Strategies to increase profitability in...

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Strategies to increase profitability in HospitalsDipl. Betriebswirt

Heinz Jörg Schwarz, MS ISGlobal Business Development Director Regional Health, AGFA HealthCare, Mortsel, BelgiumSr. Adjunct Professor, Ageno School of Business, Golden Gate University, San Francisco, CA

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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

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Agenda





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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?

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Outcomes based payments require integrated care

Source: McKinsey

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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

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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)

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March of Progress

Level 1 - MessagingLevel 2 - Sharing

Level 3 - EHRLevel 4 - Analytics

Level 5 – Smart CareLevel 6 – Integrated Care

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AGFA Maturity Model – Integrated Care

Maturity

Level

Objectives Characteristics

1 Messaging • Simple pnt-to-pnt messaging (e.g. email) 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 quality management mechanisms (e.g.

validation, normalization) to ensure that the data is structured and 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 email) 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

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Agenda





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Manage new Service Lines

The Glass is half full,Not half empty

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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,

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Integrated information for Outpatient Care

Specialty Domaini.e. Radiology,

Cardiology,Pathology

Regional Community

RIS/PACSDICOM Archive

DICOMViewer

Clinical Documents

Portal

Image Enabled HIEs-Provide Clinical Information to Radiologists

-Provide Ordering and Results Delivery to Physicians

-Provide an integrated clinical community view (Maturity level 2)

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Integration of clinical documents & imaging

HYDMedia as IHE document consumer

HYDMedia as IHE document consumer + ICIS View

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Pre- and post- acute coordination

Hospital Domain Regional Community

HISXDS-I Archive

DICOMViewer

DCM

Portal (Orion or AGFA OEM)

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

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Patient activation and involvement

Radiology or Cardiology Domain Regional Community

RIS/PACS ICISXDS-I.b

ICIS VIEW

Provider Portal

Value Proposition-Patient Activation & enpowerment

-Regulatory Requirement or condition (such as Meaningful Use)

HYDMediaREM+

Patient Portal

Information FlowInformation Flow

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Post acute integration


Extend Hospital EMR to Community

-Provide Clinical Information and Results to Community Physicians (post acute)-Provide an integrated clinical community view-Prevent early readmissions

ORBIS / HIS HYDMedia

Provider Portal

Information Flow

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Pre- and post acute integration


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)

ORBIS / HIS HYDMedia

Provider Portal

Information Flow

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Clinical and Imaging integration



-Provides Clinical Information, Images and Results to Community Physicians (post acute)



Information Flow

ORBIS ICISXDS-I.b

ICIS VIEW

Provider Portal

HYDMedia

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Patient activation



-Provides Clinical Information, Images and Results to Community Physicians (post acute)



ORBIS ICISXDS-I.b

ICIS VIEW

Provider Portal

HYDMedia

Patient Portal

Information Flow

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Maturity

Level












different locations


care team










6 Integrated

Care



social media,


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Maturity

Level












different locations


care team










6 Integrated

Care



social media,


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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

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Agenda





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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 / 2nd 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!

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Agenda





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Reduce Supply cost

1. Identify Areas of excellence1. Usually requires Business intelligence data 2. Quality Metrics (Clinical outcomes)3. Cost Metrics (i.e. DRG costs)

2. Identify Areas of lower performance1. BI data2. Quality metrics (Clinical outcomes)3. Cost metrics (i.e. DRG cost)

3. Provide Services beyond hospital in areas of excellence1. Leverage quality and cost advantage2. 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 performance1. Leverage other providers superior cost and quality for your patients2. Leverage eHealth Infrastructure to integrate ….

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The New Supply chain within an Integrated care conti nuum

ReferringServiceProvider

ReferringSpecialist

Core Clinical Services

Referring GPS

In-SourcedSpecialist In-Sourced

Service

eHealth IT Infrastructure For integrated Care Delivery,Bundled Payments,Shared Risk/Reward=New Business Model for sustainable growth

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Don’t ask if you can afford to invest in eHealth.

Ask if you can afford not to invest in eHealth Technologies!

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Heinz Jörg [email protected]

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