© 2011 The Center for Business Innovation and Resource Management Professionals Page 1
Six Steps to
Healthcare Business
Intelligence Success
July 2011
Scott Wanless
© 2011 The Center for Business Innovation and Resource Management Professionals
Agenda
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1. The New World for a Typical Healthcare Organization
2. Research Results
3. Six Steps to Healthcare Business Intelligence Success
4. A Question for You
© 2011 The Center for Business Innovation and Resource Management Professionals
We want information! Now!
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© 2011 The Center for Business Innovation and Resource Management Professionals
At the Front Door
Patients
Payers
Purchasers
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Quality
Cost
Service
© 2011 The Center for Business Innovation and Resource Management Professionals
At the Side Door
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Shareholders
Lenders
Credit Bureaus
Profitability
Cost
Productivity
© 2011 The Center for Business Innovation and Resource Management Professionals
At the Back Door
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Regulators
Legal
Quality Organizations
Compliance Data
Evidence
Comparative Data
© 2011 The Center for Business Innovation and Resource Management Professionals
First Floor
Primary Care
Specialists
Nurses
Ancillary Staff
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Decision Support
Patient Flows
Chart Reviews
Clinical Evidence
© 2011 The Center for Business Innovation and Resource Management Professionals
Upstairs
CEO
CMO
CFO
CNO
CQO
COO
CIO
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Profitability
Cost Control
Revenue
ROI
Productivity
Risk Management
Compliance
Performance
New Markets
Quality
Investment Support
© 2011 The Center for Business Innovation and Resource Management Professionals
Basement
Clinical Research
Informatics
Process Improvement
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Clinical Data
Operational Data
Financial Data
Normative Data
© 2011 The Center for Business Innovation and Resource Management Professionals
Solutions Abound
“You don’t have a
Parameter-Driven
Meta-Filtrational
Hyper-Aggregating
Whatcha-ma-hoozie?
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© 2011 The Center for Business Innovation and Resource Management Professionals
Hiding Won’t Help
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© 2011 The Center for Business Innovation and Resource Management Professionals
Research Results
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Tom Ludwig Scott Wanless
49,000+ Conversations49,000+ Conversations
5000+ People 5000+ People
Clinical Operations Business Intelligence
30 years 30 years
260 Interviews + 7 Case Studies
Six Steps to Healthcare Business Intelligence Success
© 2011 The Center for Business Innovation and Resource Management Professionals
Six Steps to Healthcare BI Success
Strategic drivers for analytics specific to your organization
Business responses to address these challengesThis step usually missed
Analytical questions behind these business actions
Translating analytical needs into clinical, operational, financial and enterprise-wide business intelligence applications
Making BI and analytics part of the new normal for the organizationThis step also usually missed
Linking analytics back to the strategic drivers and delivering benefits
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© 2011 The Center for Business Innovation and Resource Management Professionals
Use the steps to...
Challenge presenters at this conference
Challenge vendors
Challenge suppliers
Challenge your own organization
Even challenge those demanding analytical information
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© 2011 The Center for Business Innovation and Resource Management Professionals
Step 1: Strategic Drivers
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Increased Demand for Services
Increased access to information about health conditions
Comorbidities
Chronic Care vs. Episodic Care
Uncompensated Care
Public vs. Private View of Healthcare
Consumerism and Convenience Expectations
Resource Shortages
Physicians and Nurses
Administrators, Executives, Informaticists, et al
Compliance Requirements
Mandatory (regulatory)
Semi-Voluntary (contractual)
Voluntary (pay for performance, quality awards)
Financial Pressures
Revenue and Reimbursement Cuts
Cost Cuts
Risk Mitigation blocking Capital Projects
Pressure to Prove Value
Vertical and Horizontal Integration
Next Wave of Integrated Delivery Networks
Accountable Care Organizations
Rise in Cooperatives and Exchanges
Increased consolidation of hospitals, and physician group sizes
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 2: Business Responses
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Increased Demand for Services
Redesigning Care Models
Redesigning Treatment Mixes
Streamlining Patient Handoffs
Creating Facilitation Roles
Implementing Case Management
Resource Shortages
Multi-disciplinary Teams
Standardization
Physician Alignment Strategies
Compliance Requirements
Reusable Compliance Databases
Chief Compliance Officers with Staffs
Compliance Governance
Financial Pressures
Aggressive Revenue Cycle Management
P4P
New Services, Extended Hours, Franchising
Reducing Readmissions
Checklists, timeouts
Lean, process redesign
Reducing Physician Preference Items (PPI)
Performance Contracts
Outsourcing and Offloading
Increased electronic information and workflow
Vertical and Horizontal Integration
Retail, quick and one-stop clinics
Telehealth methodologies
Mergers, joint ventures, divestitures
Standalone urgent and emergency services
Leading ACO formation
Cooperatives
Health Information Exchanges (HIEs)
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 3: Analytical Questions
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Chief Medical Officer Medical Management. Which docs are doing the best? Worst? What are best docs doing differently? Are
we cross-training effectively?
Clinical Performance. Which treatments are most effective? Which treatments are not providing clinical
payback? What is the persistency rate among patients?
Patient & Provider Satisfaction. How do the MDs, PAs, NPs, RNs get good results? Are patients
expressing delight or concern over their care?
Quality Accreditation Reporting. How are we doing against normative numbers for our quality
measures? How are we doing against normative numbers for our quality measures? How does disease
control correlate with screening? How does it correlate with other measures?
Quality Improvement Programs. What methods are producing the best results? What changes will
improve the results? What efforts are needed to effect these changes?
Chief Financial Officer Revenue and Productivity. How much revenue are we generating from efforts to control specific
conditions? Specialist revenue vs. primary care revenue? What is the trend? Where are we losing
revenue due to competition? Reimbursement cuts? Patients not coming in for treatment? Coding
problems?
Costs and Waste. What are the cost of procedures, treatments? Are we wasting any money on
ineffective interventions? Are we wasting money on duplicate efforts?
Capital Decisions and Funding. Do we have facilities set up to achieve better results? How about
equipment and supplies to support this?
Pay for Performance (P4P). How are we doing against contract targets? What economic impact does
this have for purchasers?
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 4: Analytical Applications
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Patient Registries
Outcomes Analysis
Clinical Quality Reporting
Epidemiology Support
Clinical Trials Support
Care Management Support
Case Management Support
Clinical Guidelines Support
Patient Safety Reporting & Analysis
Disease Management
Physician Report Cards
E&M Coding Utilization
Revenue Cycle Management
Strategic Planning
Demand Prediction, Volume Analysis
Claims Analysis
Service Lines Analysis
Public Reporting
Reusable Compliance Reporting
P4P Pay-for-Performance Contract Fulfillment
Lean / Six Sigma Support
Value Stream Design
Operations Statistics
Efficiency & Cost Control
Staffing & Scheduling Analysis
Marketing / Sales Support
Access and Outreach Analysis
Clinical Applications Financial Applications
Operational Applications
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 4: Analytical Applications
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Enterprise Applications Specific Applications
Balanced Scorecards
Benchmarking
Long-Tail Analysis
Constraint-Based Decision Support
Accountable Care Organization (ACO) Analysis and Reporting
Health Information Exchange (HIE) Analytics
Regional Health Information Organization (RHIO) Analytics
Retail Clinics Analytics and Information Integration
Medical Tourism Analytics and Information Integration
Meaningful Use Incentives Capture
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 5: Using Analytics
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Selling the BI Concept to Your Organization
Champions
Compelling Business Questions
Show People a Brighter Future and the Path to Get There
Keep Selling the Concept
Project Roadmap
Systems Development Life Cycle (SDLC)
Ralph Kimball Methodology
Bill Inmon Architecture
Planning, Requirements, Design, Test, Implement, Support, etc.
Keep Selling the Concept
Marketing the Application
Tips
Tours
Internal Case Studies
Strategy for Phase 2 and Beyond
Vision for BI
Keep Selling the Concept
© 2011 The Center for Business Innovation and Resource Management Professionals
Step 6: Delivering Benefits by Supporting...
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Increased Demand for Services
Redesigning Care Models
Redesigning Treatment Mixes
Streamlining Patient Handoffs
Creating Facilitation Roles
Implementing Case Management
Resource Shortages
Multi-disciplinary Teams
Standardization
Physician Alignment Strategies
Compliance Requirements
Reusable Compliance Databases
Chief Compliance Officers with Staffs
Compliance Governance
Financial Pressures
Aggressive Revenue Cycle Management
P4P
New Services, Extended Hours, Franchising
Reducing Readmissions
Checklists, timeouts
Lean, process redesign
Reducing Physician Preference Items (PPI)
Performance Contracts
Outsourcing and Offloading
Increased electronic information and workflow
Vertical and Horizontal Integration
Retail, quick and one-stop clinics
Telehealth methodologies
Mergers, joint ventures, divestitures
Standalone urgent and emergency services
Leading ACO formation
Cooperatives
Health Information Exchanges (HIEs)
© 2011 The Center for Business Innovation and Resource Management Professionals
Six Steps to Healthcare BI Success
Strategic drivers for analytics specific to your organization
Business responses to address these challengesThis step usually missed
Analytical questions behind these business actions
Translating analytical needs into clinical, operational, financial and enterprise-wide business intelligence applications
Making BI and analytics part of the new normal for the organizationThis step also usually missed
Linking analytics back to the strategic drivers and delivering benefits
Page 22
© 2011 The Center for Business Innovation and Resource Management Professionals
Help you deal with these guys...
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© 2011 The Center for Business Innovation and Resource Management Professionals
Help you deal with these information
demands
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© 2011 The Center for Business Innovation and Resource Management Professionals
Your organization can get back to its
day job
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© 2011 The Center for Business Innovation and Resource Management Professionals
Now, let’s hear from you...
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What do you want to make sure to get outof this conference?
...success stories?
...specific business applications?
...lessons learned?
...other?
© 2011 The Center for Business Innovation and Resource Management Professionals
Scott WanlessTitle: Consultant,
Healthcare Practice Lead,
Resource Management Professionals
Location: Appleton, WI
Phone: 920.585.9630
Email: [email protected]
photo
Book, Articles, University Courses and Presentations on Healthcare Business
Intelligence can be found in: Ark Group Report Business Intelligence and Analytics for Healthcare Organizations
BeyeNetwork (www.b-eye-network.com) Click on Healthcare channel.
BeyeUniversity (www.beyeuniversity.com/topics/business-intelligence/)
Healthcare Data Warehouse Association
World Research Group Predictive Analytics Conference
Patient Safety and Quality Healthcare
Continuing Care News
Healthcare Review
American Health Insurance Plans Coverage
Managed Healthcare Executive
DM Review
CIO Update
BetterManagement.com
The Center for Business Innovation
HIMSS Oregon Chapter
Healthcare Finance Management Association (HFMA)
Midwest Healthcare Business Intelligence Summit
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