Session #22 Getting an ROI in Your Programs

1. Session #22Getting an ROI in Your Programs Bobbi Brown, Vice President of Financial Engagement, Health Catalyst John Henderson, Director of Enterprise Systems, Texas Children’s Hospital Leslie Hough Falk, Vice President, RN, Health Catalyst

2. Learning Objectives • Understand the value of establishing a Goal and Aim Statements and how to develop them. 2. Learn how to determine ROI in your initiatives • Know the ROI formula • Understand the three categories of waste that will help you determine where possible gains can come from • Define and distinguish between direct and indirect benefits 3. Learn how to effectively communicate your results using an Agile ROI/communications framework

3. Learning Objective # 1 Understand the value of establishing a Goal and Aim Statements and how to develop them

4. Poll Question 1 Does your organization require a Goal and Aim Statements for all of its improvement initiatives? • Never • Not often • Sometimes • Frequently • Always • Unsure or not applicable

5. How will you know if you’re successful? Goal and Aim Statements What is a Goal? • A Goal is an explicit description of your long term objective What is an Aim Statement? • An Aim Statement is an explicit description of the individual projects that will help you achieve your Goal Current baselines help with establishing a Goal and Aim Statements Agile approach: Goal and iterative project Aim Statements • All improvement initiatives need a Goal and Aim Statements SMART • How do you develop Goals and Aim Statements? Think SMART. • Specific • Measurable • Attainable • Relevant • Time Based

6. Goal: To achieve and sustain a 20 percent reduction in 30-day all cause readmission rates for patients with heart failure (HF) by (date), and sustained reduction in readmission rates through fiscal year XX, while lowering the CMS penalties by X percent. Sample Aim Statements: Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients by (date). Goal and Aim StatementsExamples Identify high risk heart failure patients and extend the identification of these patients to a risk stratification model to predict the likelihood of all cause 30-day readmission rates by (date). Schedule a follow-up appointment for all HF patients within 24 hours of discharge with a focus on high risk patients being seen within 48-72 hours after discharge by (date). Establish a medication reconciliation baseline and track compliance in order to achieve 75% compliance by (date). Aim #1 Aim #2 Aim #3 Aim #4

7. Poll Question 2 and 3 On a scale of 1 to 5, with 5 being the highest, how would you rate this Aim Statement, “To reduce 30-day all cause readmission rates?” 1 2 3 4 5 On a scale of 1 to 5, with 5 being the highest, how would rate this Aim Statement, “To establish a baseline C-Section rate and validate data by (date)?” 1 2 3 4 5

8. Evaluating Aim Statements • What’s good and what could be improved? • To achieve and sustain a 30 percent reduction in 30-day all cause readmission rates. • To improve patient care. • To establish a baseline C-Section rate and validate data by (date). • To improve variation in outcomes, while lowering our costs. • None. Group unable to come to consensus.

9. Goal and Aim Statement Team Exercise Scenario: You live in California and you have decided to take your family of three persons for a visit to your grandparents in New York for seven days in June, 2015. You’ve allocated a budget of $5,000 to cover all of your expenses. After the vacation you want a thumbs up rating from your family. Exercise: Using SMART principles • Define your Goal • Develop 3-5 project Aim Statements that will help you achieve your Goal

10. Goal: To take my family of three to visit my grandparents in New York for seven days in July, 2015, within a budget of $5000, and with a thumbs up rating from my family, two days from when we return home. Sample Aim Statements: • Talk with my grandparents and my family about possible dates that work best for them in July, 2015, by (date). Goal and Aim Statement Team Exercise • Investigate transportation options and transportation costs between California and New York — with date options determined from Aim #1 —by (date). • Review optional day trips and excursions within two to three hours from my grandparents home, including features and costs — and understand my grandparents and family’s preferences — by (date). • Establish — and gain alignment with my family — on a budget allocation, including transportation, lodging, meals, excursions, gifts and misc. items by (date). Aim #1 Aim #2 Aim #3 Aim #4

11. Learning Objective # 2 • Learn how to determine ROI in your initiatives Know the ROI formula Understand the three categories of waste that will help you determine where possible gains can come from Define and distinguish between direct and indirect benefits

12. Poll Questions 4 and 5 4.How often does your organization include finance as part of its multidisciplinary improvement teams? • Never • Not often • Sometimes • Frequently • Always • Unsure or not applicable 5.Does your organization currently measure ROI in its improvement initiatives? • Never • Not often • Sometimes • Frequently • Always • Unsure or not applicable

13. ROI Formula (TOTAL BENEFIT) (COST OF BENEFIT) - 100% ROI = x COST OF BENEFIT

14. Where To Find Benefits 14

15. Direct and Indirect Benefits Direct Benefits Enhanced efficiency and productivityExamples: reductions in FTEs or less overtime; business process improvement; supply chain standardization allowing lower supply costs; increased departmental capacity; and reductions in capital expense Clinical improvement and waste reduction Examples: lowering LOS; reductions in uncompensated hospital readmissions; lower medication cost per case or per capita; fewer ICU days; and patient safety improvements leading to fewer complications or medical errors Indirect Benefits Can be more difficult to measure Longer-term benefits Examples: an improved medical outcome such as a reduction in future hospitalizations associated with neonatal respiratory distress syndrome (RDS), which will require long-term analysis to reveal an impact on costs; shared savings with payer associated with pre-term delivery rates; the opportunity cost of not purchasing a point solution

16. Show Me the Money Exercise Scenario: The radiology operations team lost access to their analytics metrics for three years after they deployed their EHR. They now have an EDW and lots of metrics — including measurements like cycle times and referrals — but they didn’t start out with Aim Statements. Now they are trying to define their ROI. … Department operations manager, IT and finance conversation

17. Sample Visualization • Cycle times

18. Sample Visualization • Results turnaround times

19. Sample Visualization • Outbound referral rates over time

20. Sample Visualization • Order Pareto

21. Sample Visualization • Anesthesia utilization

22. Show Me the Money Team participation… do you have some ideas on potential benefits?

23. Show Me the Money Benefit Examples

24. Show Me the Money Benefit Examples

25. Maximizing the ROI of your EDW Best Practice Example Leveraging your EDW to its fullest capacity • Quality improvement includes clinical areas AND operations • Organizational transformation and governance • Establish baselines • Measure results Results • 67% average savings on labor costs • Average time to build reports declined from 97 hours to under 30 hours • 1 EDW report = 10 EHR reports • 25% faster turnaround on remaining EHR reports

26. Sample Outpatient Volume Analytics

27. Sample Radiology: Operational Performance Analytics

28. Sample Outpatient Women’s Clinical Performance Analytics

29. Reflection • What did you learn about Aim Statements? • How will you use the ROI learnings in your organization? • What best practices do you have to share from your organization? • …

30. Excel document

31. Learning Objective # 3 Learn how to effectively communicate your results using an Agile Outcomes/ROI and communications framework

32. Measuring and Communicating Your Results Outcomes/ROI Communications Stakeholder Adoption, Leadership Stakeholders • Start with a core group (most enthusiastic and influential, “coalition of the believers”) • Paint a vision of the future to meet objections (e.g., what is the impact to my job) • Use governance bodies and management teams expand reach (“tops down”)

33. Cardiovascular: Heart Failure Date: [complete] Overall Status Project Progress Launch/Rollout date : XX Key Strong concerns Some concerns Done well In process Not started

34. Analytic Insights Questions & Answers A

35. Session Feedback Survey • On a scale of 1-5, how satisfied were you overall with this session? • Not at all satisfied • Somewhat satisfied • Moderately satisfied • Very satisfied • Extremely satisfied What feedback or suggestions do you have? • On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)? • Not at all satisfied • Somewhat satisfied • Moderately satisfied • Very satisfied • Extremely satisfied

36. Upcoming Keynote Sessions Location Main Ballroom 2:20 PM – 3:10 PM • Predictive and Suggestive Analytics Dale Sanders Senior Vice President, Health Catalyst 3:25 PM – 4:25 PM • From The Heart: Healthcare Transformation From India To The Cayman Islands Dale Sanders Senior Vice President, Health Catalyst Chandy Abraham, MD Chief Executive Officer, Director of Medical Services Health City, Cayman Islands Gene Thompson, Health City Director, Director of Thompson Development, Ltd. 4:15 PM – 4:45 PM • Closing Keynote Dan Burton, Chief Executive Officer, Health Catalyst