Innovative Approaches to Using Data to Demonstrate Value: Measuring & Reporting Clinical, Operational, Financial Improvement Jonathan Chapman Director, CHC Advisory Services AACHC/CVN Annual Conference February 11, 2019 1
Using Data to Demonstrate Value Value? Using existing data to better identify, address, and/or convey health center performance and value Demonstrate? Utilizing this data and value in operational and planning efforts 2
Capital Link Launched in 1995, nonprofit, HRSA national cooperative partner Offices in CA, CO, FL, MA, MO, and WV Over $1.1 billion in financing for over 230 capital projects - Direct assistance to health centers and complementary nonprofit organizations in planning for and financing operational growth and capital needs - Industry vision and leadership in the development of strategies for organizational, facilities, operational and financial improvements - Metrics and analytical services for measuring health center impact, evaluating financial and operating trends and promoting performance improvement 3
Goal: Improved Access to High Quality Care AND Financial Sustainability Staffing Financial Operations Productivity Improved Access & Financial Sustainability Patient Satisfaction Utilization Clinical Outcomes 4
Preparing for Value-Based Healthcare "Everyone's talking about it, no one really knows how to do it everyone thinks everyone else is doing it, so we all say we're doing it." Deb Gage, president and CEO of Medecision 5
Defining Value 6
Value? Noun 1. the regard that something is held to deserve; the importance, worth, or usefulness of something. 2. a person's principles or standards of behavior; one's judgment of what is important in life. synonyms: synonyms: synonyms: principles, ethics, moral think highly of, have a high opinion of, hold in worth, code, evaluate, morals, usefulness, assess, standards, estimate, advantage, code appraise, of benefit, price, gain, put/set profit high regard, rate highly, esteem, set (great) store, behavior"society's a good, price on"his help, merit, estate values helpfulness, was valued are passed avail;more at $345,000" on to us as by, put stock in, appreciate, respect; More children" Verb 1.estimate the monetary worth of (something). 2.consider (someone or something) to be important or beneficial; have a high opinion of. "Value" is what the customer is buying 7
Defining Organizational Value 8
Medical Value Equation 9
Medical Value Equation Healthy Outcomes Patient and Provider Experiences Timely, Comprehensive Service Options Conscientious Budgeting and Operations 10
Quadruple Aim 11
Preparing for Value 12
Transition to Value-Based System 13
Value Transition Based to Transition Value-Based System 14
Transition to Value-Based System 15
Transition to Value-Based System - HRSA 16
Transition to Value-Based System - CMS 17
Calculating Value 18
What to Measure? 19
How to Measure? 20
Expectations? 21
Key Performance Metrics Metric 1 Operating Margin 2 Bottom Line Margin Why This Is Important Measuring stick of your business model; margins typically small but need to be positive Is performance dependent upon large capital grants and/or other sources of non-operating revenue? 3 Personnel-Related Expense Consumes 70-75% of budget; key driver of financial performance 4 Days Net Patient A/R Financial management starts with collecting your money efficiently 5 Days Cash on Hand Is there enough liquidity to keep operations running smoothly? 6 Physician Productivity (visits) Productivity is the basis for revenue generation 7 Mid-Level Productivity (visits) Productivity is the basis for revenue generation 8 Dental Provider Productivity (visits) Productivity is the basis for revenue generation *Capital Link Performance Benchmarking Toolkit 22
Operating Margins - Medians 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% 2014 2015 2016 2017 Arizona FQHC US FQHC Benchmark 23
Personnel-Related Expense as a Percent of Operating Revenue - Medians 73.00% 72.00% 71.00% 70.00% 69.00% 68.00% 2014 2015 2016 2017 Arizona FQHC US FQHC Benchmark 24
Days Cash on Hand - Medians 70 60 50 40 30 20 10 0 2014 2015 2016 2017 Arizona FQHC US FQHC Benchmark 25
Physician Visits per Physician FTE - Medians 4,000 3,500 3,000 2,500 2,000 2014 2015 2016 2017 Arizona FQHC US FQHC 26
Mid-Level Visits per Mid-Level FTE - Medians 4,000 3,500 3,000 2,500 2,000 2014 2015 2016 2017 Arizona FQHC US FQHC 27
Key Performance Metrics Metric Why This Is Important 9 Medical Provider Productivity (patients) Becomes more important in transition to team-based care 10 Medical Team Productivity Who are your teams? How do they perform? 11 Cost (Revenue) Per Visit How are your visit costs changing over time? 12 Cost (Revenue) per Patient With the move to PCMH, how are patient costs changing? 13 Medical Support Staff Ratio How strategic is the staffing of the medical teams? 14 Non-Clinical Staff Ratio Non-clinical employees are not revenue drivers 15 Visit/Patient Growth Rates Are visits growing faster than patients? Is demand growing? *Capital Link Performance Benchmarking Toolkit 28
Total Patients per Provider FTE - Medians 950 900 850 800 750 700 650 600 550 500 2014 2015 2016 2017 Arizona - Total Patients per Provider FTE US - Total Patients per Provider FTE 29
Total Unduplicated Patients per Total FTE - Medians 135 130 125 120 115 110 105 100 2014 2015 2016 2017 Arizona - Total Unduplicated Patients per Total FTE US - Total Unduplicated Patients per Total FTE 30
Organizational Productivity per FTE - Medians 1000 800 600 400 200 0 2014 2015 2016 2017 Arizona - Total Unduplicated Patients per Total FTE Arizona - Total Patients per Provider FTE US - Total Unduplicated Patients per Total FTE US - Total Patients per Provider FTE 31
Operating Revenue & Expense per Patient - Medians $1,000 $950 $900 $850 $800 $750 $700 2014 2015 2016 2017 Arizona - Operating Revenue per Patient Arizona - Operating Expense per Patient US - Operating Revenue Per Patient US - Operating Expense Per Patient 32
AZ Operating Revenue & Expense per Patient - Percentiles AZ FQHC Revenue / Patient AZ FQHC Expense / Patient 33
Medical Services Cost per Patient - Medians Arizona Arizona Median 34
Percentage of Patients 18+ with BMI And Follow Up Documented Percentiles Arizona FQHC, UDS 35
Conveying Value 36
Conveying Organizational Value Dashboards Recognize Representation, Audience, etc Celebrate through Organizational Alignment and Actions Create and/or Acknowledge Traditions Engagement Social Media, Virtual Meetings, Visual, Share All Successes Connect Meetings, Talk, Deliberate Encouragement Have Fun with It Puns, Anniversaries, Contests Lead by Example Establish a Champion Accountable to Oversee/Coordinate 37
Basic Visuals 38
HRSA s Emphasis 39
HRSA s Press Releases 40
HRSA s Messaging 41
Previous Economic Impact Report 42
Recent Value & Impact Report 43
Recent Value & Impact Report 44
Anticipated Value & Impact Report 45
Anticipated Value & Impact Report 46
Sample PCA Publications and Websites About the Organization and FQHC Model Defined Overview of Board, Leadership, Staff, and Membership Service Area Geographic and Service Mix (Quality) Description and Characteristics of Patients Outcomes Economic Impact and Value of FQHCs to Communities Partners Collaborations and Communication (SDOH) Innovations - HCCN, Workforce, HIT, ACO, IPA, etc Programs - Education, Policy, Training, Emergency Preparedness, etc Financial Transparency and Sustainability Both PCA and Health Centers 47
Examples of Value and Engagement AACHC Awards Arizona Health Centers in the News - Hepatitis C: The Silent Epidemic - Take a Book, Leave a Book Little Free Libraries - Healthy Arizona Worksites Program GOLD Award - CHC Talks to Chamber about Community Health Services - Donate and Receive a Dollar-for-Dollar Arizona Charitable Tax Credit 48
Data & Value In Operational Planning Efforts 49
Assumptions and Scenarios 50
Financial Sensitivity: Medicaid Eligibility 51
Financial Sensitivity: Medicaid Eligibility 52
Financial Sensitivity: Medicaid Eligibility 53
Financial Sensitivity: Medicaid Eligibility 54
Financial Sensitivity: Reimbursement 55
Financial Sensitivity: Reimbursement 56
Financial Sensitivity: Reimbursement Initial Budget 57
MEDICAL CORRECTION - Financial Sensitivity: Reimbursement 58
Financial Sensitivity: Reimbursement Actual Payment 59
PROJECTED MIGHT BE ACTUAL NOW CORRECTION Financial Sensitivity: Reimbursement 60
Low Income Population Establishing Priorities HIGH LOW HPSA Score 61
Establishing Priorities MISSION FUNDING CAPACITY 62
Establishing Priorities 63
Community Health Centers Defining and Creating Valuable e To All For All 64
Jonathan Chapman Director of CHC Advisory Services 970-833-8513 jchapman@caplink.org Visit us Online: www.caplink.org Learn more about our products and services Download our free publications and resources Register for upcoming webinars Sign up for our e-newsletter, Capital Ink Subscribe to our blog at capitallinksblog.blogspot.com 65