Financial Operations Track

Transcription

1 Financial Operations Track Benchmarks and Decision Making in Financial Operation

2 FACULTY DISCLOSURE The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity: Greg Meier, Vice President, Finance, ROi-none to report Richard Bagley, Director SCO Business Development, Intermountain Healthcare- none to report Kreg Koford, Director Supply Chain Solutions, Intermountain Healthcare- none to report

3 Financial Operations Track Measuring Supply Chain Savings Presenter: Greg Meier, Vice President, Finance, ROi Greg Meier

4 Supply Chain Quotes I ve delivered $4 million in savings, but my finance team doesn t believe me My CFO won t let me count savings in these areas My savings reported aren t matching performance per hospital metrics

5 FY15 VALUE REPORT FMOLHS (Through 6/30/15) FY15 VALUE REPORT Mercy (Through ) Savings Report

6 Hard vs. Soft Savings Hard Savings: Reduction in cost or activity that truly creates an actual expense reduction on the P&L Soft Savings: Reduced level of potential cost or activity that does not create an actual expense reduction on the P&L

7 Hard Savings Examples Reduction from the price paid for a current product or service Change in activity that results in an actual reduction in hours paid Standardization of products or services that result in a net reduction in expense For new products, services or mandates; reduction from market price or volume

8 Soft Savings Examples Reduction from list price to a normal market price of a product or service Reduction of 15 minutes nurse time per shift Value-added services or products provided by a supplier that would not normally be used

9 Reporting Savings Hard Savings 12 Months at a Time Clarify Savings Calculations

10 Reporting Savings Hard Savings VALUE Many organizations speak about the concept of value, but what really is value? From ROi s view, we focus upon the Member in making this determination. Do you actually see bottom line benefit from what we do? We believe that, unless you do see a bottom line benefit, we shouldn t be talking about value. Our value is split into the following areas: 12 Months at a Time Contract savings We reflect the decrease/increase in costs for new contracts that we negotiate for the first 12 months the contract is in place. Services provided We reflect the difference between what you pay ROi versus the market value of that service if otherwise obtained outside of ROi. Clarify Savings Calculations Initiative savings If our services provided a bottom line hard benefit to you, we will reflect this. We appreciate the opportunity to provide this information to you as a starting point to have a conversation about our services and the value we provide. Gene Kirtser Greg Meier President & CEO Vice President, Finance ROi ROi

11 Driving Financial Impact Typical Supply Expense Reporting: Most Price and Mix Some Volume Few Outcomes Volume Outcomes Mix Price

12 Department Level Reporting

13 log(dvc) Outcomes Based Analysis high cost, high readmit lowest cost, low readmit The above study applied to three very specific ICD-10 codes that account for 9.2% of all cases at Mercy. The finding indicate an 8.0% weighted average savings to direct variable cost. If we extrapolate the results across all Mercy s procedural spend, it would indicate a potential opportunity of $110 million annually.

14 Driving Financial Impact Typical Supply Expense Reporting: Most Price and Mix Some Volume Few Outcomes Volume Outcomes Price Mix Takeaway: Supply Chain must acknowledge and be an influencer in all reporting types

15 Supply Expense Percent of NPSR Median 75th Percentile -25% -20% -15% -10% -5% 0% 5% 10% 15% 20% 25% % Change FY2012 to FY2014

16 Supply Expense Adjusted Discharge 5,000 4,500 4,000 3,500 3,000 2,500 Median 2,000 1,500 75th Percentile -30% -25% -20% -15% -10% -5% 0% 5% 10% 15% 20% 25% 30% % Change FY2012 to FY2014

17 Comparison of Metric Bases IDN Per Adjusted Discharge Labor Supplies Other % of Net Operating Revenue Labor Supplies Other

18 Comparison of Metric Bases IDN Per Adjusted Discharge Labor Supplies Other % of Net Operating Revenue Labor Supplies Other

19 Prototype of Me-To-You Reporting Comparisons between facilities require effort to normalize data and openness, but provide great opportunity to truly improve your supply chain

20 Summary Report on hard savings Document and discuss your savings calculations Discuss and be influencer on all levels of financial cost Seek out ways to compare outside your IDN Have open dialogue with finance about different metrics and impact of each

21 Financial Operations Track Governance of Making Decisions Presenters: Richard Bagley, Director SCO Business Development, Intermountain Healthcare Kreg Koford, Director Supply Chain Solutions, Intermountain Healthcare

22 Richard Bagley Director, Business Development Intermountain Healthcare Phone: Richard currently leads Intermountain Healthcare s Supply Chain Business Development Office. He is responsible to lead commercialization efforts of the Supply Chain. He leads the supply chain efforts to be a model in the industry and share supply chain best practices. He has lead major award winning supply chain initiatives like our procurement transformation efforts. Prior to his current role, he led the sourcing and contracting teams at Intermountain. Prior to joining Intermountain, Richard served as a program manager for Siemens, a senior software engineer for 3M Health Information Systems and a commissioned officer in the Army. He is a graduate from the University of Utah with a degree in computer science and also has a master s degree in business administration from the University of Phoenix where he has taught information system courses part time.

23 Kreg Koford Director, Category Management Intermountain Healthcare Phone: Kreg Koford, Director of Category Management for Intermountain Healthcare, leads contract management, strategic sourcing, program development and supplier collaboration. He is responsible to deliver strategies to manage $2B in spend across all non-labor categories. He is also responsible for managing Intermountain s key customer and supplier relationships to develop new sources of value that extend beyond traditional price decrease and margin shifting activities. Prior to joining Intermountain in 2003, Kreg worked in the high-tech sector providing consultation, implementation, and management of key customer relationships. Kreg received a Bachelor of Science and MBA degree from Brigham Young University.

24 Based in Salt Lake City, Utah Hospitals 1975 Began 22 hospitals 2,800 licensed beds 37% of Utah hospitals Intermountain in Brief A Large, Integrated Health System with a Tradition of Innovation Charge: Be a Model Health System 35,600 employees $1.9B non-labor spend AA+ Standard & Poor s Aa1 Moody s Intalere Health Plans 1983 Started SelectHealth 700,000 members 25% of Utah market Medical Group 1994 Started 1,200 employed physicians 4,000 affiliated physicians 185+ clinics 22% of Utah physicians Continuum Care TeleHealth Homecare Life Flight Central lab Central pharmacy 1986 Started 2015 Ownership Commercial platform $8B Spend GPO

25 Healthcare is costly and inefficient; the winners will take costs out of the system and become more efficient Common Issues Representative Drivers Best Practices?? No Bar Codes Costly Not-for-profit presence on clinical quality at all costs lacking science! dependence upon distributors & of supply chain talent pay & strategy executives haven t viewed traditional Materials Management as strategic left in basement much focus on rev in vs Standard door and patient Focus Industry optimize Inefficient traditional care GPOs Lack Hospital Preferences Too the volume But Optimizing the expense category will not

26 There is less PAIN to remove supply chain costs than there is in reducing clinical care What is the correct balance? As a healthcare leader, should I increase focus and investment in supply chain? Partner with clinicians in decision making? Elevate our focus on taking costs OUT of care? As a healthcare leader, should I reduce clinician presence? How many? At what cost to patient satisfaction/clinical quality?

27 The proper alignment and strategy in your organization will evolve to Total Cost of Ownership (TCO) Purchase costs How much do I pay at time of transaction? Easier To See Purchase price Internal business costs How much do my usage patterns and processes add to cost? Joint supplier/ customer costs How much does the way I work with my vendor affect my cost? Harder To See Freight cost Procure-to-pay costs Non-compliant utilization Inventory carrying costs Payment terms Physician preference/ specifications Lack of standardization Logistics/Distribution Early access to new technology Damaged product Expired product Other transaction Costs Expediting/ special delivery TCO Includes all of these areas. What is your organization doing about all these?

28 Price is the historical bias we will be moving towards utilization management at the case level Our Focus Phase I Phase II Phase III Price Management Product Standardization Utilization Management Aggregate where it makes sense What We Need from Our Physicians/ Clinicians Buy Preferred Items from a Contracted Supplier Use Fewer Suppliers and Fewer Products Utilize Right Product for Right Purpose in Right Quantity What it Means to Suppliers Improved Contract Compliance Significantly More Business Aligned Incentives Benefit Potential 5-10% 10 20% 70 85%

29 Layered into utilization, will be a more longitudinal episode of care; we are headed toward capitation Hospital Acuity Community-Based Care Acute Free-Standing ED Care Retail Pharmacy Physician Practice Sites Ambulatory Procedure Center IP Rehab Home Wellness and Fitness Center Urgent Care Center Diagnostic/ Imaging Center Post- Acute Care SNF OP Rehab Home Care

30 Governance Establish a governing council supply chain No strategies (including supply chain) should be executed in a vacuum Internal customers deserve an appropriate voice Seek input on objectives, goals and key strategies Leverage council to escalate conflicts and issues Council members become your change agents! Empower cross-functional teams to make supplier and product decisions Supply Chain SHOULD NOT make supplier, product, software or service provider decisions Sourcing should facilitate debate and help the stakeholder make the best decision Category Councils should be permanent since each category has a lifecycle; source, implement, manage, reevaluate Don t become so rigid with structure that supply chain can t quickly tend to basic service requests

31 Tier 1 Tier 2 Tier 3 Governance Typical Structure Who? Purpose Procurement Steering Committee Direction Setting Category Council Portfolio Oversight Category Work Team Project Execution Decision Making Role Prioritizes Project Across Category Councils AND Approved Complex Decisions Impacting the Entire Organization Approves Most Supplier, Product, Software and Service Provider Decisions Executes Sourcing Projects Makes Recommendation to Category Council

32 Tier 1: Role of Procurement Steering Committee Prioritize sourcing projects across all functions Approve sourcing project prioritization methodology Approve exception requests from the functional teams Balance project/resource allocation to cost savings, quality improvement and risk mitigation Approve and initiate new category councils to ensure clear decision making panels are in place for all supplier and product selection decisions Serve as final escalation point to approve complex sourcing decisions, which have a company-wide impact COLT and other committees will be consulted, but Approval rights move to Procurement Steering Committee Supply Chain team members are non-voting members Serve as escalation point for stakeholders, SCO or functions in need of related support: Appeals to system wide decisions that can t be resolved within the functions Requests for support to enforce system-wide decisions

33 Specific Roles of Tiers 2 & 3 Tier 2 Tier 3 Functional Steering Committee Category Council 1 Category Council 2 Category 1A Category 2A Category 1B Category 2B Category 1C Category 2C Category 1D Category 2D PURPOSE Set annual goals for sourcing initiatives within function Prioritize sourcing projects within function Approve sourcing strategies Resolve related conflicts Serve as escalation point for complex sourcing decisions, conflicts and disputes Initiate ad hoc work teams as needed (project specific) PURPOSE Prioritize sourcing projects within scope of council Execute sourcing strategies and projects Determine clinical equivalency Recommend supplier and product selections to Development Teams Approve most supplier selection recommendations Ensure all impacted stakeholders are consulted Implements and enforce decisions Perform value analysis on new products Evaluate new products Product standardization Reduce unnecessary supply utilization and minimize unnecessary supply variation Help resolve post-contract issues Important Note: Tier 2 is a flexible tier; some category councils may report directly to the Procurement Steering Committee while other functions may require more extensive tier 2 structures. See next four slides for Clinical Operations design.

34 Example slide of what was just presented

35 Clinical Integration Show Me The Data Assume good intent; physicians are NOBLE SCIENTISTS Collect data about all possible opportunities from supply base Show physicians how decisions will impact the system, the hospital and each of them Leverage the cooperative competitiveness of physicians transparently share outcome, productivity and cost data! Comparative analysis where appropriate Link products to care practice guidelines to outcomes where appropriate Align don t negotiate Ensure physicians/clinicians lead selection panels Allow physicians to determine tradeoffs between preference AND total cost Create appropriate incentives for Physicians to support change Change management 101 Shine a bright spotlight on your physician/clinician champions Make your physician/clinician champions the hero s Publically celebrate successes

36 Patient Lack of standardization Preference based decisions Inefficient processes Lot s of waste

37 Symptom Strategic Sourcing department doesn t have consistent decision support No Established Team: structures Contingent Labor, Software Maintenance, Rehab Supplies, Urology Initial Team is Disbanded and Post Contract Topics Can t Be Addressed: Patient Monitoring decisions were made by a team in the past that subsequently disbanded. When issues arise, there is no committee to provide guidance Multiple Teams with Responsibility, but No Decision-Making Authority: Infant Formulary Four separate committees want involvement, but no committee initially assumed authority to make the decision No Work Team Established: Energy / Vessel Sealing Work team disbanded following sourcing event. Development team did not have the time or appropriate resources to help resolve a post-contracting problem once it arose. Cross-Functional Teams Not Used to Make Decisions TVs and Monitors Physician/Supplier Relationships Continue to Evolve: Clinical Operations - We had product selection panels with conflicted chairs and participants

38 Plan Contract Renewals Customer (s) Procurement Key Objectives: 1. What do you want to do 2. What do you have to do 3. What do we (Supply Chain) recommend doing Spend Analysis & Benchmarking Suppliers Category Plans Materials

39 Engaging Decision Makers Presenting data in a familiar way creates buy-in Present the data with the eye of a clinician Look holistically at CQO, never C without O Provide incentives Public Recognition (tell a good story) Medical Staff Engagement Funds Peer pressure Unblended data Discuss variation in practice

40 Lesson #1: Connect to Business Business is already making procedure and process decisions, plug into those

41 Lesson #2: Use Data to Enable Change Change conversations with customers to be data driven NOT preference driven Be transparent and open with usage with clinicians Demonstrate variation in outcomes and cost objectively with data

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