Profit, Ethics, and Quality For health care organizations that aim for excellence

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Background ► What the patients say  Over 70% see access to their complete health record as important  Over 80% see access to quality of care data as important  Over 80% see access to cost of care data as important

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Background Continued ► What is important to patients  Transparency in clinical data  Transparency in quality of care  Transparency in costs Most patients want to understand their health and want to be able make intelligent choices about it. They want to know their health, quality of their providers, and what is the cost.

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Path to excellence ► What needs to be done  Healthcare must be more effectively managed  Healthcare must integrate quality controls  Healthcare costs must be transparent ► There are three essential elements

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC What they are? ► Quality  Commitment to excellence ► Ethics  Commitment to integrity ► Profits  Profits ensure sustainability Quality ProfitsEthics

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC How do they relate? ► Quality is a measure of compliance and measuring ensures organizational integrity ► Profits come from continuous process improvement possible by measuring quality ► High quality depends on organizational profitability

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Quality is not a mystery ► Quality is quantitative  Quality plan defines metrics and methodology  Each metric must be quantifiable ► Quality is part of BPI  Measuring compliance is an essential part  Measuring frequency ensures continuity  Six-Sigma methodology uses DMAIC  Definition and Measurement are critical ► Quality Metrics  Clinical outcomes  Customer experience  Operations

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Ethics is measurable ► Patient Expectations  Qualified and caring personnel  Clinically sound treatment  Clean and safe environment  Efficient and correct operation ► Expectation Basis  Common expectations about a health facility  Facility specific marketing materials ► What is ethical?  To have processes in place that ensure that both implicit and explicit patient expectations are met.

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Profit is not a bad word ► Profit is the cost of efficiency  Profit attracts both capital and talent  Profitable operations are better managed  Profitable operations are more efficient ► Profit focus concerns  Quality will be sacrificed to save costs  Short term cash flow consideration will result in long term increase in costs ► Profit focus opportunities  Resources to develop and sustain quality  Resources to implement process improvements

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Role of Quality Control ► Ethical Profit Assurance  Quality plan describes goals  Quality control measures goal compliance  Compliance drives process improvement  Process improvement increases profits ► BPI, Six-Sigma  Multiple acronyms, similar concepts  DMAIC – process outline  Quality control is the foundation  Definition and Measurement are critical DefineMeasureAnalyzeImplementControl

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Quality and Measurements ► Quality Plan Content  Defines what is the desirable process using metrics  Metrics may be qualitative and quantitative  Grading is used to translate qualitative to quantitative  Quality plan includes schedule of measurements (surveys) ► Using Quality Plan  Manual survey entry either direct or indirect  Automated data load from transaction system  Analysis of results is used for process improvement

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC QC and Focus ► Pareto Chart  Shows frequencies of discrepancy type in descending order  Minority of discrepancies types cause majority of discrepancy instances ► Control Diagrams  Focus on facilities that are outliers ► Risk Tables  Focus on high risk areas first

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC How BPI pays for itself ► A simple example  Profit = Revenues – Costs  Example: ► Revenue $110, Costs $100 => Net is $10 ► Revenue $110, Costs $90 => Net is $20  By decreasing costs by 10% we increased Net by 100% ► Business Process Improvement  Focus on processes  Activity Based Costing  Core capabilities and outsourcing

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Sustainable Healthcare ► Profit and Ethics require Quality Plan ► Quality control improves processes ► Healthcare without profit will lose quality ► Healthcare without quality control will lose integrity

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC Q & A ► Questions? ► Comments? ► Next Steps?

Relevant Metrics - Readily Available Copyright 2007 Pragmate, LLC About Pragmate ► Founded in 2007  To provide business process improvement software for health care  To provide consulting services for health care organizations  Our business model is to provide Software as a Service (SaaS) ► Expertise  In health care management  In development of robust commercial software  In application of modern management technology ► Products  PE-1 Efficiency and Performance Business Intelligence  QC-1 Quality Assurance and Compliance Metrics ► Services  Retail clinic standard operating procedures development  Health staff development and training