The Business Model Transition To Value-Based Reimbursement The 2017 OPEN MINDS Technology & Informatics Institute Wednesday, November 8, 2017 2:00pm 5:00pm Ken Carr, Senior Associate, OPEN MINDS #OMTechnology 1 www.openminds.com 163 York Street, Gettysburg, Pennsylvania 17325 Phone: 717-334-1329 - Email: info@openminds.com
Agenda I. The Fee For Service Business Model II. III. IV. The Value-Based Reimbursement Business Model Becoming A Data-Driving Organization The Role of Population Health in Value-Driven Market V. Break VI. VII. Assessing What Technology & Informatics Competencies Are Needed For Performance-Based Reimbursement Case Study Assessing Your Technology Infrastructure Functionality 2
I. The Fee For Service Business Model
Financial Model Fee For Service Variable Costs Create Less Risk Under FFS 4
The Fee-For-Service Health Plan Network Contract Most fundamental of all business relationships for provider organizations in health and human services Often need to begin with privileging professionals individually, rather than being privileged at the organization level Difficult market position but often necessary No assurance of volume and no likelihood of referrals Often commodity positioning 5
Key Challenges In A FFS Environment Aligning internal operations to manage payer requirements Positioning the organization in the market to maximize payer opportunities Revenue Cycle & Workflow Design Market Positioning 6
The FFS Revenue Cycle Verifications Authorizations Claims Analytics Process Improvement Referral & Intake Credentials Documentation Monitoring & Process Improvement Service Delivery Billing & Collections Claims Submission Denials Management Payment Receipt & Posting 7
The Goal In FFS Environment: Preferred & Exclusive Being Preferred Within A Payer Network Having preferential referrals due to some market differentiation Need a demonstrable value proposition almost always involving P4P or value-based payment Gaining Exclusivity Within A Payer System Having a financial relationship (most often with significant financial risk) that gives you exclusivity by geography and/or consumer type Your organization is the narrow network 8
II. The Value-Based Reimbursement Business Model
The Shifting Reimburse Market A Change In Focus: Reducing costs while delivering and demonstrating value A Change In Methods: Managed care and value-based purchasing 10
The Payer Goal For Integrated Care Coordination Acute care Post-acute care Primary care Long-term care Social and human services 11
Examples Reimbursement Moving From Volume To Value To Support Integrated Care Coordination Small % of financial risk Moderate % of financial risk Large % of financial risk Fee-forservice Performancebased Contracting Shared Savings Bundled and Episodic Payments Shared Risk Capitation Capitation + Performancebased Contracting Low Accountability Moderate Accountability Maximum Accountability P4P/Shared Savings Contracts with Qualified Facilities and Outpatient Providers (national footprint across all payor types) SUDS Medication Assistance Therapy (MAT) Providers DRG ACOs, medical-behavioral integration in health homes Results Metrics Outpatient Quality : Case-mix adjusted member reported outcomes (wellness assessment) Cost: Case-mix adjusted average visits per episode and episode cost Inpatient Quality: HEDIS 7- day follow-up; CMS readmission rate for 30 and 90 day (case mix adj) Cost: Case-mix adjusted ALOS and episode cost Quality: Readmit rate (case-mix adjusted) 30 and 90 day Cost: Case-mix adjusted average visits per episode and episode cost DRG/Bundled payment methodology 8 metrics across 6 domains Care coordination Care transition Referral management Health promotion Individual support Family/caregiver support 15% to 20% reduction in readmit rates Ambulatory follow-up rate improved from 3% to 10% Reduced readmissions Improved community tenure Improved care coordination 9% increase in adherence to quarterly PCP visits 4% increase in primary caregiver or peer support linkages 12 2015. All Rights Reserved. From Optum presentation, October, 2017
Why More Value-Based Reimbursement (Risk- Based & P4P Contracting)? Increase Transparency Of Performance Link Professional, Service Provider Organization, & Care Manager Reimbursement To Desired Performance Increase pressure for improvement Facilitate consumer-directed care Improved access to care Increase care integration and coordination Person-centered planning and recovery focus Supports Integrated Care & Control Costs Of Care Financial incentives to help consumers become and remain healthy for longer periods of time Increase lower-cost interventions for not yet seriously ill population Reduce unnecessary use of high-cost services 13
With Pay-For-Performance Components What Are the Pay-For-Value Reimbursement Options? Specialist positioning Case Rates & Bundled Rates Comprehensivist positioning Medical Homes & Specialty Medical Homes Capitation &/Or Population Health Gainsharing Arrangements 14
Managed Fee-For-Service Provider Paid An Established Fee For A Defined Service Clearly defined package of services to be provided Quality standards can be established for defined services Varying Degrees Of Management Preauthorization Concurrent review Retrospective review 15
Pay-For-Performance Pay-for- Performance (P4P) A term that describes health care payment systems that offer financial rewards to providers who achieve, improve, or exceed their performance on specified quality, cost, and other benchmarks 16
Capitation In Population Health Arrangements Capitation/Subcapitation Population Health Capitation A contracted rate for each member assigned, known as the "per-member-per-month" (PMPM) rate Regardless of the number or nature of services provided Contractual rates are usually adjusted for age, gender, illness, and regional differences Behavioral Health Carve- Out Capitation Medical Home/Health Home Capitation PMPM for behavioral health treatment benefits (or other cognitive disability support services) PMPM to cover the cost of care coordination and preventative services Arranged with the physician, hospital, or other health care provider or plan Primary Care Capitation PMPM for primary care services (assess, prescribe, refer) 17 Global Capitation PMPM for cost of delivering all (or some) of the care for a group of consumers
Example: Value-Based Payment Methodology Goal for a pediatric practice is to immunize 80% of its patients by age 2, in accordance with the nationally accepted immunization guidelines. A provider that exceeds that goal and immunizes 90% of its patients would receive bonuses in addition to the standard FFS reimbursement rate from the payer. 18
All Types Of Services Moving To Pay-For-Value Specialty medical homes for consumers with serious mental illness (SMI), addictions, traumatic brain injury (TBI), Alzheimer s, and chronic health conditions with all care coordination services paid in per member per month (PMPM) payment Capitated contracts for Intellectual and Developmental Disabilities (I/DD) services Kansas Medicaid and 18 other states to follow Pay-for-value changes the rules for service reimbursement and opens up opportunities for leveraging new science and technology to reduce costs and improve consumer convenience. Capitated contracts for senior services (including nursing home care) planned for 19 state Medicaid plans Case rates for children s services in child welfare system Case rates for TBI support services Voluntary self-directed I/DD services with individuals consumer budgets launching in California 19
Service Line Cost Accounting Responsibility Center service line or division with oversight for the results of a unit creates a line of accountability and focus for reporting of results Cost Center operating unit with responsibility only to control expenses Revenue center operating unit with responsibility for both creating revenues and managing expenses 20
Strategic Financial Implications Of Shifting Reimbursement Market Develop competencies and internal culture to compete in a performance-based market Develop infrastructure and information technology and realign processes Improve understanding of cost drivers manage and reduce costs 21
Target Costing Pricing method to reengineer the cost of a service to hit a specific target market rate Determines the maximum cost for a service that can be incurred to earn the required profit margin at market rate Traditional cost-plus pricing calculates cost of producing a service and adds the desired margin to determine the price Why is target costing important? Because as we move to a more customer-driven competitive market, our customers (both payers and consumers) don't care about our costs to deliver a service. They only care about the rate we charge and how that rate (and the other attributes of the service, called the value equation) compares to our competition. 22
How Does Activity Based Costing Work? Map Activities & Processes Determine The Cost of Each Activity & Process Determine How Activities Relate To Services Select Measures To Track Each Activity & Its Cost Determine and manage the cost of services Evaluate outsourcing options Develop What if scenarios for service expansion or reduction Assist marketing staff in product design and service pricing Develop budgets Measure performance Evaluate the cost benefits of alliances or mergers 23
Financial Model Capitation Managing Variable Costs As Volume Increases Is Key With Capitation 24
Capitation - Understand Target Population Focus: Populations will include the full range of consumers from low to high utilizers. Target Population Consumers 50,000 Implication: Understand the population service need characteristics to target the most efficient interventions for the available resources. 25
Understand The Nature Of Your Costs Fixed Costs remain the same over a given level of services Variable Costs how can I control my variable costs and still provide the best services? Case Examples: Members stay the same, but acuity increases (and related costs) - inpatient Members increase, but fixed and variable costs stay the same 26
Business Model Transition For Service Provider Organizations Payer Policy = Pay For Cost Or Volume Payer Policy = Pay For Value What is paid for is good for the consumer - and doing more is the business model A revolution in performance management required Giving the consumer (and their payer) what they want and need is the business model Focus on maximizing price and managing volume Good outcome at low cost conveniently 27
Increasing Market Share Captured By The New Model 30+% of Medicare beneficiaries have opted into Medicare Advantage 2.4 million Medicare beneficiaries (nearly 12%) are enrolled in special needs plans (SNPs) focused on specific consumer types About 2.0 million consumers dually eligible for Medicaid/Medicare are enrolled in Medicare Advantage Dual Eligible Special Needs Plan 20 state Medicaid plans with health homes enrolling 1.25 million consumers an increase of 25% over 2014 Accountable care organizations (ACOs) cover 12% of the U.S. insured population Vertical carve-outs emerging. In Medicaid, 3 states with vertical carveouts for the SMI population 5 states with vertical carveout for other populations 28 Secondary carve-outs of behavioral health are less common, but still prevalent 40% of Medicaid health plans
Value-Based Reimbursement Here To Stay Because... Political and competitive pressure on payers federal government and employers Downward price pressure on health plans The success of some ACOs The early findings of the Medicare bundled rate initiative Pressure on health plan medical loss ratios Return to fee-for-service not feasible only lever is to reduce rates and doesn t support integrated care coordination for superutilizer populations Value-based reimbursement will not only permit the expanded use of technology it will make technology essential for success 29
III. Becoming A Data-Driven, Technology-Enable Organization
Tactical Data Focus Tactical Orientation Grid Data Management Discipline Assesses organizations on tactical infrastructure to capture data, and cultural focus to use data to drive better outcomes Data-driven organizations must have data and an outcomes focused intent to use that data Data, No Outcomes Focus No Data Or Outcomes Data Driven Outcomes Focus, No Data Outcome Focused Intent 31
Strategic Data Focus Strategic Data Orientation Performance Domain Assesses organizations on their ability to adapt performance to improve outcomes Data-driven organizations must track and analyze services, and adapt performance to create social value Relate Efforts To Outcomes Performance Tracking, But No Adaptation Of Approach No Performance Tracking Or Adaptation Of Approach Tracks Performance And Adapts Approach Adapts Approach, But No Performance Tracking Adjust Approach 32
Program Impact Data Focus Program Value Performance Domain Assesses organizations on their ability to deliver intended outcomes Focus is on program data, not capacities and practices of the organization Program Impact Data Program Results, Not Those Intended No Intended Results Or Supporting Data Data Demonstrates Intended Impact Intended Results, But No Supporting Data Capacity To Deliver Services / Programs With Fidelity 33
Social Investing As Value-Based Purchasing Data Driven Tactical Orientation Grid Strategic Orientation Grid Program Value Grid 34
So Where Does Technology Fit In This Equation? Necessary To Manage Risk & Compete On Value Analytics technology to support performance measurement capability For analytics technologies, use of the data for decision making is key to ROI Treatment technology into increase value of consumer care For treatment technologies, increasing treatment value is key to ROI 35
Technology Has Changed The Expectations Of Payers & Consumers 36 New treatment technologies have changed the options for consumers Health information exchange provides data exchange and creates big data for consumer service planning 1. Personalization of consumer treatment through analytics-informed decision support 2. More efficient and effective coordination of consumer services across the service system 3. The measurement of value of services Smartphone and other technologies for inexpensive consumerdirected disease management Telehealth and virtual consultation changing geographic market boundaries for services
Technology currently enables... Same day scheduling and on-line appointment scheduling Completion of paperwork on-line before appointments Drop-in immediate appointments On-line consumer health assessment and diagnostics (both real-time and expert systems) Clinical professional visits on-line - and access to clinical professionals via telephone and e- mail on demand access to primary care and specialists Expert systems delivering care without synchronous professionals On-line consumer self-managed support groups (for just about every segment of the market) On-line consumer self-service disease state management tools Consumer access to and management of health information Remote monitoring and in-home case management using on-line tools and robots More consumer informed choice of health plan, provider organization, professional, and treatment options with transparency More use of science-based treatments with higher probability of success the advent of personalized medicine -- Beyond talk and pharma Case management and care coordination remade 37
New Genetics, Pharma, & Neurotech: The What of Service A New Market Model Is Emerging Telehealth & Remote Services: The Where of Service Web-Enabled Admin Tools: The How of Service New Service Delivery Paradigm Analytics & Decision Support: The Right Service 38
Tech Tools #1 - Technology Infrastructure To Support Performance Management Electronic health records Getting The Necessary Data Patient registries Health informatio n exchange Referral tracking Optimizing Organizational Performance, Care Coordination & Population Health Management Consumer segmentation and health risk stratification Care coordination platforms Performance monitoring and management tools Advanced population analytics and clinical decision support 39
Tech Tools #2 - Technology Infrastructure To Optimize Value Of Consumer Care Engaging Consumers Patient portals and web sites - and web-based consumer tools Automated consumer outreach Reducing The Cost Of Service Tech to improve administrative and service efficiencies Telehealth and telemedicine Remote patient monitoring Tech-enabled treatment 40
Adoption Of Technology Innovations By Specialty Provider Organizations, 2017, % Currently implemented Implementation in process Considering implementing in future 80.0% 60.0% 31.1% 30.6% 33.2% 38.3% 40.0% 13.3% 13.8% 15.8% 20.0% 0.0% 34.7% Text messaging/email communication with consumer 30.6% 25.5% 18.4% 16.8% Telehealth/telepsychiatry Consumer portal Patient engagement apps/tools 3.6% 22.4% 4.1% ecbt 41
The Emerging Tech-Enabled Service System 1. Tech Input On The Right Service 4. The Technology Substitution Effect 2. Technology Facilitating The Right Service Location 3. Technology-Facilitated Convenience As Driver Of Consumer Preference 42
1. Tech Input On The Right Service Decision support - an interactive software-based system intended to help decision makers compile useful information to identify problems and make decisions. Based on big data and artificial intelligence Key market effects: Matching consumers (their conditions, their characteristics) to optimal interventions Determining what interventions have an impact on outcomes and resources use and when 43
2. Technology-Facilitated Convenience As Driver Of Consumer Preference Easy 24/7 with a click the amazon and Uber phenomenon Access to appointments Automated administrative burden Online standardized service packages and pricing 44
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3. Technology Facilitating The Right Service Location Web-Based Telehealth Mobile Apps Remote Monitoring 47
More Services Being Provided Virtually Services Can be Offered at a Lower Cost Remote Diagnoses, treatments follow reliable standard protocols based on evidence-based medicine Suggested therapies are nearly always effective Physical exam not required, visual exam adds nominal value Emerging Areas for Virtual Care Management, Maintenance Chronic disease checkups, follow-ups Care plan updates Specialist consults Diagnosis, Treatment Remote diagnostics Self-guided interventions In-Person Diagnoses, treatments more complex, may vary within disease category Therapies may need careful selection and monitoring Physical exam or diagnostic test required to correctly identify issue and select treatment Intervention required (i.e., immunization) 48 Source: Marketing and Planning Leadership Council interviews and analysis. Advisory Board
Modalities Use Cases Telehealth Used Across Multiple Modalities Professional Consultation Telehealth Use Cases, Relevant Modalities, & Investment Required Diagnosis & Treatment Education & Engagement Ongoing Monitoring & Care Coordination Videoconference Asynchronous Store-and-Forward Remote Device Telephone Patient Portal Mobile App Need software, secure internet access for patients Home and hospital-based technology Need additional bandwidth, storage space Can replace nonurgent phone calls and visits More expensive hardware investment Used for highrisk patients in non-hospital site Little tech investment, requires proper staffing Used for pre-visit triage High security needs require significant investment Must integrate EHR Minimal hardware investment for providers Complex security and data storage issues 49 Source: Marketing and Planning Leadership Council interviews and analysis. (Advisory Board)
4. The Technology Substitution Effect Replacing a faceto-face service with a tech-enabled service Replacing billable case manager time Replacing billable time for diagnostic testing/assessment 50
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IV. The Role Of Population Health In A Value-Driven Market
Population Health Management Population health management seeks to improve the health outcomes of a group by monitoring and identifying individual patients within that group... 1 A best-in-class PHM program brings clinical, financial and operational data together from across the enterprise and provides actionable analytics for providers to improve efficiency and patient care 2 The health outcomes of a group of individuals, including the distribution of such outcomes within the group 1 55
Behavioral Health System Optimization Is Central To Successful Population Health Management Consumers with behavioral disorders are often superutilizers of health care resources Lack of integrated care coordination addressing the medical, behavioral, and social needs of consumers - results in poorer outcomes and higher cost per consumer Undiagnosed and/or untreated behavioral health conditions hinder the treatment of a wide range of medical conditions 56 Consumers with behavioral disorders and comorbid chronic medical conditions have higher average costs than those consumers without comorbid conditions
Key Components Of Population Health Management Aggregation Of Health Data On A Population Of Consumers Analysis & Risk Stratification Of The Health Data Identification Of High-Risk Consumers Identification Of Optimal Interventions For High-Risk Consumers Care Management & Follow-up 57
Four Domains In OPEN MINDS Model For Assessing Population Health Management Readiness 1. Financial Management & Leadership/Governance Structure Alignment of strategy with infrastructure and resources 2. Technology & Reporting Infrastructure Functionality Data leveraged to gain insight 3. Provider Network Management & Clinical Performance Optimization Data analyzed to drive clinical decision-making 4. Consumer Access, Customer Service, & Consumer Engagement Processes to empower consumers and create engagement 58
Domain #1 1. Seven Key Competencies Of Organizational Leadership, Infrastructure, & Financial Management 1. Strategic Alignment Around Population Health 2. Culture Of Innovation 3. Workforce Adequacy 4. Revenue Cycle Effectiveness 5. Encounter Reporting 6. Value-based Payment Capabilities 7. Financial Performance Monitoring 59
Domain #2 2. Seven Key Competencies Of Technology Infrastructure Functionality 1. Capacity To Collect Data 2. Capacity To Analyze Data For Population Health Management 3. Ability To Manage Value- Based Contracts 4. Ability to Exchange Health Care Information 5. Care Management Functionality 6. Consumer Portal Functionality 7. IT Performance Monitoring 60
Domain #3 3. Six Key Competencies Of Provider Network Management & Clinical Performance Optimization 1. Provider Organization & Professional Recruiting & Credentialing 2. Care Coordination & Care Management 3. Consumer Screening, Care, Provider Referrals, & Case Authorizations 4. Decision Support & Care Standardization 5. Integration of Physical Health, Behavioral Health, & Social Services 6. Clinical Performance Tracking, Assessment, & Optimization 61
Domain #4 4. Seven Key Competencies Of Consumer Access & Customer Service Functionality 1. Consumer- Informed Access To Services 2. Automated Consumer Service Functionality 3. Mobile Health Applications 4. Consumer Wellness Support 5. Appeals & Grievance Procedures 6. Customer Satisfaction Feedback 7. Consumer Performance Metrics 62
V. Break
VI. Assessing What Technology & Informatics Competencies Are Necessary For Value- Based Purchasing
Seven Key Competencies Of Technology Infrastructure Functionality 1. Capacity To Collect Data 2. Capacity To Analyze Data For Population Health Management 3. Ability To Manage Value- Based Contracts 4. Ability to Exchange Health Care Information 5. Care Management Functionality 6. Consumer Portal Functionality 7. IT Performance Monitoring 65
1. Capacity To Collect Data Focus: Technology infrastructure to collect data strategic in identifying health needs of the population of consumers served Key Competencies For Success EHR core functionalities fully implemented Structured data collection around assessments, diagnoses, and services Workflows and processes to ensure data integrity Ability to collect data at the time and source of service provision 66
2. Capacity To Analyze Data For Population Health Management Focus: Ability to perform strategic analysis of data for risk stratification and care management Key Competencies For Success Development of or access to consumer data registries Deployment of data analysis tools Implementation of risk stratification strategies Ability to integrate multiple sources of data 67
3. Ability To Mange Value-Based Contracts Focus: Technical ability to bill, track utilization, and maximize performance of value-based purchasing (VBP) contracts Key Competencies For Success EHR functionality that meets billing requirements for VBP models Integration of clinical, operational, and financial data Unit costing and cost accounting capabilities Predictive modeling and forecasting capabilities 68
4. Ability To Exchange Health Care Information Focus: Ability to exchange clinical and financial information with other health care providers Key Competencies For Success Health information exchange agreements with key providers Secure infrastructure, policies, and workflows that comply with Heath Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Service notification agreements, automation, and processes with other providers 69
5. Care Management Functionality Focus: Ability to manage eligibility, coordination of benefits, inquiries/referrals, decision support, care authorization, care coordination, and utilization management Key Competencies For Success Automated risk assessment tools Redesigned workflows to maximize care management technology Provider referral database to aid in care matching and management 70
6. Consumer Portal Functionality Focus: Ability to provide service data, resources, and interaction options with consumers through the EHR Key Competencies For Success Convenient, secure access to personal health information through the internet Ability to access staff and services through technology Access to forms and account payment functionality 71
7. IT Performance Monitoring Focus: Ability to monitor actual Information Technology (IT) outcomes against established goals Key Competencies For Success Established Key Productivity Indicators Ability to measure IT outcomes Process to assess outcomes against KPIs 72
VII. Case Study: Assessing Your Technology Infrastructure Functionality
1. Capacity To Collect Data Questions Weak Some Progress Strong a. EHR fully implemented in the core functionality areas of scheduling, clinical documentation, billing, and reporting b. EHR fully implemented in the additional functionality areas of data analysis and business intelligence c. Additional data collection and service coordination functionality available through a care management system d. Remote documentation capabilities available for services provided in the community e. Process in place ensure that consumer enrollments and discharges are regularly updated f. System for maintaining a master consumer index that is comprehensive and up-to-date (pulling all relevant data related to a client into one location) 74
2. Capacity to Analyze Data for Population Health Management Questions a. Data summarized in registries to stratify consumer populations by diagnosis for risk-adjusted care planning Weak Some Progress Strong b. System to access data for longitudinal analysis of high utilizers related to utilization by service type, quality results, costs and anticipated revenue c. Process to identify top 5% - 10% of consumers accessing high cost healthcare services (ER visits, hospital admissions) and intervene with care management strategies d. Ability to identify, access and analyze multiple sources of data, including claims data from payers e. Ability to quantify the prevalence rate of chronic conditions of super-utilizers 75
3. Ability To Manage Value-Based Contracts Questions Weak Some Progress Strong a. EHR fully implemented in the core functionality of billing b. EHR has capability to submit encounters and claims related to value-based purchasing requirements c. Cost accounting system to calculate unit costs, target costs and identify the total cost of care d. Implementation of a service utilization prediction model to assess resource needs and impact on financial resources e. Ability to identify all needed data sources and contract for access to that data 76
4. Ability To Exchange Healthcare Information Questions Weak Some Progress Strong a. Health information exchange agreements in place for key providers in the community (hospitals, ER's, physicians, specialty providers) b. Automated technology to notify staff of inpatient or crisis services provided to consumers (ER visit, hospital admission, hospital discharge) c. Secure infrastructure in place that meets federal and state requirements, including HIPAA and HITECH d. Policies, procedures and protocols in place for HIE, including information access rights, medical record correction, IT contingency planning and record access e. IT staff have experience with system integration, data conversion and managing expert resources to fill gaps in internal skills 77
5. Care Management Functionality Questions a. Utilization of risk assessment tools to identify those consumers needing care management intervention plans b. Redesigned workflows to maximize use of care management technical functionalities c. Healthcare provider and social services referral database to facilitate care management referrals efficiently d. Technological functionality for patient identification and risk assessments (patient registries, at-risk consumer identification tools, real time alerts related to utilization e. Standardized documentation functionality with flexibility to individualize the information to support effective care planning and track effectiveness f. Assigned responsibility to ensure the utility of documentation for supporting effective care management performance and utilization management Weak Some Progress Strong 78
6. Consumer Portal Functionality Questions Weak Some Progress Strong a. EHR provides convenient, secure consumer access to personal health information via the internet b. Consumer portal provides access to information related to recent service documentation, medications, care plans and view educational material c. Consumer portal provides exchange of secure communication with care teams d. Consumer portal enables consumers to request prescription refills e. Consumer portal enables consumers to schedule appointments and updated contact information f. Consumer portal allows consumers to make payments g. Consumer portal facilitates download and completion of form 79
7. IT Performance Monitoring Questions Weak Some Progress Strong a. Established process to assess the number of IT service requests and the length of time required to resolve requests b. Established process to assess the number of analytics data requests and the length of time required to resolve requests 80
Questions & Discussion
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