1. Value-based Purchasing Jude Odu Senior Business Analyst, Health Care DataWorks Detlev “Herb” Smaltz, PhD Co-Founder & CEO, Health Care DataWorks September 27, 2012

2. Speaker Jude Odu Senior Business Analyst and Healthcare Subject Matter Expert at Health Care DataWorks Former Supervisor for Clinical Analytics and Decision Support, University Hospitals Case Medical Center, a multi-hospital health system in Northeast Ohio 14+ years in long-term care, in acute care, and on the payer side Instructor in healthcare informatics at Ursuline College Master’s degree in Health Science, The George Washington University

3. Speaker Detlev H. (Herb) Smaltz, Ph.D., FHIMSS, FACHE Co-Chairman and CEO, Health Care DataWorks 21+ years experience in healthcare management Former CIO of The Ohio State University Wexner Medical Center Fellow of the Healthcare Information & Management Systems Society (FHIMSS) HIMSS Board of Directors (2002-2005) and Vice Chair (2004-2005) Fellow in the American College of Healthcare Executives (FACHE) Bachelor’s degree in MIS, University of Tampa, MBA, The Ohio State University, and Ph.D. in Information & Management Science, Florida State University

4. Today’s Webinar Value-based Purchasing (VBP) – What is it? – Who came up with it? – When does it happen? – Who does it affect? – Why should I care? – How do I recover reimbursements withheld through this program?

5. WHAT IS VBP?

6. VBP Final Rule VBP was established by the Affordable Care Act of 2010 (ACA) Budget neutral payment changes begin October 1, 2012 – Reduce base operating payments for each discharge by Rewards for achievement or improvement 6 Year20132014201520162017 Payment Reduction 1%1.25%1.5%1.75%2%

7. VBP Measures – FY 2013 Core Measures or Clinical Process of Care Acute Myocardial Infarction Fibrinolytic Therapy Received within 30 mins of Hospital Arrival Primary PCl Received within 90 mins of Hospital Arrival Congestive Heart Failure Discharge instructions received Pneumonia Initial antibiotic selection for CAP in Immunocompetent patients Blood cultures before first antibiotic in ED Healthcare Associated Infection (SCIP) Prophylactic antibiotic given 1 hour prior to incision Appropriate antibiotic selection for Surgical Patients Prophylactic antibiotic discontinued within 24 hours of surgery Cardiac patients with Controlled 6 a.m. Postop. Serum Glucose Surgical Infection Indicators Beta blocker prior to admission and periop Recommended VTE Prophylaxis ordered Appropriate VTE Prophylaxis timing HCAHPS Patient Experience Nurse Communication Doctor Communication Hospital Staff Responsiveness Pain Management/Control Medication Communication Hospital Cleanliness and Quietness Discharge Information Overall Hospital Rating

8. 2 Ways to Earn-Back 8 Improvement Hospital Performance Standards Baseline: Hospital performance for all 20 metrics during the Baseline Period Performance: Hospital performance for all 20 metrics during the Performance Period

9. 2013 2012 Timeline 9 2011 JulyMarch FY 2013 Performance Period Aug Estimated Payment Adjuster Delivered Nov Final Payment Adjuster Delivered Hospitals will be informed of VBP payment at least 60 days in advance of the payment year 2010 2009 JulyMarch FY 2013 Baseline Period

10. 2 Ways to Earn Back 10 or Improvement Hospital Performance Standards Baseline: Hospital performance for all 20 metrics during the Baseline Period Performance: Hospital performance for all 20 metrics during the Performance Period Achievement CMS Performance Standards Benchmark: Mean of top decile performance (95 th percentile) nationally Threshold: 50 th percentile performance nationally Floor (HCAHPS only!): Minimum performance nationally

11. WHAT DOES VBP MEAN FOR ME?

12. The Questions Do you know your VBP score? Do you know how much is projected to be withheld? Can you get to the data to understand your score? Can you pinpoint which measure is costing you most? Can you build a plan to improve your score? How can you maximize your earnback?

13. The People Financial Management – Wants to earn back the money CMS withheld Quality & Clinical Management – Needs to understand VBP scores – Take action to improve processes that target nurses, doctors, housekeeping staff, nursing units, etc.

14. The Challenges Hospitals and their technology solutions have evolved as siloed point solutions

15. The Challenges Data, systems and technologies are virtually everywhere with limited commonality in format and accessibility

16. The Challenges So you can’t get the information you need when you need it!

17. The Opportunity Get as much money back as possible Improve hospital performance across measured areas

18. HOW DO I MANAGE THIS?

19. Common Approaches Hospitals vary in their approach: Implement stand-alone solution Retain consulting firms Manage compliance manually Figure it out later

20. There’s a Better Way Unified VBP Application – Automate the collection of all data required – View the organization across all 20 measures – Evaluate root cause of positive or negative results – Calculate how score improvements increase reimbursements

21. TSI Surgery LabPremier e Clinical Diver Essbase Cognos Hyperion ICU Dashboard ED Dashboard Nursing Dashboard Prism Cerner VisionW Signature Morrissey Exploring Crimson Kronos ERP Vision Reports Dashboards Surgery Dashboard Manual & Semi-Manual CBO Dashboard VBP Dashboard Surgery Compass Lawson DM Access Departmental Analytics Initiatives Thousands of hours of manual labor Cerner Invision Signature Ad hoc Cerner Insight Invision Ad hoc Typical Health System

22. 22 W Transactional SystemsIslands of Data End User Reporting abc12349x External Systems Analytics at Many Hospitals and Health Systems

23. W Internal Systems End User Reporting External Systems Unified data Model Cleanse Validate Standardize Transform Aggregate Geo Code Data Profile Data Model Meta Data Load DATA GOVERNANCE SOA/We b Services Multi-Dimensional Analysis & Data Mining Ad-hoc Query Benchmarking Research Web Scorecards & Dashboards Predictive Modeling Clinical Trial Screening Error s Text Mining, NLP De-identified Data GL Registries HR PA PM SIS Cost Cntrct EMR Time SIS Orders Lab META DATA Readmits Census Meds Rejection Revenue Pt Sat Encounter EDW Transformation and Mapping Unified Analytics via an EDW

24. Additional Value Effective VBP management will lead to positive change: Improve the quality of patient care as a result of operational enhancements – Increase management visibility – Increase accountability across the organization – Decrease workforce burden Estimate and manage financial implications

25. Takeaways/Summary The CMS VBP program is here and will continue to evolve A portion of your CMS reimbursements will be withheld starting Oct. 1 and will increase through 2017 In the absence of a unified solution, managing VBP will require heavy lifting

26. Questions? Herb Smaltz, Ph.D., FHIMSS, FACHE 877 979 4239 herb.smaltz@hcdataworks.com