Download - CHIME College LIVE - The Chartis Group€¦ · CHIME College LIVE How to Define ... Specialty-compatible documentation note templates ... Chart Tracking system 170,000 175,747 Pharmacy

CHIME College LIVE

How to Define, Influence and Drive an EHR Value

Realization Agenda to Support Your Organization’s

Strategic Objectives

Presenters:

Joanne SunquistHealthEast Care SystemSenior Vice President and CIO

Myra AubuchonThe Chartis GroupPartner

August 2016© 2016 The Chartis Group, LLC. All Rights Reserved.

Objectives

Define EHR value realization

Discuss perspectives on how to achieve EHR value realization

Describe the organizational core competencies necessary to be

successful with value realization

Describe how to define, influence and drive a value realization

agenda to support your organization’s strategic objectives


The Promise of EHRs: Tremendous Value PotentialWhen leveraged, the EHR should be integral to achieving your organization’s strategic and operational goals. Real clinical and

operational opportunities can be associated with focused efforts to realize value from EHR investments.

Achievable Benefits

Improve physician and staff

satisfaction

Support safe and successful transitions of care between

settings

Enable adoption of Evidence

Based Medicine

Reduce clinical

denials and improve revenue collection

Improve communicationamongst the care team and between the care team and

patient

Support an efficient and

effective discharge

process

Increase efficiency of ambulatory

visits

Increase adherence to

clinical standards and

protocols

Enable virtual

access to care services

and information

Reduce preventableclinical errors

and readmissions

Improve physician &

staff productivity


“Live” with Your EHR

NowWhat?

Our revenue is back to baseline, but I expected to exceed that!

Wasn’t this EHR supposed to

streamline care and open up some

capacity?

We still can’t seem to identify and manage our sickest patients. I thought that was

our primary objective for this investment.

With MACRA on the horizon, have we built this

system to capture and send the required data?

Our physicians are frustrated that it

takes longer to see their patients now.


What is EHR Value Realization?

Value Realization:

Leveraging the EHR to achieve the next level of efficiency, cost management, quality, or experience through quantifiable clinical, financial and operational improvements.

Optimizing the technology alone will not bring significant value. Value is achieved when technical and operational performance teams share the value agenda.

Comprehensive EHR systems are significant investments with a great deal of promise to add value, improve clinical quality, and enrich the care experience.

Organizations are looking for a comprehensive, renewable and sustainable approach to value realization.


Optimization vs. Value RealizationExample: an “at Capacity” ENT Group Practice

Chief complaint drop-down list refined to mirror patient

mix

Specialty-compatible documentation note templates

Physician-specific, drop-in text (smart text)

Improved data-carry-forward functionality

Hot links to frequently used documentation tools

Physician-led development of documentation standards

Physician, peer-based audit and feedback loop established to maintain and improve documentation standards

Scribe policies, workflows, and training plans implemented

Patient check-in and check-out staff roles expanded to include tablet-based pre-visit questionnaires and distribution/review of after-visit summaries

Improved efficiency by modifying technology build and functionality in support of current clinical workflows

Changes to care team roles and responsibilities and clinical workflows to achieve additional improvements in efficiency and patient experience

Improvements to system build and configuration

An Optimization approach focuses on EHR system build

and configuration

A Value Realization approach focuses on improving clinical and operational workflows in

tandem with EHR system build and configuration

Benefit ImpactStreamlined documentation reduced visit times by 2.25 minutes, resulting in 750 additional patient visits per year contributing to significant downstream perioperative, ancillary and other system revenue.


Your EHR: An Underperforming Organizational Asset

Technologies to support care delivery are no different that

any organizational asset, they require leadership

commitment to both maintain and expand; otherwise they

face stagnation and underperformance

Unlike fixed assets that increase volume, improve quality

and reduce capacity constraints, EHR technology, as a value-

generating investment is not always easy to track

Deriving value from technology depends on operational

ownership and a planned approach; quantified benefits must

be identified, built into process / system design and

monitored

Although operational and clinical leadership accepts accountability to drive value from costly organizational assets; those same

leaders often do not exhibit the requisite accountability for their EHR, even though the magnitude of that investment supersedes

most others.

Organizations must

build an EHR Value

Realization Agenda –

a strategic and balanced

portfolio of qualified

projects producing tangible

economic benefit which can

be re-invested to grow this

strategic asset.


Value Realization Agenda

Comprehensive, long-term and renewable

agenda

Aligned with organizational strategies to

maximize organizational value

Targeted, qualified and measurable clinical

and financial outcomes

Balanced short- and long-term returns; total

portfolio value calculated and tracked

Funds functional operating and capital costs

year-after-year

Funds growth and renewal year-after-year

Ownership and oversight by multi-disciplinary

clinical, financial and operational leadership

Clinical Quality &

Effectiveness

Provider Engagement

& Satisfaction

Clinical &OperationalEfficiencies

Organizational Growth

Reporting and Regulatory

ImprovedRevenue

ApplicationRationalization

Physician Documentation

EHR ValueRealization

Agenda

Documentation Standards

Peer-Review and Audit

Streamlined workflows

Optimized Content and Data Visualization

Ambulatory Throughput

Service line Redesign

Physician Productivity

Connected Community

Extending EHR to newly acquired partners

MU 3 CMS MACRA Payors

CDI Centralized

Access Pre-Admission

Testing

Vendor Selection

Sunsetting Legacy Systems

Service Line Planning

Care Management Clinician

Communications

Date© 2016 The Chartis Group, LLC. All Rights Reserved.

HealthEast’s Value Realization Agenda


The Starting Line or the Finish Line?Total Cost of Ownership for decision-making on EHR investments clearly identify areas of planned savings and cost avoidance. ROI

on the initial investment is critical. Value realization is the next step in the journey.

In addition to cost avoidance and savings, EHR value realization is a broader definition that includes both qualitative and

quantitative outcomes tied to organizational strategies. Revenue generation, cost avoidance and risk mitigation all are key results

that can be achieved.


EHR Sample ROI Analysis (7 Year)

EHR Cost Benefit Analysis (7 Year) PROJECTED ACTUALTotal Total

REVENUE SAVINGS

Clinical Staff Utilization - reduced nursing overtime 222,000 -

NonStaff Clinical Utilization 3,036,000 -

Unnecessary Radiology Tests 2,278,000 2,426,691

Unnecessary Laboratory Tests 1,498,000 -

Document Imaging 2,377,450 2,018,631

HIM Staffing 5,718,700 8,908,224

Off site Record Storage/Recall 3,014,000 3,789,271

Reduction in Transcription 9,073,000 8,805,453

Charge/Order Entry Staffing- HUC 2,085,000 1,216,788

Redundant Prescriptions 1,082,000 -

Order Entry Pharmacy Staff Reduction 657,000 -

Therapeutic Substitution 390,000 -

APC Improvement 1,531,000 845,000

Scheduling Productivity 905,000 -

Clinic Revenue 4,249,700 4,149,115

Consulting Outsource Cost Avoidance 938,000 2,077,047

Denials/POS Collection 36,130,100 27,033,356

SUBTOTAL BENEFITS 75,184,950 61,269,576

OPERATING COST AVOIDANCE

Legacy Billing System 5,762,282 4,811,648

IT Salary 14,171,769 13,825,499

Mainframe 14,017,948 19,037,246

ADE's 2,241,000 21,758

CDR 2,461,000 2,481,756

Unnecessary Laboratory Tests 1,846,000 -

Charge/Order Entry Staffing 1,437,000 1,256,000

Chart Tracking system 170,000 175,747

Pharmacy 796,000 281,491

Rad System 626,000 445,134

OR System 370,000 173,635

ED System 1,132,000 698,159

Surg Nav - 224,936

SUBTOTAL OPERATING COST AVOIDANCE 45,030,999 43,433,010

INTEREST INCOME

A/R Reduction (interest income) 1,009,000 414,000

DNFB Reduction (interest income) 932,000 383,000

SUBTOTAL INTEREST INCOME 1,941,000 404,000

TOTAL EHR BENEFITS 122,156,949 105,106,586

Capital Costs 68,057,023 61,189,298

Ongoing Operational Costs 43,392,470 49,266,186

TOTAL COSTS 111,449,493 110,455,484

NET SAVINGS 10,707,456 (5,348,899)

The Majority of EHR Value Realization Occurs After

Implementation


Create a Value Realization Agenda Starting with Organizational Priorities

HealthEast’s Vision: Optimal health and well-being for our patients, our communities and ourselves.

HealthEastStrategic Themes

Operational Goals Success Drivers

------- ------- -------

Leading Practices

Re-Imagine & Grow Primary Care

Clinically Integrated Network Development

QuantifiedBenefits Effort

------- ------- -------

------- ------- -------

------- ------- -------

Growth in Net Revenue and Cash

Neighborhood Integration


Strategy Linked to Value RealizationSample EHR Value Realization Projects

Implementation of Care Management

Functionality (Registries, Workflow)

Risk Bearing Analytics

Establish Care Management Capabilities

Neighborhood Integration

Re-Imagine & GrowPrimary Care

Clinically Integrated Network Development

EHR Enhancements to Support Access

EHR Integration with Contact CenterRedesign Primary Care Delivery Model

Elimination of Legacy Systems Costs

Revenue Cycle System EnhancementsDevelop “Medicare Break Even” Model

Growth in Net Revenue and Cash

Patient Portal, Virtual StrategyDesign and Launch Neighborhood Initiative

Strategic Themes Strategic Initiatives EHR Value Realization


Example: Re-Imagine and Grow Primary Care

Primary Care

Workstreams Initiatives

Care Management Integrated care management model including populations of intervention with care guidelines and protocols

Care Team Care Team re-design and implementation of supporting tools, training, technology

Leadership visual controls

Access Standards for provider time away

Provider time and capacity – normalized expectations for FTE and hours; standardization of contact hours

Template re-design

Care Connection (Contact Center)

Provider and Patient profiles (i.e., improve scheduling accuracy and ease)

Care Connection/Clinic Partnership Council; local-level decision-making body

Communications between Care Connections and primary care clinics

Re-Imagine & GrowPrimary Care

Redesign Primary Care Delivery Model


An Integrated ApproachThe true integration of clinical and operational performance improvement with EHR value realization is a powerful accelerant for

moving provider organizations along the benefit curve.

Two Dimensions to this Work:

Governance

Clinical &Operational Leadership

ChangeManagement

Informatics & ContinuousImprovement

IT Services

Reporting &Analytics

High ImpactOpportunitiesPerformance

Improvement

EHR Redesign


Prioritize through a Strong Governance StructureOperational ownership is key; it is essential to have a governance model that delivers the structures, processes and feedback loop

needed for organizations to make the effective decisions at the appropriate levels by the people most informed to make those

decisions.

PIC CLICClinical Councils

Rev CycleBusiness Systems

Analytics

ELT

ISBGB

EAC

HIC

OSOC

CSS Group

NIC

Others

Sched/Reg

HIM

Board for Intake Review (BIR) + Resource Board (RAB) + Security & Architecture Review Board (SARB)


Sample Optimization/Project WorkflowIntegration with Service Management System Important for Tracking

Governing body

assesses request

Governing body

assesses request

ANALYTICS

Governing body assesses/

ranks request

BIR /SARB /RAB define preliminary

scope

ISBGB reviews and prioritizes

Work request submitted

Governing body informed

OPTIMIZATIONS

PROJECTS

BIR validates request and distributes request to appropriate

governing body

Denied

Project into Intake Process

Complete requirements,

design, reviews

Active Project

Project completed

Project On Hold

Project Withdrawn

Approved

PROJECTSINTAKES/REQUESTS


Re-Imagine and Grow Primary Care Planned Outcomes

Metrics Definition Goal

Lives served Number of unique lives seen in 18 months 350,000

Financial health Operating margin (net margin/cFTE) At or above top quartile

% visit requests are seen on day requested

Number of patients who request care on same day (or next day after 5pm) and are seen that day

90% of requests

Avg. panel size per physician (right sizing)

Total number of unique MRNs by provider within 18 months (normalized to 1.0 FTE)

>3,500

Likelihood of recommending practice

% of patients who responded in the top box to the “likelihood to recommend” question

At or above 95th percentile

Staff and provider satisfaction

Staff and provider voluntary turnover <8%

Positioned for MACRA bonus# of quality metrics in the top quartile of CMS performance

MACRA metrics in the top quartile


How do you define and influence your organization’s definition of EHR value realization and build and execute upon a value agenda?

1. Assess strategic priorities and understand how you can

leverage your EHR to support the strategies

2. Develop a value realization agenda, a portfolio of

projects that are approved, monitored and operationally

led

3. Quantify and deliver on those opportunities; earmark

returns for ongoing EHR investment

4. Tell your story and showcase successes in initial

paybacks and the year-over-year value realization

agenda


Questions


Contact Us

Joanne Sunquist [email protected]

Myra [email protected]