Align Patient Outcomes with Financial Data: a Formula for Correlating Cost and Quality

Thank you for your time
and attention today.
Please visit us at Perficient.com
Align Patient Outcomes with
Financial Data: A Formula for
Correlating Cost and Quality

Perficient is a leading information technology consulting firm serving clients throughout
North America.
We help clients implement business-driven technology solutions that integrate business
processes, improve worker productivity, increase customer loyalty and create a more agile
enterprise to better respond to new business opportunities.
About Perficient

• Founded in 1997
• Public, NASDAQ: PRFT
• 2013 revenue ~$373 million
• Major market locations throughout North America
• Atlanta, Boston, Charlotte, Chicago, Cincinnati, Columbus,
Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Los
Angeles, Minneapolis, New York City, Northern California,
Oxford (UK), Philadelphia, Southern California, St. Louis,
Toronto and Washington, D.C.
• Global delivery centers in China, Europe and India
• >2,200 colleagues
• Dedicated solution practices
• ~85% repeat business rate
• Alliance partnerships with major technology vendors
• Multiple vendor/industry technology and growth awards
Perficient Profile

BUSINESS SOLUTIONS
Business Intelligence
Business Process Management
Customer Experience and CRM
Enterprise Performance Management
Enterprise Resource Planning
Experience Design (XD)
Management Consulting
TECHNOLOGY SOLUTIONS
Business Integration/SOA
Cloud Services
Commerce
Content Management
Custom Application Development
Education
Information Management
Mobile Platforms
Platform Integration
Portal & Social
Our Solutions Expertise

Partnership & Expertise:
• Oracle Platinum Partner
• Oracle Certified Education Training Partner
• 12+ year relationship of loyalty and trust
• Hundreds of successful implementations
• Over 200 delivery consultants on-shore and off-shore
• Five pillar practices
Oracle Partnership

Connected
Health
and Analytics
Interoperability
and Integration
Information
Exchange
Regulatory
Compliance
Solutions & Services
Experts in Consumer-Driven Healthcare Technology
HEALTH PLAN PROVIDER
CONSUMERS
Select Clients
Healthcare PracticeGlobalDeliveryCenters/OffshoreDelivery

Lesli Adams, MPA
Director, Oracle Healthcare Business Intelligence
Lesli is the Director of Oracle Healthcare Business Intelligence for Perficient.
She is a clinical measurement advocate with 17 years of healthcare analytics
and business intelligence experience covering for-profit, state, academic and
federal healthcare including ambulatory clinic management, comparative
effectiveness evaluation, evidence-based medicine, population health and
clinical data warehousing. Prior to joining Perficient, Lesli championed
activities with Tenet, MD Anderson, The University of Virginia Medical Center
and the US Navy.
William Bercik
Director of Healthcare, Oracle
William has over 25 years of experience in the healthcare industry and has
specialized in enterprise applications and technology solutions since 1992. He
provides specialist product expertise and develops and executes solution
strategies for the healthcare market. Prior to joining Oracle, William was a
former chief financial officer of a 350 bed acute care hospital.
.
Our Speakers

“To put it bluntly, there is an almost
complete lack of understanding of
how much it costs to deliver patient
care.”
– Robert S. Kaplan (Baker Foundation Professor at
Harvard Business School)
– Michael E. Porter (Bishop William Lawrence
University Professor at Harvard Business School)
The Big Idea: How to Solve the Cost Crisis
in Health Care
Harvard Business Review, Sept 2011
Why Now?

“We view this as a game changer….
We’ve got all the money we’re ever
going to get – we need to manage
smarter.”
– Don Riefner, Vice-President, Finance
Oracle Open World 2013
Game Changer

• Labor-intensive cost capturing process
• Need for departmental analysis of procedures and cost
• Lack of budgeting by service-line
• Inability to detail traceability all the way back to the episode of care and the
charge code
• Automating payor contract management process and analysis
• Executive-level decision reporting impacting key decisions on how to run their
business
• Lack of dashboards to service-line management in order to impact day to ay
operations
The Challenges We’re Hearing

Healthcare Cost Management:
Macro Drivers
• Increased market competition combined
with increasing healthcare costs have
made understanding product line and
market segment costs and profitability
essential
• Efficiency will allow insurers to maintain
stability in operations and rates
• Increased regulation and oversight will
require payers and providers to have a better
understanding of cost drivers
• May alter the ways that benefits are funded
and delivered
• Complex rules regarding reimbursements
• Shift from “fee for service” payment
structures to shared risk has placed
increased emphasis on cost and cost control
• Patient profitability at the service line is
becoming best practice
Revenue
Clinical
Quality
Cost
Provider
Operational
Analytics

Drugs
Blood
Products
Corporate
Expenses
Administrative
Support Utilities
Physician
Support
Diagnostic
Equipment
Clinical
Salaries
Others require analysis
to appropriately assign
Some costs are obvious and
easy to assign
Direct Costs
Semi-Direct Costs
Indirect Costs
Why Do We Need to Allocate?
Provider

Data is recorded in structures to satisfy statutory requirements
Country
Region
Hospital
Sub account
Account
Department
Line item
Financial
P&Ls
Traditional Financial Statements

P&L by Patient / Clinician
Indirect
Semi Direct
Direct
Physician
Procedure
Patient Interactions
Potentially millions of unique
items
Rows of Data
True Profitability

Events
Financial
Events
Operational
Sub Systems
Key drivers and details are retained
Specialty
Surgeon
Patient
Ward
Procedure
Insurer
ImplantPatient
P&Ls
Retained By Dimension
Revenues and expenses are connected strategically
The Patient Level P&L

What Does the Market Want?
Defining a Business Decision Support System (DSS)
EDW
• Retrospective and prospective
(planning) view
• Merges clinical and financial
information
• Real-time access
• Care process and results
orientation
Business Decision Support Systems Clinical Decision Support Systems
• A fully integrated business and clinical repository
• Gives executives and managers the tools to:
• Control cost
• Improve productivity
• Manage change
• Increase quality
• Achieve successful clinical outcomes
• Plan strategically in an increasingly
competitive and volatile health care
environment

Help Answer Critical Questions
Strategy
Development
Capital
Allocation
Revenue Cycle
Management
In what services do I make money? Lose money? Why?
How do my hospitals services compare across the health system?
How can I optimize service location? Should I consolidate services?
What is my profitability across service lines by hospital?
Where should I focus my cost reduction initiatives? How do I track success?
Why are costs for X service increasing, is it labor, supplies or physician practices? How
can we decrease these costs?
Are patient care processes following protocols? Why not? Is it physician or patient
complexity driven?
What impact to my bottom line will a rate change create? Can I afford to sign this
managed care contract?
What types, how much and where are my denials originating?
Are my payors paying correctly? Timely?
Can I compare my payors profitability and score them?
Am I charging for all the services I am performing?
Operations
Improvement
What services should I invest capital? What financial return can I expect?
What incremental ancillary capacity will be affected by additional capital purchases?
Decision Support Systems (DSS)

DSS - Key to Enterprise
Management Reporting
End Users
Executive
Team
Information
Quality
Management
Information
Physician/Clinical
Management
Information
Financial
Information
Managed Care
Information
Data Integration
(Comprises the processing engine to collect, cleanse,
transform, and aggregate data from different sources)
Enterprise Portal
(Provides a single, secure and integrated point
of access to reports, content, and applications)
Data Aggregation and Storage
(Comprises the data repository of historical details
and summary transaction data)
 Presentation, Personalization
 Access / Authorization
Views Views Views Views Views Value Delivered
(Provides reporting and analytic capabilities
across varying levels of granularity and timeliness
(e.g., historical, operational, predictive and what‐if analysis)
Infrastructure
(Comprises the infrastructure platform
to host, maintain and operate the BI solution)
Online Analytical Processing
 Pre‐Defined Data Cubes
 Pre‐Defined Reporting
 Data Consolidation
 Historical Data
 Data Extraction
 Data Cleansing
 Data Loading
 Data Sources, Real time data
 Certain Operational Reports
Data Acquisition
(Comprises internal, external, reference,
and shared sources of data)
 Hardware, Software
 Network
 Operations
ERPCIS
Revenue
Cycle
Decision
Support

Top 5 Expensive Conditions Treated
• Septicemia
• Osteoarthritis
• Device, implant or
graft complication
• Birth
• Acute myocardial
infarction
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare
Research and Quality (AHRQ), Statistical Brief #160, Dec 2013.
http://hcup-us.ahrq.gov/reports/infographics/HCUP_MostExpensiveCond2011.jpg

In the Numbers
Average hospital overall operating margin
% of hospitals with a NEGATIVE operating margin
As bundled payments, ACOs, and population health comes into focus
The level of effectiveness in setting and controlling operating
and capital expenses for service line and populations will be
the mark of survival
2%
33%
American Hospital Association Database www.aha.org/research/reports/tw/chartbook/ch4.shtml

High Performance Costing Expressway
• Faster deployment, lower risk,
reduced cost of ownership,
scalable and flexible
• Provider effort and clinical
evidence for resources used
• Impact day-to-day service line by
providing patient level margin
• Enhanced understanding =
enhanced planning and
forecasting models
• Cost management culture
needed to measure cost vs.
quality

Perficient
Analytics
Oracle Hyperion
Profitability & Cost
Management
Perficient
Standard
Interface Files
EPIC
Data
Warehouse
Labor
General
Ledger
High Performance Costing Expressway
• Oracle Hyperion Profitability &
Cost Management platform
• Built to leverage the Oracle
Enterprise Health Analytics
model for continual integration of
data for advanced costing
subject areas including:
• Service line costing
• Pharmacy costing
• Surgical costing
• Encounter level: cost vs. quality
• Built to leverage Oracle
Engineered Systems (Oracle
Exadata and Oracle Exalytics)

Enterprise Healthcare Analytics

EMR OBIData Mart
HPCM
EHA
Patient
Accounting
Patient
Event
Human
Resource
General
Ledger
Data Flow (Simplified)
Data
Oracle
Perficient
Legend

Use Case - Stages
• Hospital-based clinic – Pediatric visits, well-child w/vaccine or cellulitis
• 4 pediatricians, 19 support staff
• Forecasted annualized and monthly volumes and capacity for
providers, clinic spaces, and treatment rooms
• Synthetic data set as proxy for EMR file, general ledger, labor sub-
ledger and supply sub-ledger
Answering the question..
• Every patient is different, why is their cost the same?

Costs for Indirect Supplies and Furniture & Fixture allocated per visitCosts for Indirect Supplies and Furniture & Fixture allocated per visit
Costs (Direct Labor + Direct Fringe) for physicians to patient
encounters based on CPT4 992x2; time and motion study
5
Direct Supply Costs per patient visit (e.g. Vaccines)Direct Supply Costs per patient visit (e.g. Vaccines)
2
Costs for Indirect Labor / Clinical Staff (Semi-Direct Labor + Semi-Direct Fringe)
allocated per visit
allocated per visit
3
4
Overhead G&A and Support Services allocated per visitOverhead G&A and Support Services allocated per visit 1
Use Case - Stages
Patient Visit

Overhead G&A
Patient Visit
Overhead Activities - to be allocated Driver Budgeted Amount
HR Support Headcount ($1,367,560)
Administration Headcount ($3,499,400)
IT Devices ($3,986,920)
IT / EMR Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($13,000,000)
Supply Chain / Inventory Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($4,353,000)
Finance Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($2,346,400)
Patient Access Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($1,513,960)
Perf Improvement/Quality Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($3,063,960)
Nursing Management Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($13,754,400)
Case Management Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($2,100,480)
Provider Relations Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($2,290,480)
Records/HIM Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+ OBS+ (Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($1,731,200)
Maintenance & Repairs Square Feet ($54,026,000)
BME Equipment $ ($21,202,000)
Cleaning/Housekeeping Square Feet ($9,726,000)
Insurance Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+OBS+(Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($100,738,480)
Utilities Square Feet ($100,100,000)
Laundry & Linen Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+OBS+(Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($1,437,000)
Dietary Visits + (Patient Days) +(Births*3)+(Surgeries*3)+(Lab tests/5)+OBS+(Pharm Doses/5) + (Prescriptions/2) + (Procedures/4) ($5,656,960)
Total Overhead Expenses ($345,894,200)
Overhead G&A and Support Services allocated per visitOverhead G&A and Support Services allocated per visit 1

Indirect Supplies
Patient Visit
Cost Type Supplies Supply Item CPT Each
Indirect Supplies Clinic Supplies Treatment Room Supplies 11042 $ 16.25
Clinic Supplies Bandages & Consumables Each Visit $ 1.50
Clinic Supplies Room Prep Materials Each Visit $ 1.92
Costs for Indirect Supplies and Furniture & Fixture allocated per visitCosts for Indirect Supplies and Furniture & Fixture allocated per visit 2

Semi-Direct Labor
Patient Visit
Cost Type Clinical Staff Annual Salary Fringe
Fully
Burdened
Salary
Monthly Labor
+ Fringe
Monthly
Visits
(Budget)
Indirect Labor +
Fringe Per Visit
Indirect
Labor +
Fringe
RN Doyle $ 45,000 $ 10,800 $ 55,800
RN Gibson $ 45,000 $ 10,800 $ 55,800
RN Howard $ 45,000 $ 10,800 $ 55,800
RN Ignacio $ 45,000 $ 10,800 $ 55,800
NA Jones $ 33,500 $ 8,040 $ 41,540
NA Kilmore $ 33,500 $ 8,040 $ 41,540
NA Limon $ 33,500 $ 8,040 $ 41,540
Cost Type Clinical Staff Annual Salary Fringe
Fully
Burdened
Salary
Monthly Labor
+ Fringe
Monthly
Visits
(Budget)
Indirect Labor +
Fringe Per Visit
NA Micheals $ 33,500 $ 8,040 $ 41,540
NA Noman $ 33,500 $ 8,040 $ 41,540
NA Oscar $ 33,500 $ 8,040 $ 41,540
NA Phillips $ 33,500 $ 8,040 $ 41,540
NA Quinn $ 33,500 $ 8,040 $ 41,540
NA Roscoe $ 33,500 $ 8,040 $ 41,540
NA Simmons $ 33,000 $ 7,920 $ 40,920
MA Taylor $ 33,000 $ 7,920 $ 40,920
RN Ukon $ 45,000 $ 10,800 $ 55,800
MA Vikes $ 27,500 $ 6,600 $ 34,100
MA Farmer $ 27,500 $ 6,600 $ 34,100
MA George $ 27,500 $ 6,600 $ 34,100
Totals, 19 Staff $ 837,000 $ 69,750 1,996 $ 34.94
allocated per visit
allocated per visit
3

Direct Supplies
Patient Visit
Cost Type Supplies Supply Item CPT Each
Direct Supplies Vaccines Flu 99460 $ 5.13
Vaccines Pneumo 99470 $ 12.45
Direct Supply Costs per patient visit (e.g. Vaccines)Direct Supply Costs per patient visit (e.g. Vaccines)
4

Direct Labor
Patient Visit
Cost Type Physician
Basic $ /per Visit
992x1
Inter $ / per Visit
992x2
Inter $ / per Visit
992x3
Inter $ / per Visit
992x4
Complex $ / per
Visit 992x5
Direct Labor Dr. Adams $ 14.33 $ 21.49 $ 28.66 $ 35.82 $ 42.99
Dr. Bishop $ 15.43 $ 23.15 $ 30.86 $ 38.58 $ 46.30
Dr. Crisp $ 14.33 $ 21.49 $ 28.66 $ 35.82 $ 42.99
Dr. Edwards $ 13.78 $ 20.67 $ 27.56 $ 34.45 $ 41.34
Direct Fringe Dr. Adams $ 2.15 $ 3.22 $ 4.30 $ 5.37 $ 6.45
Dr. Bishop $ 2.31 $ 3.47 $ 4.63 $ 5.79 $ 6.94
Dr. Crisp $ 2.15 $ 3.22 $ 4.30 $ 5.37 $ 6.45
Dr. Edwards $ 2.07 $ 3.10 $ 4.13 $ 5.17 $ 6.20
5

Time for Action
1. Combine clinical & financial data
2. Use enterprise wide data sets to improve validity
3. Drive to an actionable level of detail
4. Show findings in a highly visual, action-ready format

Cost Management: Overall Analysis

1. Evaluate Payment Model Structures
2. Evaluate Performance Levels
3. Partner with Finance/Clinical Operations
4. Start the Conversation
5. Develop a Prototype
6. Implement Capability / Improvements Incrementally
Next Steps

Lesli Adams, MPA
Director, Oracle Healthcare Business Intelligence
lesli.adams@perficent.com
281-435-8473
William Bercik
Director of Healthcare, Oracle
William.bercik@oracle.com
312-203-9641
Perficient/Oracle Contacts

Follow us on Twitter
@PRFT_Oracle
@Perficient_HC
@lesliadams
@teriemc
Out and About
Stop by and see us at
Oracle Open World
Booth #2221
Sept. 28 – Oct. 2
San Francisco, CA

Align Patient Outcomes with Financial Data: a Formula for Correlating Cost and Quality

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Align Patient Outcomes with Financial Data: a Formula for Correlating Cost and Quality

Semelhante a Align Patient Outcomes with Financial Data: a Formula for Correlating Cost and Quality (20)

Mais de Perficient, Inc.

Mais de Perficient, Inc. (20)

Último

Último (20)

Align Patient Outcomes with Financial Data: a Formula for Correlating Cost and Quality