Confidential — For Internal Use Only 1 Truven Health Analytics Puerto Rico Summit 2015 Patti Medvescek, MT ASCP, MPA August 13, 2015 Finance and Clinical Services Collaboration Aligning Hospital Resources to Save Costs

Confidential — For Internal Use Only 2 Truven Health Analytics Puerto Rico Summit 2015 Objectives 1.Identify key success factors for using benchmarks in the budgeting process. 2.Gain knowledge about tools used to successfully maintain on- target performance. 3.Review results from the continuous monitoring process used by Indiana University Health facilities. 2

Confidential — For Internal Use Only 3 Truven Health Analytics Puerto Rico Summit 2015 Admissions 136,371 Outpatient Visits 2,638,074 Employees 29,395 Staffed Beds 3,098 Physicians 2,111 FY 2014

Confidential — For Internal Use Only 4 Truven Health Analytics Puerto Rico Summit 2015 Indiana University Health Facilities reporting in Action O-I  IU Health Methodist  IU Health University  IU Simon Cancer Center  IU Health West  IU Health North  IU Health Arnett  IU Health Ball Memorial  IU Health Bloomington  IU Health Goshen

Confidential — For Internal Use Only 5 Truven Health Analytics Puerto Rico Summit st Upload 2002 Focused Staffing 2005 Benchmarks Compared to Budgets 2006 Department Engagement 2008 Budget process Integration 2010 Timeline

Confidential — For Internal Use Only 6 Truven Health Analytics Puerto Rico Summit 2015 Benchmarks used to determine budgets – all flexing centers 2013 Benchmarks used to determine budgets – all centers 2015 Timeline

Confidential — For Internal Use Only 7 Truven Health Analytics Puerto Rico Summit 2015 The Budget Process  Budget Pre-Work  Budget Open  Budget Reviewed  Negotiations begin 7

Confidential — For Internal Use Only 8 Truven Health Analytics Puerto Rico Summit 2015 Adding The Benchmarks Within Finance Compared budgets to benchmarks Review for outliers

Confidential — For Internal Use Only 9 Truven Health Analytics Puerto Rico Summit 2015 The Process : A Review  1 st : Budgets  2 nd : Benchmark reports  3 rd : Organizational Change

Confidential — For Internal Use Only 10 Truven Health Analytics Puerto Rico Summit 2015 Improving the Process  Added Clinical Management Review Meetings  Skill Mix reports  Volume Confirmation  Characteristic Surveys  Compare Group Facilities  Benchmarks accepted by Clinical Leaders

Confidential — For Internal Use Only 11 Truven Health Analytics Puerto Rico Summit Budget CCCC Description 2016 DaysD HPPD W HPPD50th HPPD Variance HPPD Variance Impact FTEs Impact A7 SOUTH-ONCOLOGY MH 4, (0.54) (2,666) (1.28) YELLOW ROSE B6 MH 2, A7N SOLID ORGAN TRANSPLANT MH 6, A6 SOUTH FAMILY PRACTICE MH 14, (1.45) (20,928) (10.06) NEUROSCIENCE NURSING MH 10, , Summary Report : All Units Planned Performance to Benchmarks

Confidential — For Internal Use Only 12 Truven Health Analytics Puerto Rico Summit Finance and Clinical Services A Collaborative Effort

Confidential — For Internal Use Only 13 Truven Health Analytics Puerto Rico Summit 2015 Continuous Improvement  Budget Training  Benchmark Review  Biweekly monitoring  Incorporating benchmarks in budgeting process

Confidential — For Internal Use Only 14 Truven Health Analytics Puerto Rico Summit 2015 The Budget Process 1.Budget Calendar 2.Roll Out Budgets 3.One on One Meetings 14

Confidential — For Internal Use Only 15 Truven Health Analytics Puerto Rico Summit 2015 Tools for Budgeting  Historical Performance  Benchmark reports  Staffing Grids (the budget)

Confidential — For Internal Use Only 16 Truven Health Analytics Puerto Rico Summit 2015 Biweekly Performance Reports  Visionware 6 Pay Period Trends  Performance to current target  Overtime Utilization  Volume trends 16

Confidential — For Internal Use Only 17 Truven Health Analytics Puerto Rico Summit 2015 Visionware 6 PP Trend 17

Confidential — For Internal Use Only 18 Truven Health Analytics Puerto Rico Summit 2015 Benchmark Reports  Custom Comparison Report  Department Statistics  Skill Mix  Labor Productivity 18

Confidential — For Internal Use Only 19 Truven Health Analytics Puerto Rico Summit 2015 Benchmark Reports 19

Confidential — For Internal Use Only 20 Truven Health Analytics Puerto Rico Summit 2015 Benchmark Reports 20

Confidential — For Internal Use Only 21 Truven Health Analytics Puerto Rico Summit FTE Detail Grid UH RH Neurophysiology Starting Assumptions Target 2015 % Mix Procedures Proce dures Procedures100.0% 5, Direct Care Hours per Unit of Service (Weighted Average) Fixed FTE Units of Service 5,773 4,698 Var/ Fix Position Variable Fixed Mtg/Edu Orient. Prod. FTE Non. Calc Total Prod. FTE F C1178Coord - Neuro Clin Education F C343Coord-Intraoperative Neuro F C496Technol-Neurodiagnostic I V C500Technol-Neurodiagnos III-IONM V C628Technol-Eeg-Flat Rate F C687Technol-Neurodiagnostic II Total , Budget Request Direct Care FTE needed: th %ile Ftes Check should = zero (0.00) Variance th %ile FTEs Variance th %ile FTEs Variance 3.41

Confidential — For Internal Use Only 22 Truven Health Analytics Puerto Rico Summit 2015 The New Budget Process  One on One meetings  Finance and Clinical Services  Real Time Revisions  Discussions about staffing changes  Impact  Implementation  Realistic goals 22

Confidential — For Internal Use Only 23 Truven Health Analytics Puerto Rico Summit 2015 End Result Budget review and approval complete – in one day. 23

Confidential — For Internal Use Only 24 Truven Health Analytics Puerto Rico Summit 2015 For the first time, nursing managers could SEE the impact of their changes immediately. Knowing that they were accountable for meeting their targets – they were very interested and very serious about this process.

Confidential — For Internal Use Only 25 Truven Health Analytics Puerto Rico Summit 2015 What Didn’t Change  Finance provided the volumes and historical data  Staffing grids used to quantify productivity  Clinical leadership actively involved

Confidential — For Internal Use Only 26 Truven Health Analytics Puerto Rico Summit 2015 What Did Change  Direct connect Finance -> Clinical Services  All tools available during process  Focus on accountability

Confidential — For Internal Use Only 27 Truven Health Analytics Puerto Rico Summit 2015 What Didn’t Work So Well  Group meetings  Individual discussions lost in the process  Focus on outcomes lost in the process  Lack of collaboration

Confidential — For Internal Use Only 28 Truven Health Analytics Puerto Rico Summit 2015 The Tools We Used  Benchmark reports  Productivity reports  Finance 101 curriculum  Daily staffing tools 28

Confidential — For Internal Use Only 29 Truven Health Analytics Puerto Rico Summit 2015 Finance 101 Curriculum  Benchmarks, Budgets and Income Statements  Staffing and Scheduling  Productivity  Advanced Staffing and Scheduling

Confidential — For Internal Use Only 30 Truven Health Analytics Puerto Rico Summit 2015 Daily Staffing Tool  Tool for nursing unit managers on a day to day level.  Staff hours entered  Patient census entered  Calculated variance to target (Red/Green) by 4 hour shift, by day and by pay period

Confidential — For Internal Use Only 31 Truven Health Analytics Puerto Rico Summit 2015 Conclusion  Finance and Clinical Services are working together.  Finance = pre-work,  Clinical Services = acuity, staffing patterns

Confidential — For Internal Use Only 32 Truven Health Analytics Puerto Rico Summit 2015 The Impact for Our Customers: “The partnership with finance and nursing has helped us build a budget and operational plan that is realistic and obtainable-with the sharp aim on achieving organizational and unit level goals.” Sally, CNO 32

Confidential — For Internal Use Only 33 Truven Health Analytics Puerto Rico Summit 2015 The Impact for Our Customers: “The discussions across the budget planning table are rich and educational. Finance brings their perspective and expertise; nursing brings their perspective and expertise and through active exchange, participation and clarification among all participants, learning across disciplines occurs and a realistic budget plan gets built.”Sally, CNO 33

Confidential — For Internal Use Only 34 Truven Health Analytics Puerto Rico Summit 2015 The Impact for Our Customers: “I have been surprised and pleased at the depth of knowledge and insight shown by our colleagues in finance. They have challenged me to think differently-which has resulted in improving productivity and operations. Without this relationship, key opportunities may have been left on the table.”Sally, CNO 34

Confidential — For Internal Use Only 35 Truven Health Analytics Puerto Rico Summit 2015 The Impact for Our Customers “The tools we have available now help my management team understand the impact of staffing decisions, while providing guidelines for safe staffing levels. The daily staffing tool ties it all together – from the budget and benchmarks to the day to day unit decisions.”Jill, Nursing Director 35

Confidential — For Internal Use Only 36 Truven Health Analytics Puerto Rico Summit 2015 The Impact for Our Organization “By working in collaboration with Nursing to understand benchmarks and using those benchmarks in aligning goals, we have found a much more fair and equitable approach to meeting budget goals. Not only has benchmarking made the budget process more efficient, but we have found that the collaborative approach has made the budget process more effective since Nursing is engaged in the target setting process.” Lesley, Director-Finance 36

Confidential — For Internal Use Only 37 Truven Health Analytics Puerto Rico Summit 2015 The Results: Improved Utilization 37 Center2010 HPPD 2011 HPPD VolumeFTE Impact Total19.64

Confidential — For Internal Use Only 38 Truven Health Analytics Puerto Rico Summit 2015 Objectives 1.Identify key success factors for using benchmarks in the budgeting process.  2.Gain knowledge about tools used to successfully maintain on- target performance.  3.Review results from the continuous monitoring process used by Indiana University Health facilities.  38

Confidential — For Internal Use Only 39 Truven Health Analytics Puerto Rico Summit Confidential — For Internal Use Only Questions?