KaufmanHall Report. Using Data And Analytics To Improve Clinical And Financial Performance. In This Issue. Fall A New Normal

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1 KaufmanHall Report Fall 2016 Kaufman, Hall & Associates, LLC. Provider of management consulting services and software solutions since 1985 Using Data And Analytics To Improve Clinical And Financial Performance Walter W. Morrissey, M.D. Managing Director Robert W. Pryor, M.D. Senior Vice President Anand Krishnaswamy Vice President Data and analytics are no longer nice-to-have tools; rather, they underpin an organization s ability to achieve high-value care, defined as patient-centric care with improved quality and outcomes, at lower costs. Because healthcare reform particularly Medicare reform under MACRA 1 puts all providers at risk for not improving value, data and meaningful analytics are critical elements of the cost of doing business. With such tools, hospitals and health systems can drive the performance improvement needed to succeed in a value-based environment. For most hospitals and health systems, unwarranted variation in care is a significant source of suboptimal patient outcomes and unnecessarily high costs. Such variation is present in clinical practice when there is a gap between the desired best practice and current practice. An analysis that excludes outliers and is riskand severity-adjusted can indicate when quality outcomes and/or costs differ significantly by physician or other care provider. This apples-to-apples analysis produces actionable data that can be used to eliminate or decrease the performance gap. Causes of unwarranted or inappropriate variation may include: Suboptimal clinical practices or processes, such as not implementing an accelerated mobilization protocol, which is a practice expected of care providers for patients following hip or knee replacements (except in rare cases) 2 Overuse of supply-sensitive care, such as higher use of specialists in regions where more specialists practice (for example, obtaining cardiology consults for all patients with chest pain) Misuse of preference-sensitive care, such as use of a high-cost orthopedic prosthesis or drug when a lower cost one would be equally effective or appropriate for a particular patient Underuse of proven effective care, such as not using prophylaxis for deep venous thrombosis with surgical patients Provision of services or procedures that are not clinically indicated, such as unnecessary diagnostic testing In This Issue Using Data and Analytics to Improve Performance 2016 Healthcare Leadership Conference New Guide to Partnerships Staff Notes SCL Health Uses Data and Analytics to Improve Performance Calendar of Events Challenges to reducing unwarranted variation include: gaps in clinicians knowledge; lack of economic incentives to drive desired clinical behaviors; concerns about malpractice risk; physicians value of autonomy and personal preference; and inadequate decision-support tools. 3 A New Normal In the traditional hospital-centric, fee-for-service environment, hospitals and physicians typically have been compensated for the care they provide, even if such care creates unwarranted variation in quality and/or cost. The value mandate from both private and public purchasers is rapidly changing this situation, putting a high-intensity spotlight on unwarranted variation in care, and providing incentives or penalties to reduce such variation. Now becoming the norm with all healthcare purchasers, value-based purchasing involves performancebased payment strategies that hold providers accountable for both care cost and quality by linking financial incentives to providers performance on a set of defined measures. 4 Such purchasing brings information on the quality of healthcare, including patient outcomes and health status, together with data on the dollar continued on page 2

2 continued from page 1 outlays going toward healthcare. 5 It focuses on managing the care system to reduce inappropriate care and unwarranted variation. Hospital board, executive, and medical staff leadership must tackle this problem; it can no longer be treated as a third rail. Use of national, regional, and organization-specific benchmark data can identify opportunities to reduce inappropriate variations in clinical practice in both inpatient and ambulatory settings. Assuring Credible Data An organization-wide approach to reducing clinical variation must be supported by a commitment from the leadership team to aggregate, analyze, and disseminate credible data related to quality, outcomes, and cost. Benchmark data and advanced analytics using such data enable the organization s leadership and quality teams to compare performance against a variety of factors, including: Historical trend performance and/or performance targets: This assessment looks at the performance of the hospital or health system using the organization s own data overall, or by hospital, department, physician, treatment type, patient diagnosis, or other considerations Peer group comparisons: Data from public and commercial sources enable comparison of the organization s performance with that of an appropriate peer group, defined as one being of similar type with like functions, services, operating revenue, or other factors Using benchmark-based reports and scorecards, hospital executives and managers are able to observe patterns of performance based on factors such as diagnosis, co-morbidities, treatment type, department, and physician. Areas of undesirable variation can be explored and targeted for improvement. Determining Early Areas of Focus: Case Study One health system with three hospitals and approximately 300 affiliated and employed physicians sought an assessment of its performance compared to peer organizations on selected utilization, quality, cost, and patient safety measures. The goal of the assessment was to enable the health system to identify areas where it should focus its early clinical variation-reduction efforts. The health system used data from its own performance record, and that of public and proprietary databases. A robust analytic platform with more than 2,000 performance indicators enabled a view of how the system performed internally over time and comparatively with other organizations in the region and nation. 6 Peer organizations were drawn from more than 5,000 hospitals nationwide. Measures included length of stay (LOS), mortality rate, critical care utilization, emergency room admissions, hospital-acquired conditions, and cost. Based on all-payer data for the most recent 12-month period, in comparison to data from all hospitals and a regional community hospital subset nationwide, the organization was performing below the 50 th percentile with LOS (Figure 1) and mortality rates, and below the 25 th percentile for critical care utilization. The data were severity and risk adjusted. 7 Analytics identified specific departments, clinical conditions, and physicians who accounted for the greatest performance variance. Employing a data-driven approach will be critical to successfully engaging physicians in reducing care variation. Data credibility is the essential foundation for driving behavioral change. Physicians who receive reliable data with evidence of unwarranted variation in their own care whether related to quality, outcomes, and/or cost typically need no further inducement to bring their practices in line with their colleagues. Figure 1. LOS Variance Source: Total Benchmark Solution DRG-Based p50th LOS p25th p75th Needle Profile: Needle Profile Period: Benchmark Profile: Hospital July 1, 2014 to June 30, 2015 All Payer Nationwide 50 th Percentile Needle Value: 25th Percentile: 50th Percentile: 75th Percentile:

3 Where to Start Building a sustainable program to eliminate unwarranted clinical variation can be undertaken one step at a time. The focus initially may be on an individual diagnosis-related group, or on use of a certain drug, device, test, procedure, condition, work process, clinical program, or other element of patient care. Prioritization of which areas to tackle first can be based on a number of factors, including likelihood of early success, magnitude of the benefit/opportunity, resources required to effect change, and expected implementation timing. Based on such a prioritization exercise, certain data/measurement categories typically offer insights into the most significant opportunities to reduce unwarranted care variation. For example, a few of the major categories of resource utilization are as follows: 1. Medical/surgical supplies: physician preference items often have high cost differentials 2. Pharmacy: brand versus generic drugs and drugs for certain therapies have high cost differentials, at times without effectiveness differentials 3. Accommodation: LOS can indicate physician and staff practice patterns and processes that positively or negatively impact how patients move through the hospital and discharge 4. Laboratory and pathology: standing orders for daily tests, for example, may or may not be needed/appropriate 5. Imaging: the physician s choice of imaging options, including MRI, CT, ultrasound, and X-ray, has a large impact on cost For one $3 billion hospital system, benchmark data of peer-group large hospitals in the northeast indicated the size of the improvement opportunity in these and other categories (Figure 2). For the top five categories, the hospital system had costs that were approximately $135 million higher than its peers. Looking at its own data across the top five measure categories and total cost, the organization was able to identify which physicians had the most significant opportunities to reduce variations in care. All Patients Refined Diagnosis Related Groups (APR-DRG) data were severity adjusted, and outliers were excluded. When compared to their peers, three physicians in different specialties accounted for nearly $2 million in potentially unwarranted care variation. This variation represented percent of the total variation and spend in each of their service lines. The opportunities to reduce variation and costs in medical/surgical supplies and imaging were particularly notable. Further assessment of spending by category indicated specific products that might be adding unnecessary cost and/or variation from patient protocol. Physician 1, for example, used more anesthesiology supplies per minute than his peers, and the highest-cost surgical mesh. As was the case in this hospital, oftentimes physicians simply are unaware of the cost of the items, tests, or drugs they order, and can shift their ordering behavior without impact on the patient. Drilling Down to Identify Best-Practice and Best-Improvement-Opportunity Performers Even more powerful analytic work looks at the relationship between care quality, patient satisfaction, and cost indicators by hospital and physician. Reducing unwarranted variation in knee and hip joint replacements has been an area of focus nationally, and therefore presents an important place for organizational focus in this regard. Effective April 1, 2016, the Centers for Medicare & Medicaid Services (CMS) rolled out a new mandatory bundled payment program. Called Comprehensive Care for Joint Replacement (CJR), it involves approximately 800 hospitals in 67 markets and covers nearly one-third of all hip and knee replacements for Medicare patients nationally. 8 The program incentivizes hospitals to optimize inpatient care, streamline postoperative care, and to discharge patients to lower-cost settings Figure 2: Charges and Costs Detail Source: Total Benchmark Solution continued on page 4 3

4 KaufmanHall Report Fall 2016 continued from page 3 Figure 3: Best Practice Analysis: Knee Replacement by Physician Source: Total Benchmark Solution or directly to home when appropriate. Hospitals are responsible for charges within 90 days of discharge. If costs are below the target rate set by CMS, hospitals keep the difference; if above, hospitals pay the difference. CMS caps losses (and gains) at a percentage of the target price. This program puts hospitals at financial risk for payments to physicians and post-discharge providers, not just for the index hospitalization services.9 A Best-Practice Analysis for one multihospital system identified the best-performing hospital in the system based on indicators including length of stay; total cost; a risk-adjusted patient safety index including pressure ulcer rates, post-operative infections, and others; the hospital-acquired condition (HAC) rate; and a patient satisfaction rating. The benchmark was based on all-payer data for short-term acute care facilities nationwide. Drilling down within the best-performing hospital, the analysis identified the best-performing operating physician for knee joint replacement using the same indicators. Based on data covering a two-year period, Figure 3 shows the results for eight physicians, highlighting that Physician 1 performed above the national all-payer benchmark on all dimensions. Figure 4: Best Practice Analysis: Knee Replacement by Physician, with Physician 1 as the Benchmark Source: Total Benchmark Solution 4

5 Next, the system requested further drill-down analytics to learn what the improvement opportunity might look like if the lowest-performing physicians performed at Physician 1 s level. Figure 4 shows those results, which would bring nearly $10 million in cost reduction opportunity. The health system s chartered clinical improvement team closely studied Physician 1 s clinical practices to learn specific means by which he was able to better assure patient safety and quality while reducing surgical and related hospital costs. Directed by physicians, with participation from nurses and other clinical team members, this is the hard work that needs to be done to reduce unwarranted clinical variation in hospitals and other facilities nationwide. The benchmark data and analytics identified the target. Concluding Comments Hospital leaders need access to credible and accurately attributed data and analytics that enable them to identify significant opportunities to improve financial and clinical performance, and the root causes of suboptimal performance that require corrective action. Armed with the ability to simultaneously access utilization, quality, patient satisfaction, and cost data, and benchmarks to internal and external best-practice care, executives can quickly identify underperforming areas to which attention should be directed. To understand and improve their performance, credible and accurately attributed data and analytics are equally important to physicians and other clinicians. References 1 Medicare Access and CHIP Reauthorization Act (MACRA) is a law passed by Congress in 2015 that makes sweeping changes to how Medicare pays for physician services moving payment aggressively from volume to value. 2 Soni, S.M., Giboney, P., Yee, H.F.: Development and Implementation of Expected Practices to Reduce Inappropriate Variations in Clinical Practice. JAMA (315:20): May 24/31, Soni, S.M., Giboney, P., Yee, H.F. (May 2016). 4 Damberg, C.L., Sorbero, M.E., Lovejoy, S.L., et al.: Measuring Success in Health Care Value-Based Purchasing Programs. Rand Corporation, Agency for Healthcare Research and Quality: Theory and Reality of Value- Based Purchasing: Lessons from the Pioneer. Publication: , Nov meyer/index.html#head3 6 The platform/analytic tool, called PEAK, was provided by Total Benchmark Solution. 7 Adjustments were based on the proprietary 3M Health Information System APR DRG severity of illness (SOI)/risk of mortality (ROM) algorithm. Specifically, LOS was severity adjusted and Mortality Rate was risk adjusted meaning that the benchmarks are calculated at the SOI or ROM level to take into account patient mix. 8 Beck, M.: Hospitals Brace for New Medicare Payment Rules. Wall Street Journal, Apr Bahl, V.: Medicare Payment Reform: Hospitals Cannot Succeed without Medicare Data. Health Affairs Blog, Apr. 1, The right tools are critical to the achievability of efforts to reduce unwarranted clinical variation. Is your organization accessing the best possible benchmark data and analytics to identify and make the needed improvements to quality, outcomes, and cost? For more information on Total Benchmark Solution, please contact Jim Stewart at jim.stewart@totalbenchmarksolution.com or Contact the authors at , or by at: Walter W. Morrissey, M.D. (wmorrissey@kaufmanhall.com) Robert W. Pryor, M.D. (rpryor@kaufmanhall.com) Anand Krishnaswamy (akrishnaswamy@kaufmanhall.com) 5

6 Kaufman Hall Presents The 2016 Healthcare Leadership Conference Time is running short to register to attend this exceptional educational and networking opportunity October at the Four Seasons Hotel Chicago. Don t miss this year s conference, which features a rich agenda with expanded opportunities to gain valuable insights from and engage with other healthcare leaders across the country. Highlights from the agenda follow. Keynote presentations: The 2016 Elections - Issues and Implications David Brooks Columnist, The New York Times The End of Competitive Advantage Rita Gunther McGrath, Ph.D. Professor, Columbia Business School Something Wicked This Way Comes Kenneth Kaufman Chair, Kaufman Hall Thursday morning will feature a panel discussion titled A New Role for Legacy Organizations, including: The Earlybird and Breakout sessions on Thursday include presentations from more than 10 leading health system executives about lessons learned in significantly advancing their organizations toward transformation goals. Earlybird Sessions: At the Crossroads of Consolidation and Regulation Engaging Physicians in the Transition to Value-Based Healthcare Expanding Your Care Continuum: Lessons from Western Connecticut Health Network Pricing Strategy: A New View in the Consumer-Centric Era Timing the Transition to Value: Lessons from Baystate Health Breakout Sessions: A Data-Driven Approach to Reducing Clinical Variation: Lessons from Franciscan Alliance Advances in Population Health Management: Lessons from Sharp HealthCare Partnership Planning: Strategies for Success Lessons from Barnabas Health System and Robert Wood Johnson Health System The Best Cost-Savings Opportunity You ve Never Tried New Provider Practice Models for Efficient and Effective Operations: Lessons from Scott & White Clinic Strategic Planning in 2017: Think Harder/Act Bolder Successful Practices in Merger Integration: Lessons from Northwestern Memorial HealthCare Transforming Your Costs: From Opportunity to Action David P. Blom President and Chief Executive Officer, OhioHealth M. Beatrice Grause, RN, J.D., FACHE President, Healthcare Association of New York State Kenneth A. Samet, FACHE President and Chief Executive Officer, MedStar Health Bill Kurtis Documentary Host, Producer, and Broadcaster, Panel Moderator This year s Rating Agency Update on Friday is titled Six Years into the ACA What Rating Agencies Are Looking for in Transformation Plans. Register Now at 6

7 New Guide to Partnerships by Kaufman Hall Released in AHA s Hospitals in Pursuit of Excellence Series Partnerships are accelerating as healthcare participants reposition themselves for a value-based, population health-focused delivery system. Developed by Kaufman Hall for hospitals, health systems, and other healthcare organizations, the Guide to Health Care Partnerships for Population Health Management and Value-based Care is intended to help executive management and board teams address key issues of the new strategic partnerships that are forming nationwide, and evaluate such partnerships in their area. Guide to HealtH Care PartnersHiPs for PoPulation HealtH ManaGeMent and Value-based Care Published as part of the American Hospital Association s Hospitals in Pursuit of Excellence series, the guide provides key considerations in partnering for population health management, and examples of types of partnerships that could be appropriate including a merger, management services agreement, brand extension, development of an entirely new company, and a joint venture insurance product, health plan, or care network. Additionally, the Guide outlines a recommended process for evaluating potential partnerships and defines what makes strategic partnerships successful. July 2016 Download this 40-page guide, free of charge, at Staff Notes Please join us in welcoming David Woodward joined Kaufman Hall as Vice President, Higher Education, with the Strategic and Financial Planning practice. Rich Oakford also joined the practice as an Assistant Vice President focusing on healthcare, and Nathan Detro, Rebecca Duffin, Christopher Nguyen, and Jacob Pritikin joined as Associates. Jennie Dulac joined the firm as Vice President, Clinical Solutions, for Total Benchmark Solution. In Software, Justin Martin and Linda Holden joined as Software Implementation Consultants, and Patrick Lehman joined as Client Service Director. Stewart Clark joined as Senior Solutions Engineer, Higher Education, and Melissa Gillispie, David Haqq, and Natheena Harris joined as Software Support Analysts. Bina Vayalil joined the firm as a Tax Manager with the Corporate Finance Team. In IT, Joe Weiss joined as the QA Manager, Garrett Gosselink joined as Salesforce Administrator, and Tim Wright joined as a Help Desk Associate. 7

8 SCL Health Uses Data and Analytics from Total Benchmark Solution to Improve Clinical and Financial Performance SCL Health is a nine-hospital, faith-based system, with three safety net clinics, one children s mental health center, and approximately 200 ambulatory sites in three states Colorado, Kansas, and Montana. Based in Broomfield, Colo., this not-for-profit health system has 15,000 full-time associates, more than 500 employed physicians, and annual revenues of $2.4 billion. SCL Health inpatient sites are diverse, ranging from a major academic medical center, to suburban hospitals, rural regional referral centers, smaller rural hospitals, and a critical access hospital. The Challenges SCL Health recognizes that data and analytics are not nice-to-have tools; rather, they underpin the organization s ability to achieve high-value care, defined as person-centric care with improved quality and outcomes at lower costs. With such tools, SCL Health can drive the performance improvement needed to succeed in a value-based environment. Monitoring performance against relevant peer groups was deemed essential for determining the greatest clinical, financial, and/or operational improvement opportunities. Organizations like to find one source of credible data. They don t want to have to consult 14 different portals to understand the breadth of a care delivery issue, says Chris Bliersbach, Senior Director of Clinical Outcomes at SCL Health. Our prior vendor did not offer the analytic flexibility, data integration, or wealth of benchmarking capabilities that we felt were necessary. A Solution In the summer of 2015, SCL Health selected Total Benchmark Solution (TBS) as its vendor for benchmark data and advanced analytics. Thousands of benchmarks available on TBS s cloud-based platform enable leadership and quality teams to quickly and easily compare performance using historical trends and/or performance targets, and peer group data. Organizations then can identify areas of undesirable variation to target for improvement. The firm s PEAK analytic tool allows us to integrate data sources, perform custom analytics, access a large library of benchmarks, and develop custom benchmarks, comments Bliersbach. The TBS platform allows us to filter and adjust an analysis based on various criteria, such as a certain type of patient or a particular payer. We can integrate data sources, such as our ADT feed, EPIC, and Press Ganey to see the whole picture through volume, cost, charges, supplies, quality, patient experience, and many other metrics. The Results Addressing Unwarranted Clinical Variation One of the first clinical areas of focus was sepsis, which is a potentially life-threatening infection. We needed to understand how our care sites were performing on the specific outcomes and process performance measures in anticipation of CMS s evidence-based measures, which became effective with discharges as of October 1, 2015, says Bliersbach. A systemwide approach would enable us to answer the question: Where are our opportunities to improve? An analysis using national Medicare benchmarks available through TBS indicated that SCL Health had a 17.4 percent mortality rate for patients with severe sepsis and septic shock, placing it favorably above the 50th percentile nationwide. Its length of stay (LOS) for these patients was 7.08 days two days longer than average LOS, putting SCL Health performance at about the 25th percentile nationwide. SCL convened a systemwide Sepsis Collaborative with representatives from its hospitals and system services including quality, information technology, and supply chain. The Collaborative set a first-year target of achieving the 75th percentile in mortality rate and 50th percentile in LOS. The goals were to determine unwarranted variation in our care processes and outcomes, and how we could standardize that care to meet the improvement targets, explains Bliersbach. TBS PEAK allowed SCL Health to stratify its sepsis data by a variety of factors. For example, analysis of the patient data by admission source showed that the majority of patients with severe sepsis or septic shock were walk-ins from home settings. For this population, the mortality rate was near top quartile performance at 15 percent. Importantly, for SCL Health care sites that serve as regional referral hospitals, patients with severe sepsis who were transferred to them from outlying hospitals had a much higher mortality rate of 35 percent. For these cases, the improvement opportunity was more about partnering to assure that early goal-directed care is delivered by the referring hospital or during transit prior to arrival at the regional hospital. 8

9 The first three to six hours of care is critical with sepsis patients. Timely administration of fluids and antibiotics can be the difference between a patient s survival or death. The data showed that we had an opportunity to save lives by working with referral hospitals to ensure that treatment is started prior to patient transfer, during the transfer process, and in our units on admission, says Bliersbach. Three subgroups of the Collaborative started to work on improvement initiatives. A Tools and Technology team addressed the order sets that would drive the care needed for patients with sepsis in the first few hours following admission. This team also developed a best-practice alert to identify potential patients with sepsis as soon as they hit the door. A second subgroup addressed resources for staff and clinician education on use of order sets and the alert. The third subgroup on data analytics and reporting developed performance reports for the care sites using the TBS platform. We now have a robust tool that lets us keep a pulse on how we re performing week-to-week and month-to-month, said Bliersbach. This is critical to the ability to make course corrections, as necessary. The TBS data analytics are totally integrated used in the beginning to scan the environment of comparative benchmarks in order to identify key issues, in the middle to monitor progress in addressing those issues, and at the end to evaluate whether improvement targets have been met. While we re in the early stages of the sepsis initiative, we expect to meet our performance targets for Year 1, says Bliersbach. In comparing our baseline (August 2014 to July 2015) severe sepsis septic shock data with our performance period August 2015 to July 2016 across the entire system, we estimate we have saved 33 lives and 1,159 days, and reduced costs by $8.8 million. Development of Customized Benchmarks Another important collaboration between SCL Health and Total Benchmark Solution involved creating custom-made benchmarks that could spur performance improvement beyond usual benchmark performance levels. Improvement in the outcomes of patients with hip and knee joint replacements is one area where many organizations are focusing their efforts due to the mandatory bundled payment program called Comprehensive Care for Joint Replacement, which was rolled out by the Centers for Medicare & Medicaid Services in April Considerably before this program s implementation, two SCL Health care sites and a commercial payer already had been particularly interested in hip and knee surgery improvement. Both care sites had exemplary performance with LOS as measured against Medicare and all-payer benchmarks in the TBS database. But the sites wanted an even more ambitious target for LOS reduction one that would not sacrifice quality, as measured by complication rates, for shorter LOS. Customized benchmarks would provide a stretch goal appropriate to best-practice hip and knee surgery outcomes at the care sites. To develop the benchmarks, SCL Health and TBS collected and analyzed data from Healthgrades on organizations that had 5-star ratings for hip and knee surgery. Eligible organizations also had to appear on the U.S. News and World Report Best Hospitals list, and have a similar patient volume to the SCL Health care sites. These three factors became the criteria for qualification as an appropriate peer organization for benchmarking. Eighty hospitals providing knee surgery and 56 providing hip surgery met the criteria for best-practice organizations with both low LOS and low complication rates. Data from those organizations were used to establish the tailor-made benchmarks. The Table below illustrates the customized, best-practice LOS targets and current LOS performance for care sites Nos. 1 and 2. For example, to achieve 50th percentile on LOS for hip surgery, care site No. 1 would need to lower LOS from 2.99 days to 2.67 days. Care site No. 2 which already was achieving LOS results better than 2.67 days could use the 75th percentile of 2.13 days or the 90th percentile of 2.12 days as its goal. We worked closely with TBS to develop just the right benchmarks that would enable us to set stretch goals, the progress towards which we then could monitor regularly, says Bliersbach. Again, this initiative to improve outcomes is in the early stages, but both care sites have improved their knee-los substantially year-to-date compared to LOS has decreased nearly one-third of a day across all knee cases representing nearly 500 saved days. Through development and implementation of customized stretch benchmarks, SCL Health is positioning its care sites to better achieve the goal of being a bestpractice organization in hip and knee surgery. For more information, please contact Jim Stewart at jim.stewart@totalbenchmarksolution.com or Figure 1: Best-practice LOS targets vs. current performance at two care sites Source: Total Benchmark Solution Benchmark LOS Benchmarks for Hip LOS Benchmarks for Knee 50th 75th 90th 50th 75th 90th Medicare All Payer Best Practice Care Site # Care Site #

10 5202 Old Orchard Road Suite N700 Skokie, IL Pre-sorted Standard U.S. Postage PAID Chicago, IL Permit No Phone: Fax: kaufmanhall.com CHICAGO LOS ANGELES NEW YORK PORTLAND CALENDAR OF EVENTS SHSMD Connections Conference Thought Leader Forum Ryan Gish (moderator) September 11, Chicago, IL Improving Consumer Experience: Lessons from Other Industries Dan Clarin and David Crosswhite September 13, Chicago, IL The Governance Institute September Leadership Conference Strategic Cost Transformation Walter Morrissey, M.D. September 12, Colorado Springs, CO New Rules of Healthcare Change Kenneth Kaufman September 13, Colorado Springs, CO Children s Hospital Association 2016 Annual Leadership Conference A Market-Based Approach to Meeting New Payer Expectations Dan Clarin, with Ron Blaustein of Ann & Robert H. Lurie Children s Hospital November 8, Phoenix, AZ Children s Hospital Association Revenue Cycle Forum Pricing Strategies Jason O Riordan November 10, Phoenix, AZ IHA/RushU Leadership Academy Developing Consumer-Centric Strategies in Healthcare Dan Clarin December 8, Chicago, IL The Healthcare Roundtable Population Health: Major Developments Dawn Samaris September 15, San Diego, CA HFMA Southern California and San Diego/Imperial Chapter Fall Conference A Roadmap for Population Health Management John Poziemski and Anand Krishnaswamy October 10, Newport Beach, CA Iowa Hospital Association Annual October Meeting Meeting the Consumerism Imperative Jason O Riordan October 18, Des Moines, IA Kaufman Hall Axiom Software Training For the current schedule of software training sessions and to register for a class, please visit Registration is limited. Class dates and availability are subject to change based on client demand. For more information, please call or training@kaufmanhall.com. 10