Making the Numbers Work

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Lesley Caroline Byrd
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1 Making the Numbers Work Using Data and Metrics to Improve Programs and Processes Sutter Health Who Are We? Sutter Health is a not-for-profit health system Provides health care services in more than 0 Northern California cities and towns 21 medical centers and acute care hospitals 5 medical foundations 55,000 employees 1

Barriers and Solutions 1. In your organization, what barriers have you faced in your efforts to: a) influence safe employee practices? b) actively engage senior management in safety?

2 Barriers and Solutions 1. In your organization, what barriers have you faced in your efforts to: a) influence safe employee practices? b) actively engage senior management in safety? c) secure monetary investments in safety? 2. What strategies have you found to be successful in overcoming some of these challenges? 3. What strategies have you found to be less effective? Our Structure 2

same workspace Regional and affiliate executives (CEO, CFO, CNE, WC and Safety) partner with us on initiatives Claims staff always look

3 How We Integrate Because of our structure, we are able to partner closely Safety, Informatics, Risk Finance and Claims Management are all part of the Total Health and Productivity Management (THPM) leadership team We report to the same executive leader We occupy the same workspace Regional and affiliate executives (CEO, CFO, CNE, WC and Safety) partner with us on initiatives Claims staff always look out for and convey unsafe conditions and trends to Safety so that they can be proactive Use Case #1 Workers Compensation Performance Metrics 3

Continuing to evolve metrics and dashboards to meet business needs our path forward Affiliate CY Benchmarking Trend Analysis Ad Hoc Analysis Injury Prevention Scorecard Affiliate Current Year

4 Continuing to evolve metrics and dashboards to meet business needs our path forward Affiliate CY Benchmarking Trend Analysis Ad Hoc Analysis Injury Prevention Scorecard Affiliate Current Year Reporting Period Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec YTD Headcounts Total Hours Worked Average Daily Census Injury Incidents First Aid Claims WC Claims Total Injury Incidents WC Frequency Rate OSHA Reportable Incidents Injury Incidents by Month Jan Feb Mar Apr Incidents First Aid WC Claims Predominant Loss Cause YTD MAB 2% Patient Mobilization 2% Total Injury Incidents by Department YTD MSD- MMH/RM 45% Slip, Trip and Fall 51% 4

Affiliate CY Benchmarking Trend Analysis 15 5 0 Ad Hoc Analysis Injury Incidents by Day of the Week Injury Prevention Scorecard Affiliate Current Year Other Visualization Options Incidents First Aid

5 Affiliate CY Benchmarking Trend Analysis Ad Hoc Analysis Injury Incidents by Day of the Week Injury Prevention Scorecard Affiliate Current Year Other Visualization Options Incidents First Aid WC Claims 0 Injury Incidents by Shift Shift 1 Shift 2 Shift 3 Incidents First Aid WC Claims Injury Event Tracking Reporting Period Jan Feb Mar Apr May Jun e # Exposure Events # Exposure Cases Exposure Type: Communicable Disease Exposure Type: XXXX Needle Sticks - Cont July Aug Sep t Oct Nov Dec YTD Affiliate CY Benchmarking Trend Analysis Ad Hoc Analysis Injury Prevention Scorecard Trend Analysis Frequency Rate Rolling 12 Months Type All Acute Non Acute Injury Type All Incidents First Aids WC Claims Incidents First Aid WC Claims Frequency Rate 5-Year Snapshot Comparison Jan-12 Jan-13 Jan-14 Jan-15 Jan-16 Incidents First Aid WC Claims 5

6 Takeaways: Dashboards & Scorecards Defining the business case What do we want to achieve? What are the one or two metrics that will drive outcome? The right benchmarks or targets Internal vs. external benchmarks Setting realistic targets Know your audience What visualization will be effective? Data integrity and quality Invest in data quality review (e.g., loss cause coding efforts metrics we use to drive better claims outcomes) Use Case #2 Using Data to Make the Business Case Sutter s strategic overhead lift initiative $25M project focused on ICUs, acute rehabilitation units and stepdown units Collaboration with Sutter risk, wound care nurses and other clinicians 6

7 Identify Benefits From the Intervention Initiative Work Comp ($30K per occurrenc e) Hospital- Acquired Infections ($35K per occurrence) Hospital- Acquired Pressure Ulcers ($43K per occurrence) Patient & Visitor Falls ($4K - $19K per occurrence) Patient Satisfaction (HCAPHS Impact) Patient Mobilization Fall Prevention Initiative Environmental Services Skills Training Direct Financial Benefits ROI Overhead Lifts Total Cost Reduced WC Cost Reduced Lost Time Reduced Length of Stay Reduced Pressure Ulcers Reduced Falls Regulatory Compliance Increased Patient Satisfaction Indirect Financial Benefits Reduce Turnover Increased Staff Satisfaction Equipment Engineering Lost Revenue Slings Training Sling Laundering 7

8 Examples Quantifying Benefits & Costs Metric Incidence Cost Reduced Work Comp Cost & Claims Baseline Work Comp Reports % Reduction Published Studies Cost/Claim Work Comp Department Reduced Pressure Ulcers # of Pressure Ulcers Risk Management % Reduction Published Studies, Internal Experts Cost/Pressure Ulcer CMS, Agency for Healthcare Research and Quality (AHRQ), Risk Management Reduced Staff Turnover Baseline HR % Reduction Published Studies, Internal Experts Cost - HR Examples Quantifying Benefits & Costs (cont.) Metric Incidence Cost Increase in Patient Satisfaction % Increase - Internal Studies, Internal Experts, Published Studies CMS (HCAPHS) Impact on Medicaid Reimbursement Finance Dept. Decrease in Patient Falls % Reduction Internal Studies, Internal Experts, Published Studies CMS, AHRQ, Risk Management Equipment & Engineering Cost Equipment Cost Vendor Engineering/Architectural Fees Facilities Dept. 8

Sisco Overhead Grant Program Financial Proforma -Year Format Revised March 21, 2011 Year Year Year $0 1 -year Total Workers Compensation Savings with Overhead Lifts: (Assume 50% Workers Compensation

9 Sisco Overhead Grant Program Financial Proforma -Year Format Revised March 21, 2011 Year Year Year $0 1 -year Total Workers Compensation Savings with Overhead Lifts: (Assume 50% Workers Compensation Cost Reduction and 5% annual benefit inflation) $804,393 $1,247,878 $,117,571 Value of Stage 3+ HAPU Reduction in ICUs $4,620,260 $4,620,260 $46,202,600 Value of Reduced Staff Turnover Cost (assumes overhead lifts contribute to retention of nurses; per Workforce Planning, average replacement cost is $0,000) $1,000,000 $1,000,000 $,000,000 Total Economic Benefit $6,424,653 $6,868,138 $66,320,171 Costs: SMCS WCC ICU: Capital: 48 Patient Lift $5,058/lift = $242,784 Depreciation: $242,784 $24,278 $24,278 $242,784 Other ICU & Acute Rehab Rooms: 478 $20,000/room = Depreciation: $9,560,000 $956,000 $956,000 $9,560,000 Total Expenses $9,802,784 $980,278 $980,278 $9,802,784 Return on Investment 62% 508% Payback (in years) 2 Years Use Case #3 Claims Management Metrics 9

10 More Takeaways: Claims Management Performance Metrics Metric Ratio Purpose Formula Closing How efficiently are claims being closed? Paid-to- Incurred Lost Time Claims TTD Days Litigation How adequately are claims reserved? How frequently do claims result in at least some payment of TTD? Are your providers working with you on your return-towork program? How long do injured workers remain on temporary total disability (TTD)? How is your return-to-work program working? Is TTD being extended unnecessarily? To determine how frequently injured workers are litigating. Higher numbers MAY be related to the quality of customer services provided by the employer and/or claims administrator # claims closed during time period / # claims closed during same time period Total paid on open claims / total incurred on open claims # Claims with TTD paid / 0 Full-time equivalents (FTEs) or # of claims reported TTD days / 0 FTEs or TTD days / # of reported claims # of new attorney representations or # of applications received / # of new claims reported Narcotics Compromise and Release (C&R) Customer Service Survey To determine how effectively your claims administrator and their pharmacy benefit manager are managing the use of certain Schedule II narcotics. How effectively is your claims administrator seeking and finding opportunities to C&R cases? Survey employees to determine: 1) Were they contacted within x days of their injury by the claims administrator or carrier? 2) Was the claims administrator helpful? 3) How could services have been improved? Total narcotics spend / total Rx spend or Total narcotics scripts / total Rx scripts # of C&R settlements secured / # of new claims reported or # of open claims Design a scoring system and share results with your claims staff, third party claims administrator or carrier. Collaborate to seek improved results.

R o l l i n g F o r e c a s t i n g :

R o l l i n g F o r e c a s t i n g : A S t r a t e g y f o r E f f e c t i v e F i n a n c i a l M a n a g e m e n t Debra Miller Vice President Client Success January 22, 2016 Discussion Topics Overview