Advisory Board Fellows

Transcription

1 Talent Development Advisory Board Fellows Delivering impact through a signature initiative Talent Development s marquee leadership program, the Advisory Board Fellowship, is an accelerated two-year, MBA-like leadership development experience aimed at preparing health care s future leaders to strategically confront current and imminent industry challenges. As those most likely to step into the upper echelons of their organization s leadership ranks, Fellows explore what it means to be an effective leader in the context of a health care ecosystem that has been rocked by economic uncertainty and regulatory change. The program is designed to help Fellows draw meaningful connections between external forces, organizational strategy, and internal health system dynamics all with the goal of enabling Fellows to successfully lead their organizations into the future. Central to the fellowship experience is the Practicum Initiative. The Practicum is a signature initiative that provides Fellows with a high-visibility opportunity to showcase their strategic and leadership acumen in advancing their institutions priority objectives through large, complex, cross-system projects that deliver tangible results. Fellow-designed and Fellow-led, the Practicum symbolizes Fellows hallmark achievement during their two-year leadership journey and signals their capacity for assuming leadership roles of increased responsibility. Through the Fellowship, Advisory Fellows have a unique opportunity to: Advance their organization s strategic priorities Promote improved organizational performance and outcomes Enhance their capacity for leading complex and cross-functional projects Expand and strengthen their professional networks In November of 2013, graduates of the spring 2012 cohort showcased the tangible and powerful contributions they have made to their organizations through the Practicum Initiative. These five projects, described in Fellows own words, offer a small but telling glimpse into the collective impact that a national cohort of health care leaders equipped with essential business and leadership skills can have. For questions or more information, contact Graham George at or georgeg@advisory.com.

2 1.5 million-member regional health plan Baton Rouge, LA Sabrina B. Heltz, SVP Healthcare System Quality A recently established patient-centered medical home (PCMH) and accountable care organization (ACO) care and payment transformation program aimed at fully insured business members relies on nontraditional mechanisms such as care management fees and shared-savings bonuses. However, because the PCMH and ACO program do not include all of their Blue Cross members 40% of whom are covered by selfinsured group plans providers are reluctant to support the payment model. Expand PCMH and ACO programs to include selfinsured account patients Educate and engage employer accounts toward participation in provider care and payment transformation programs Build a business model to account for the payments made to providers under alternative and transformative payment arrangements From Concept to The Way We Do Business Multidisciplinary team formed to socialize challenge and create solution Systems configured to incorporate selfinsured members in the program Self-insured employers begin funding PCMH and ACO payments to providers Spring 2012 Oct 2012 Jan 2013 Dec 2013 Jan 2014 PCMH and ACO program developed, approved and piloted with fully insured businesses; challenges become evident during pilot Self-insured group administrative agreements begin to be modified; providers notified of inclusion of self-insured business into the program Employer account communications delivered Reshaping the Way Health Care Is Delivered and Funded in Louisiana 90 Primary care practices targeted 100% 10 0% to participate in PCMH program Potential accountable care arrangements focusing on quality and total cost of care Opt-outs 250,000 Participation by self-insured accounts Louisiana state employees with access to: Population health program Care coordination Data-driven health/cost improvement

3 635-bed tertiary academic medical center Omaha, NE Michael Battreall MHA, Director Medical Information Systems Annual increases in the federal Medicare and state Medicaid budgets, continued growth in health care spending, and the continued transfer of costs to Nebraska employers and consumers are unsustainable. Create an accountable care alliance (ACA) that is a physician-led accountable care network dedicated to improving the health of all patients by delivering high-quality, affordable, and accessible health services throughout Nebraska and western Iowa. Create Integration and Operationalize ACA Determine Required Data Elements Work with medical management department to understand metrics for measuring quality Investigate operational procedures of established business units that will potentially align with the ACA Develop Input and Output Communication Methods Create patient and provider portals Define population management strategy Implement measures that align with membership criteria Establish Ongoing Evaluation Methods to Measure Success Extract claims data, employee wellness screening, and EHR data Standardize care transitions across the continuum of care By January 2014, go live for employee populations Delivering High-Quality, Affordable, and Accessible Health Services As of January 2014, the ACA has become the sole sponsor of the health plan to cover employees and dependents of The Nebraska Medical Center and The Nebraska Methodist Health System Momentum gained through the development of the business plan is expected to be carried through to the search and selection of these three vital roles, as outlined below Chief executive officer Chief medical officer Director of information technology

4 450-bed academic medical center Seattle, WA Julie Nelson, Sr., Director, UW Medicine A perfect storm of challenges UW Medicine s higherthan-average ED denial rate, its inability to provide patients with appropriate cost estimates, low pointof-service (POS) collections, low patient satisfaction scores, low employee engagement, and ongoing divisions between clinical and administrative staff compromise patient care quality. A Three-Pronged Approach Increase POS collections by providing patient price estimates Improve denial rate by creating hardwired best practice workflow design and employee accountability structures and standards Improve registration quality and patient satisfaction by creating specific metrics and targets, employee education, patient scripting, and competency requirements Technology Implementation Partnered with Advisory Board to implement their front-end revenue tools: e-plus realtime eligibility and Payment Navigation Compass price estimates In-house Epic enhancements Single location website for all ED registration/patient access tools, work instructions, tip sheets, and training materials People Engagement Using GE s change acceleration and adoption methodology, brought cross-functional teams together to collaborate on gaps, recommendations, metric review, and team communication Held patient advisory council to get feedback on estimates and scripting Best Practice Workflow Redesign Created new best practice workflow using crossfunctional teams with Lean and Kiazen methodology Created side by side triage and quick reg with bedside registration and discharge checkout for all collections Created HIX/ME financial advocate for all self-pay patients Translating Targeted Efforts into Hospital Gains Exceeded all targets Increased POS collections by over 250% Decreased denials Decreased unverified accounts by 88% Increased insurance verification/correct selection Increased patient satisfaction Unverified Left Without Full Registration 18% Before 2% After Copay Collections (First Month) $4,200 Before $16,000 After

5 264-bed hospital Houston, TX David Denton, Director Operational Effectiveness For FY 2012, the average observation length of stay was more than 30 hours while chest pain observation length of stay was more than 27 hours. Cardiologists working as attending physicians managed chest pain more efficiently but achieved only 37% of volume. Upsetting internal medicine physicians could jeopardize hospital admissions. Reduce overall observation length of stay to less than 24 hours Reduce chest pain observation length of stay to less than 18 hours Reduce ED holding of admitted and observation patients Comply with CMS observation rules Physician Engagement by Alignment of Incentives The Plan Incentivize physicians to work with the hospital to improve operational metrics Incentivize physicians to improve quality Provide frequent feedback to physicians Data Analysis Analyze historical data for opportunities Work with A Team to define quality and operational metrics Establish baseline data Create proposed goals for each metric (including any systemmandated or national benchmarks) Reduced Observation Length of Stay Physician Negotiations Work with medical staff leadership to negotiate quality and operational metrics Illustrate proposed benefit and risk to the physicians using historical data and negotiated goals Create legal contracts for each physician Implementation Roll out program to identified cardiologist and internal medicine ED on-call physicians Work with ED physicians to change patient assignment process Convene quarterly meetings with physicians to review metrics and payout incentives Chest Pain Observation Volume by Attending Service 37% 57% 65% 56% Cardiology 37% 32% Medicine 7% 6% 4% Other FY12 FY13 FY14 Chest Pain Observation Length of Stay, Hours Overall w/med Attending w/crd Attending 20% 33% Reduced overall observation length of stay from 30 hours in FY 2012 to 24 hours in FY 2014 YTD Reduced chest pain observation length of stay from 27 hours in FY 2012 to 18 hours in FY 2014 YTD

6 6-hospital health system Fountain Valley, CA Dan Exley, Executive Director, Data Strategy New Shared Services campus is fully occupied after just four years a clear signal that strategic growth is outpacing organizational plan. In addition, massive growth in health IT staffing, marketing, physician society, and decision support place additional stress on facilities. There is clearly an immediate need and a tight timeline to maintain and improve the synergies that the teams close quarters created throughout this campus. Increase capacity Work within the limitations of existing leased square footage and physical plant Learn what works and what needs improving to inform standard work for future MemorialCare office/non-clinical facilities growth Space Modernization/Optimization Initiative Rapid Growth at Shared Services Facility HIT staff necessary for Meaningful Use, ICD-10, analytics, specialties Increase in ambulatory EMR affiliate deployment Employees sharing desks; limited space for visitors or consultants Three Key Steps to Adding Capacity Secured facilities remodeling and furniture funding based on financial pro forma Implemented design and installed new workstation systems and offices Worked with campus leadership to deploy existing staff and new teams into added capacity Office Space Synergy >$575K Avoided lease costs Added 26 hotel workstations Added three private offices Added or freed 35 workstations 15% Increased capacity Provided capacity for FY12-14 growth Existing furniture assets redeployed in system Increased conference room capacity and flexibility