high-risk populations Modeling risk-based contract terms n = 214 CFOs 15% 37% 36% 35% 49% 46% ) The Population Advisory health Board management. Company advisory.com/consulting Source: Health Care IT Suite research and analysis.

7 7 IT Leaders Defer New Investment to Save Costs Survey Question: How important are these actions in helping you manage current IT-related costs or performance? Future initiatives can suffer when cost control is the objective Initiatives Voted Most Important for Managing IT Cost and Performance n=43 Initiatives % Voted Important Utilizing better IT management tools in order to do more with less 81% Revamping governance 77% Deferring new initiatives 74% Implementing process improvement 70% Renegotiating contracts or rebidding services 69% Implementing virtualization of computer systems 63% Implementing VDI 1 60% Moving to cloud-based infrastructure 52% Utilizing chargeback 44% Deferring refreshes 44% 2014 IT Related Cost and Performance Management Survey Results

8 8 Most Resources Allocated to Keeping the Lights On Survey Question: Approximately what percentage of resources is allocated to new IT-enabled initiatives vs. keeping the lights on? Percentage of resources allocated to new IT-enabled initiatives (versus keeping the lights on ) n=43 I don t know Less than 10% 10-19% 40% or greater 12% 5% 7% 26% Only one third had more than 30% available for new initiatives 30-39% 21% 30% 20-29% 2014 IT Related Cost and Performance Management Survey Results

9 Investment Is Insufficient for the Challenge 9 What s The Disconnect? IT Departments Face Pressure from Multiple Directions Cost Pressures Flat or lower budgets Escalating IT costs Government Mandates Meaningful Use ICD-10 Reimbursement changes More IT-Enabled Initiatives EMR implementation and optimization Mobile health Population management Higher Need and Expectations for Value Community integration Business intelligence CIO Not Always Involved in Strategic Decisions More initiatives than ever involve an IT component Strategy may not account for IT capacity IT Issues Challenging for Non-IT Executives Rapidly changing IT marketplace Paradigm shift in healthcare Source: Health Care IT Suite research and analysis.

10 10 A Tactical IT Approach Can Miss the Bigger Picture IT projects advocated by stakeholders to address targeted problems do not always align with larger strategic priorities and may compete for limited resources IT Project IT Project X IT Project Leadership Agenda IT Project X X Strategic Priorities X IT Project X X X IT Project IT Project Departmental Agendas Health systems need better alignment of IT resources to strategic organizational priorities Table of Contents

11 11 IT Left Alone to Carry Project Across the Finish Line De Facto Accountability Lets Business Sponsors Offload Ownership Typical Sponsor Involvement Across Project Life Cycle Level of Business Sponsor Involvement Business sponsor lobbies for project funding, then withdraws from ensuing planning and implementation phases Problem or Opportunity Identified Project Funded Planning Design Build Rollout Project Closed Project Life Cycle Source: Health Care IT Suite research and analysis.

12 Road Map Market Insights Starting Point 4 5 Building an IT Roadmap Tactical Process Organizational Optimization 2015 The Advisory Board Company advisory.com

13 13 Common Institutional Challenges Implementing a project based tactical fix does not achieve strategic goals Typical Approach Executive Notes Need for Optimization Fixes Implemented Tactical Project-Based Solutions Provider satisfaction Financial loss Value from EHR investment Strategic initiative alignment Unclear, broad impact Not proactive Not aligned to broader strategic initiatives

14 14 Finding the Right Starting Point Strategic approach to organizational prioritization and process 1 2 Questions Priorities Outcomes Organizational Strategy & Vision Words matter Why? Where do we want to go? Governance: Data, Clinical & IT Decision makers, process, communications, and accountability Critical step before roadmap creation 3 4 Roadmap Resources, projects, process This is ongoing. Choose Direction Organization-wide, Specialty-focused, Tactical Initiatives How to incorporate all if needed. Aligned with strategic goals, proactive, and based on priorities at the organizational level

15 15 Clear Strategic Priorities and Strong IT Governance Prerequisites to Roadmap Development Strategic Priorities Governance Need to be: Clear Measurable Developed with support of all relevant stakeholders Supported by strong organizational buy-in Should: Meet stakeholders needs Cover the enterprise end to end Apply a single integrated framework Enable a holistic approach Separate governance from management

16 Road Map Market Insights Starting Point 4 5 Building an IT Roadmap Tactical Process Organizational Optimization 2015 The Advisory Board Company advisory.com

17 17 Defining a Technology Roadmap Healthcare organizations benefit from a single consolidated view of the projects and resources required to address their strategic and operational priorities. A technology roadmap is a comprehensive plan that aligns investments with the strategic priorities of an organization across a defined period of time. Technology Roadmap Benefits Improves leadership decision making, Transparency to technology investments, and clear direction to project resources Identifies investments with the highest potential return on investment Enables sequencing of future investments and project deployments based on the collection of key metrics over time Ties technology decision to organizational imperatives and emerging opportunities Identifies issues, gaps, and opportunities associated with project deployments prospectively

18 Aligning Technology Investments with Health System Strategy 18 The alignment of a healthcare organization s strategy with technology projects needed to achieve the objective is essential for capitalizing on emerging opportunities and allows for efficient project delivery Continual Consideration Health System Strategies Assessment of Health Technology Investments to support strategy Re-Prioritization of Existing and New Projects to accommodate emerging priorities Key Consideration How does the organization create the bi-directional linkage of technology projects to specific organizational strategies? Example If an organization s strategic project is modified, how is this change communicated with technology divisions and how are these investments reprioritized if necessary?

19 19 Using Data to Drive Priorities Metrics Should Support Frequent Improvement Cycles Sample Monthly Operating Report for Benefits Tracking Cost per case % OS used $5,000 $4,500 $4,000 $3,500 Top 10 eos Implemented Order Set Use and Costs Top 10 U.S. DRGs 1 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 June 09 80% 60% 40% 20% If you don't know how what you're doing in IT is going to benefit the business, if you can't even verbalize the connection in the investment in IT and a benefit to the business, then why are you doing it at all? Stuart McGuigan, CIO, CVS Caremark (CVS) 1) Diagnostic related groups. Source: Health Care IT Suite research and analysis.

20 20 Key Challenge Ensuring enough capacity for infrastructure, new projects, and enhancements of existing projects is a delicate balance that requires active management The Advisory Board Company advisory.com

21 21 Technology Roadmap Development The organizational strategy should be clearly defined in order to guide this process Inventory & Refine Consolidate all lists Remove duplicates Identify dependencies Detailed Scope Fully scope projects based on $, Staff, Time, ROI, Strategic Priorities, etc. Roadmap Development Available resources Project duration Existing deadlines & dependencies Work Plan Meetings Reevaluate progress and capacity Adjust work to best achieve strategic priorities Define Strategic Priorities Set out the strategic organizational vision Secure buy-in from executive and clinical leadership Initial Prioritization & Scoping Macro sort of projects Decide on projects to invest resources to fully scope Using strategic lens, rank order Final Prioritization Technology review board Funding & Deployment Match work to capacity Measure success based on strategic priorities After receiving the health system s strategic priorities, the technology strategy can be defined and the specific technology projects may be prioritized and planned effectively to align with the global strategies of the health system.

22 Road Map Market Insights Starting Point Building an IT Roadmap 4 5 Tactical Process Organizational Optimization 2015 The Advisory Board Company advisory.com

23 23 Individualized Scoring System IT Governance Committee Agrees to Rubric Criteria Example Technical Requirements Rubric: Meets technical requirements of all stakeholders; top of class workflow efficiency; ability to share data across multiple systems 3 Meets technical requirements of all stakeholders; workflow efficiency acceptable to all users; data sharing capabilities acceptable to all stakeholders 2 Lacks one or more key technical requirements desired by some stakeholders; workflow efficiency is below acceptable standards for some users; proprietary interface with limited ability to share data with other key IT systems 1 Lacks one or more key technical requirements desired by all stakeholders; significantly hiders workflow efficiency; no ability to share data with other key IT systems 0 Up front agreement on evaluation criteria and organizational priorities is key to success

24 24 Additional Evaluation Criteria Set Additional Scoring Parameters Based on Organizational Goals Lowest Cost Assign greater value to IT systems with lower cost Strategic Priority Alignment Does the system serve an indispensible health system function or enable a strategic goal? Organizational Reach Is the system used by one department or does it extend throughout the enterprise? Table of Contents

25 25 Systematically Evaluate IT Capabilities Evaluate costs and benefits Requirements: In Use Duplicate Function Product Alternatives (see vendor selection tab) Optional or Bundled Function Maintenance Cost (annual) Subscription Cost (annual) Strategic Priority Technical Rubric Score Lowest Cost Bonus Strategic Organizational Priority Bonus Reach Bonus System 1 Yes $20, $100, Function 1 No Legal Compliance 2 Function 2 No A Patient Safety 5 Function 3 No 1 Clinical Effectiveness 5 Function 4 Yes Financial Viability 5 1 Function 5 Yes Financial Viability 5 Function 6 Yes 3 Financial Viability 3 1 Function 7 Yes B None 5 Function 8 Yes 3 None 5 Function 9 Yes 3 O $10, Clinical Effectiveness 5 1 Function 10 Yes O $12, Legal Compliance 5 Function 11 Yes O $13, Legal Compliance 2 2. Total $135, System 2 Yes $54, Function 1 Yes A Clinical Effectiveness Function 2 Yes 2 Clinical Effectiveness 5 1 Function 3 Yes B Clinical Effectiveness 5 1 Function 4 No 2 Clinical Effectiveness 5 1 Function 5 No 2 Clinical Effectiveness 5 1 Function 6 Yes Clinical Effectiveness Total $54,000.00

26 26 New Product Scoring Fill IT System Gaps While Further Reducing Costs

27 Road Map Market Insights Starting Point Building an IT Roadmap 4 5 Tactical Process Organizational Optimization 2015 The Advisory Board Company advisory.com

28 28 Myriad Strategies to Prioritize Where do Annual Wellness Visits (AWVs) and Hierarchical Condition Categories (HCCs) Fit? High ROI Front Office Performance Clinical Documentation Improvement CCM Payments Participation in/scale HCC Risk-Based Contracts MSSP 1 AWVs Compensation Redesign Care Delivery Team Transformation Telemedicine Medical Home Certification Transitions of Care EMR Optimization Low Patient Access Online Patient Portal Population Health Strategy Stage 3 Meaningful Use CQM 2 Reporting Mandate Retail Strategy 1) Medicare Shared Savings Program 2) Clinical Quality Metrics Easier Ease of Implementation More Difficult

29 29 Snapshot of AWV Opportunity Additional Benefits 14.5% of eligible Medicare patients received an Annual Wellness Visit in At $145 average reimbursement per visit, for mid-large medical groups, that means $1-3M of direct revenue Maximized pathways lead to downstream revenue - $343 margin average per patient 1 Supports population health management Analytics and patient segmentation Patient activation Team based care delivery Clinical process redesign Maximizes EHR Incentive alignment Metrics improvement 1) Crimson Medical Group Advantage data.

30 30 Snapshot of HCC Opportunity An 85-year-old MA patient comes in for a visit 1 Symptoms Symptoms of UTI, reports mild claudication Tired, less energy, poor appetite, mild malnutrition Urinalysis performed shows white cells, leukocyte esterase, and microalbuminuria Medical History Stable diabetes mellitus (DM) Chronic kidney disease (CKD) stage 4 exacerbated by diabetes Stable left great toe amputation due to non-healing ulcer UTI with serum GFR 29 1) Modified from original industry example: 2) $800 per member / per month (illustrative purposes) X Risk Adjustment Factor score Codes reported: Diabetes Mellitus UTI Codes missed: CKD Stage 4 due to Diabetes Mild Degree Malnutrition H/O Toe Amputation PVD due to Diabetes $1,812 PMPM missed opportunity 2

31 31 HCC Opportunity in Context Stacking Up Well in a Portfolio of System Initiatives $15M $14. 98M $127.94M Common Impact of RAF 1 Capture Improvement (Annual) $7.78M $10. 59M $12. 17M $6.59M $6.3 7M $5M $4.15M $1.95M $.44M $.69M $.94M Urology, OP Orthopedics, OP GI, OP Orthopedics, IP Cardiac, IP Imaging, HOPD General Surgery, IP Avg. Service Line Contribution Profit, per Hospital 1) Risk Adjustment Factor 60 PCPs 60 Physicians, multispecialty Avg. Loss on Owned Practice 2,000+ beds 1,001-2,000 beds 501-1,000 beds Med. IDN Operating Income

32 32 Two Sides of a Coin How do AWVs and HCCs relate? Health Risk Assessment (AWV) Health Risk Adjustment (HCC) 1) Medicare Shared Savings Program 2) Clinical Quality Metrics

33 33 Order of Effort Depends on Context Deciding Where to Start Lean AWV Limited acceptance of payment risk Issue Risk Contracts Lean HCC Already, or close to, accepting significant payment risk for population Ample capacity for additional appointments Capacity Limited capacity for additional appointments Severely limited cash; near-term revenue realization a must Cash Position Performance Improvement Infrastructure No significant issues with cash flow; capital available to fund infrastructure Physician Integration Goals

34 34 Handful of Diagnoses Contributing to Gap Percentage of Total Opportunity Accounted for by Top Diagnoses Health System 1 38% 44% Health System 2 30% 35% Top 10 Diagnoses Top 5 Diagnoses Health System 3 36% 44%

35 35 Shared Challenges at the Diagnosis Level Top Five Diagnoses Contributing to Uncaptured RAF Opportunity Diagnosis Health System 1 Health System 2 Health System 3 Morbid Obesity Rank: #1 Opportunity: 15% Rank: #1 Opportunity: 10% Rank: #1 Opportunity: 19% Diabetes with Chronic Compl. Rank: #2 Opportunity: 8% Rank: #2 Opportunity: 9% Rank: #2 Opportunity: 6% Atherosclerosis Rank: #3 Opportunity: 7% Rank: #4 Opportunity: 4% Rank: #3 Opportunity: 5% COPD Rank: #4 Opportunity: 5% Rank: #3 Opportunity: 5% Rank: #4 Opportunity: 5% Rank: #5 Seizure Disorder Opportunity: 4% Bipolar Disorder Opportunity: 2% CHF Opportunity: 2% 1) Rank of diagnosis as contributor to total RAF uncaptured

36 36 Lacking a System Standard? Variation across Sites within the System Department-Level RAF Capture Rates 79% 83% 88% 91% 54% 54% Minimum 25 th Percentile 50 th Percentile 75 th Percentile Maximum

37 37 Pushing New Protocols Systemwide Percentage of Uncaptured RAF by Physician Performance Level, Health System Example 93% 100% 59% 69% 72% 24% Minimum 25th Percentile 50th Percentile Average 75th Percentile Maximum

38 38 Best Practice Methodology to Improve Results Three-Pronged Approach to Opportunity Capture Enabling Your People Education, training, and marketing content for patients, providers, and staff to increase engagement and visit capture Making Processes Efficient Workflow evaluation and optimization to leverage existing staff to the full extent of their licensure and to promote proactive patient outreach Getting the Most From Technology Optimize existing EHR and other clinical information technologies to automate AWV/HCC workflows, capture relevant documentation, and reduce billing errors

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