#HASummit14 Bobbi Brown, Vice President of Financial Engagement, Health Catalyst John Henderson, Director of Enterprise Systems, Texas Children’s Hospital Leslie Hough Falk, Vice President, RN, Health Catalyst Session #22 Getting an ROI in Your Programs

#HASummit14 Learning Objectives 1. Understand the value of establishing a Goal and Aim Statements and how to develop them. 2. Learn how to determine ROI in your initiatives  Know the ROI formula  Understand the three categories of waste that will help you determine where possible gains can come from  Define and distinguish between direct and indirect benefits 3. Learn how to effectively communicate your results using an Agile ROI/communications framework 2

#HASummit14 Learning Objective # 1 Understand the value of establishing a Goal and Aim Statements and how to develop them 3

#HASummit14 Poll Question 1 Does your organization require a Goal and Aim Statements for all of its improvement initiatives? a) Never b) Not often c) Sometimes d) Frequently e) Always f) Unsure or not applicable 4

#HASummit14 Goal and Aim Statements What is a Goal?  A Goal is an explicit description of your long term objective What is an Aim Statement?  An Aim Statement is an explicit description of the individual projects that will help you achieve your Goal Current baselines help with establishing a Goal and Aim Statements Agile approach: Goal and iterative project Aim Statements 5 How will you know if you’re successful? SMART How do you develop Goals and Aim Statements? Think SMART. Specific Measurable Attainable Relevant Time Based All improvement initiatives need a Goal and Aim Statements

#HASummit14 Goal and Aim Statements Examples Goal: To achieve and sustain a 20 percent reduction in 30-day all cause readmission rates for patients with heart failure (HF) by (date), and sustained reduction in readmission rates through fiscal year XX, while lowering the CMS penalties by X percent. Sample Aim Statements: Aim #1 Aim #2 Aim #3 Aim #4 Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients by (date). Identify high risk heart failure patients and extend the identification of these patients to a risk stratification model to predict the likelihood of all cause 30- day readmission rates by (date). Schedule a follow-up appointment for all HF patients within 24 hours of discharge with a focus on high risk patients being seen within hours after discharge by (date). Establish a medication reconciliation baseline and track compliance in order to achieve 75% compliance by (date).

#HASummit14 Poll Question 2 and 3 On a scale of 1 to 5, with 5 being the highest, how would you rate this Aim Statement, “To reduce 30- day all cause readmission rates?” On a scale of 1 to 5, with 5 being the highest, how would rate this Aim Statement, “To establish a baseline C-Section rate and validate data by (date)?” 12345

#HASummit14 Evaluating Aim Statements  To achieve and sustain a 30 percent reduction in 30- day all cause readmission rates.  To improve patient care.  To establish a baseline C-Section rate and validate data by (date).  To improve variation in outcomes, while lowering our costs.  None. Group unable to come to consensus. 8 What’s good and what could be improved?

#HASummit14 Goal and Aim Statement Team Exercise Scenario: You live in California and you have decided to take your family of three persons for a visit to your grandparents in New York for seven days in June, You’ve allocated a budget of $5,000 to cover all of your expenses. After the vacation you want a thumbs up rating from your family. Exercise: Using SMART principles  Define your Goal  Develop 3-5 project Aim Statements that will help you achieve your Goal 9

#HASummit14 Goal and Aim Statement Team Exercise Goal: To take my family of three to visit my grandparents in New York for seven days in July, 2015, within a budget of $5000, and with a thumbs up rating from my family, two days from when we return home. Sample Aim Statements : Aim #1 Aim #2 Aim #3 Aim #4 Talk with my grandparents and my family about possible dates that work best for them in July, 2015, by (date). Investigate transportation options and transportation costs between California and New York — with date options determined from Aim #1 —by (date). Review optional day trips and excursions within two to three hours from my grandparents home, including features and costs — and understand my grandparents and family’s preferences — by (date). Establish — and gain alignment with my family — on a budget allocation, including transportation, lodging, meals, excursions, gifts and misc. items by (date).

#HASummit14 Learning Objective # 2 Learn how to determine ROI in your initiatives 11 Know the ROI formula Understand the three categories of waste that will help you determine where possible gains can come from Define and distinguish between direct and indirect benefits

#HASummit14 Poll Questions 4 and 5 4.How often does your organization include finance as part of its multidisciplinary improvement teams? a) Never b) Not often c) Sometimes d) Frequently e) Always f) Unsure or not applicable 12 5.Does your organization currently measure ROI in its improvement initiatives? a) Never b) Not often c) Sometimes d) Frequently e) Always f) Unsure or not applicable

#HASummit14 ROI Formula 13 ROI100% (TOTAL BENEFIT) (COST OF BENEFIT) =x - COST OF BENEFIT

#HASummit14 Ordering WasteWorkflow WasteDefect Waste Ordering tests, care, substances and supplies that do not add value Variation in efficiency of delivering tests, care and procedures ordered Patient injuries incurred in delivering tests, care and procedures ordered 14 Where To Find Benefits

#HASummit14 Direct and Indirect Benefits Direct Benefits Enhanced efficiency and productivity Examples: reductions in FTEs or less overtime; business process improvement; supply chain standardization allowing lower supply costs; increased departmental capacity; and reductions in capital expense Clinical improvement and waste reduction Examples: lowering LOS; reductions in uncompensated hospital readmissions; lower medication cost per case or per capita; fewer ICU days; and patient safety improvements leading to fewer complications or medical errors 15 Indirect Benefits Can be more difficult to measure Longer-term benefits Examples: an improved medical outcome such as a reduction in future hospitalizations associated with neonatal respiratory distress syndrome (RDS), which will require long-term analysis to reveal an impact on costs; shared savings with payer associated with pre-term delivery rates; the opportunity cost of not purchasing a point solution

#HASummit14 Show Me the Money Exercise Scenario: The radiology operations team lost access to their analytics metrics for three years after they deployed their EHR. They now have an EDW and lots of metrics — including measurements like cycle times and referrals — but they didn’t start out with Aim Statements. Now they are trying to define their ROI. … Department operations manager, IT and finance conversation 16

#HASummit14 Sample Visualization 17 Cycle times

#HASummit14 Sample Visualization 18 Results turnaround times

#HASummit14 Sample Visualization 19 Outbound referral rates over time

#HASummit14 Sample Visualization 20 Order Pareto

#HASummit14 Sample Visualization 21 Anesthesia utilization

#HASummit14 Show Me the Money Team participation… do you have some ideas on potential benefits? 22

#HASummit14 Show Me the Money Benefit Examples RevenueWaste ReductionEfficiency/ Productivity Savings Opportunity or Indirect Savings Referral leakageOrdering: Anesthesia usage; Appropriate use of imaging technologies (e.g. Chest X-Ray for asthma patients) Reductions associated with manual report(s) data gathering, creation and distribution Replacement and/or not purchasing a point solution (initial layout and maintenance costs) LOS reduction (assuming demand is an issue)— additional throughput Workflow: Improved TAT from diagnosis  surgery or treatment (better outcomes); Time to read/diagnosis/ update in EHR (e.g., ED patient) Management gains from automated, integrated reports and ability to easily leverage the information into presentations Improved patient satisfaction due to improved turnaround time (TAT) Reduction in billing time/AR Defect: Number of repeat exams due to image quality; Hospital associated infections Reductions in overtime and contract work with appropriate resource planning Improved employee satisfaction from using data for resource planning Contract with payers/shared savings 23

#HASummit14 Show Me the Money Benefit Examples RevenueWaste ReductionEfficiency/ Productivity Savings Opportunity or Indirect Savings Referral leakageOrdering: Anesthesia usage; Appropriate use of imaging technologies (e.g. Chest X-Ray for asthma patients) Reductions associated with manual report(s) data gathering, creation and distribution Replacement and/or not purchasing a point solution (initial layout and maintenance costs) LOS reduction (assuming demand is an issue)— additional throughput Workflow: Improved TAT from diagnosis  surgery or treatment (better outcomes); Time to read/diagnosis/ update in EHR (e.g., ED patient) Management gains from automated, integrated reports and ability to easily leverage the information into presentations Improved patient satisfaction due to improved turnaround time (TAT) Reduction in billing time/AR Defect: Number of repeat exams due to image quality; Hospital associated infections Reductions in overtime and contract work with appropriate resource planning Improved employee satisfaction from using data for resource planning Contract with payers/shared savings 24

#HASummit14 Best Practice Example Leveraging your EDW to its fullest capacity  Quality improvement includes clinical areas AND operations  Organizational transformation and governance  Establish baselines  Measure results 25 Maximizing the ROI of your EDW Results 67% average savings on labor costs Average time to build reports declined from 97 hours to under 30 hours 1 EDW report = 10 EHR reports 25% faster turnaround on remaining EHR reports

#HASummit14 Sample Outpatient Volume Analytics 26

#HASummit14 Sample Radiology: Operational Performance Analytics 27

#HASummit14 Sample Outpatient Women’s Clinical Performance Analytics 28

#HASummit14 Reflection What did you learn about Aim Statements? How will you use the ROI learnings in your organization? What best practices do you have to share from your organization? …

#HASummit14 30 Excel document

#HASummit14 Learning Objective # 3 Learn how to effectively communicate your results using an Agile Outcomes/ROI and communications framework 31

#HASummit14 Outcomes/ROICommunications Measuring and Communicating Your Results Stakeholder Adoption, Leadership  Start with a core group (most enthusiastic and influential, “coalition of the believers”)  Paint a vision of the future to meet objections (e.g., what is the impact to my job)  Use governance bodies and management teams expand reach (“tops down”) Efficiency or Improvement Initiatives Efficiency Quick wins High ROI Improvement Core to health system mission Most easily communicated External Communications Webinars and speaking events Authored papers Awards External success stories Publications Analysts Platform Core installation and platform fools Use agile, small wins approach Document baselines and improvements Internal Communications SharePoint Internal success stories and presentations communications Roadshow and summit communications Stakeholders

#HASummit14 AccomplishmentsNext StepsIssues / Help needed Cardiovascular: Heart Failure Date: [complete] Overall Status Risks and Uncertainties Recruit /TrainKickoffAIMInterventionRollout planResults Month Year Month/Year Leadership team Mission, charter, roles confirmed Review draft cohort and data Finalize cohortDefine rollout planReview initial results Content and Analytics Leader Review Aim options Data quality issues identified Identify intervention(s) Guidance team validation Implementation plan adjusted Guidance team Best practice gathering Direct observation Solicit front-line plan input Review lessons learned Workgroup team Profile prelim. data and cohort Prioritize, select AimSolicit front line inputFinalize rollout planCreate Aim #2 Training workshop2-3 Aim candidates Additional cohort criteria Analytics dev & test Guidance team validation Repeat process Guidance team validation Project Progress Key Not started In process Done well Some concerns Strong concerns Goal To achieve and sustain a 30% reduction in the 30-day all cause readmission rates for patients with heart failure by November 2016, and sustained reduction in readmission rates through fiscal year 2018, while lowering the CMS penalties by X percent. Sample Aim #1 Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients. Launch/Rollout date : XX Key Success and Financial Measures TargetActuals Readmission rates: 30-day% Balance measures: ED visits and observation stays# Intervention compliance rates% Project costs (e.g., resources, travel, healthcare care analytic apps …)$ Opportunity costs (e.g., not purchasing a Point Solution, no reduction in Medicare reimbursements …)$ Direct benefits: productivity (e.g., previous manual data pulls…); waste reduction (e.g., length of stay….)$ Indirect benefits (e.g., patient satisfaction…)$ Long term project ROI%

#HASummit14 Analytic Insights A Questions & Answers

#HASummit14 Session Feedback Survey 35 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 3.On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 2.What feedback or suggestions do you have?

#HASummit14 Upcoming Keynote Sessions 2:20 PM – 3:10 PM 23.Predictive and Suggestive Analytics Dale Sanders Senior Vice President, Health Catalyst 3:25 PM – 4:25 PM 24.From The Heart: Healthcare Transformation From India To The Cayman Islands Dale Sanders Senior Vice President, Health Catalyst Chandy Abraham, MD Chief Executive Officer, Director of Medical Services Health City, Cayman Islands Gene Thompson, Health City Director, Director of Thompson Development, Ltd. 4:15 PM – 4:45 PM 25.Closing Keynote Dan Burton, Chief Executive Officer, Health Catalyst 36 Location Main Ballroom