1. DISSERTATION PROPOSAL DEFENSE
ARGOSY UNIVERSITY
COLLEGE OF BUSINESS
August 10th, 2015
Candidate: Joseph C. Makres
Dissertation Chair: Dr. David Hancock
Dissertation Member: Dr. Steve Shao

2. A HEALTHCARE MANAGEMENT PROBLEM
FOR TODAY’S HEALTHCARE EXECUTIVES
 Today’s Healthcare Environment
 Healthcare Consultant Perspective
 CIOs looking for guidance on what strategy / approach
to take for their particular organization
 $100 Million Dollar Investment
 Maximum reimbursement with the highest quality
care
 Data/literature lacking on VBP Program
performance and health information technology
strategies
 Literature and information on EMRs and financial
metrics available – only at application level
 Healthcare executives looking for answers

3. PROBLEM
 Uncontrolled U.S. Healthcare Expenditures
 Poor Quality Performance
 Increased financial investment in health
information technology (HIT)
 Fragmented healthcare system
 Disparate HIT applications without integration
 Transformational change to reimbursement model
 Fee-for-service to value-based care
 Failed HIT implementation can cost millions
 How to determine HIT return on investment

4. WHAT IS THE PROBLEM
Real-world Example:
Disparate Systems
Care Coordination
Patient-Centered Care

5. PURPOSE
 Examine whether HIT can improve quality, increase
efficiency, and reduce costs
 $20 billion allocated to HIT in 2009 ARRA
 Hospital reimbursement based on Quality not quantity
 Value-Based Purchasing (VBP) Program (1.5% in 2015)
 Accountable Care Organization (ACO) contracts
 Literature identifies three key HIT management
strategies
 How do they impact quality outcomes
 How do improve efficiency
 Does more or less integration improve performance
 #2 How have HIT management strategies changes over
time?

6. SIGNIFICANCE
 Managerial decision-making
 Healthcare executives making multi-hundred million dollar decisions
 What is the best way to organize their IT department, HIT applications,
and overall HIT management strategy to achieve the greatest ROI
 Improve patient satisfaction
 Increase overall quality of care
 How will we meet Meaningful Use and receive Medicare’s financial
incentive
 Stage 1
 Stage 2
 Effective HIT management requires:
 Planning
 Coordination
 Work Redesign
 Change Management
 Study will help healthcare executives evaluate and make
important decisions on which HIT management strategy
provides them with the best quality of care for patients and
maximum financial reimbursement!

7. RESEARCH QUESTIONS
 Are there significant differences in VBP Total
Performance Scores for acute-care hospitals
pursuing single-vendor, best-of-breed, or best-of-
suite HIT management strategies?
 Null Hypothesis
 No significant difference in performance between HIT
management strategies
 Has the proportion of HIT management strategies
within the acute-care hospital population changed
over time?
 Null Hypothesis
 HIT management strategy proportions have not
changed over time

8. THEORETICAL PERSPECTIVE
 Value-Based Purchasing Programs
 Ability to change provider behavior
 Davis & Damberg
 Principal-Agent Theory
 Environmental Uncertainty
 Changes to reimbursement method
 Compliance with payer demands/contracts
 Interoperability & HIT
 Resource Dependency Theory
 Pfeffer & Salancik (1978)
 Kazley & Ozcan (2007)
 Menachemi, Shin, Ford, & Yu (2011)

9. HOW
 Quantitative, non-experimental, cross-sectional
analysis with longitudinal component
 Data
 HIMSS Analytics Database (2009 & 2012)
 Value-Based Purchasing – Total Performance Score
 Fiscal year 2015
 One-way ANOVA with post hoc pairwise
comparisons
 Chi-square goodness of fit
 Simple Regression for each strategy

10. SIGNIFICANT LITERATURE REVIEW
FINDINGS

11. SIGNIFICANT LITERATURE
 Over 130 references
 Briggs (2003)
 Identified and labeled health IT strategies into
separate categories based on other industries
 Single-Vendor (SV) - enterprise-wide planning software
products are designed to integrate administrative, clinical,
and strategic applications across multiple locations and
provide hospitals with out-of-the box solutions
 Best-of-Breed (BoB) - offer more suitable products for the
needs of any department adopting this technology because
they offer richer domain-specific functionality, and since
they are designed for a specific department result in greater
buy-in from staff
 Best-of-Suite (BoS) - are a mix between BoB and single-
vendor approaches where hospitals use one package of
applications as the basis for integrating all other
applications within specific functional units

12. LITERATURE REVIEW
 Kazley & Ozcan (2007)
 Linked hospital use of HIT to securing necessary resources
(i.e. patient demand and financial reimbursement) under a
Resource Dependence Theory perspective
 Burke, Yu, Au, & Menachemi (2009)
 First to identify frequency of IT management strategies
pursued by U.S. hospitals
 SV (61%)
 BoS (29%)
 BoB (10%)
 In-house (<1%)
 Hospital characteristics associated with one strategy over
another
 Larger hospitals – BoS or SV Strategy
 Small & Medium Hospitals – SV Strategy

13. LITERATURE REVIEW
 Ford, Menachemi, Huerta, & Yu, (2010)
 Hospitals using BoS approach had fully implemented
HIT systems in significantly greater proportions than
did hospitals employing either of the other strategies
 Menachemi, Shin, Ford, & Yu, (2011)
 Number of managed care contracts per hospital (rate
of change or innovation) was negatively associated
with SV
 Complexity (market competition) was positively
associated with BoB
 Greater environment munificence negatively
associated with SV approaches*
 When access to resources is high, hospitals tend to choose
BoS strategies
 Resource Dependency Perspective

14. METHODOLOGY – PARTICIPANT SELECTION
 U.S. acute-care, non-Veterans Administration
hospitals
 Both databases
 Participants in HIMSS Analytics Survey
 Participants in Medicare VBP Program
 Burke et al. (2009), Ford et al. (2010), Menachemi et
al. (2011)
 2008 HIMSS Analytics Database – HIT Management
Strategy

15. METHODOLOGY – RESEARCH INSTRUMENT
 Secondary Data Resources
 2009 & 2012 HIMSS Analytics Database Survey
 2009 Microsoft Access dataset
 2012 Microsoft Access dataset
 Granted access to HIMSS Analytics + Dorenfest Institute for
Health Research Database
 Hospital VBP Program Results
 Fiscal Year 2015
 Over 3,000 acute-care hospitals
 Data collected through the Hospital Inpatient Quality
Reporting (IQR) Program (CMS, 2013)
 Publicly available data

16. METHODOLOGY – VALIDITY & RELIABILITY
 Burke et al. (2009), Ford et al. (2010), & Menachemi
et al. (2011)
 Collected HIT management strategy selection from 2008
HIMSS Analytics Database
 One-way ANOVA statistical test
 Normal distribution verification
 Commonly used test to determine if sample
populations have equal variances (Lind, Marchal, &
Wathen, 2010).
 Chi-square goodness-of-fit
 Normal distribution verification
 Commonly used test for expected frequencies (Lind,
Marchal, & Wathen, 2010)
 Utilized by Menachemi et al., (2011)

17. METHODOLOGY – DATA ANALYSIS
 Data matching
 Medicare provider number
 Same methodology as Burke et al. (2009), Ford et al. (2010), &
Menachemi et al. (2011)
 Statistical Procedures
 SPSS Premier Grad Pack V22.0

18. METHODOLOGY –
LIMITATIONS/DELIMINATIONS
 First study to attempt correlation between HIT
management strategies and VBP performance
 Participants focus on acute-care U.S. hospitals
 Not Included: Provider Groups/Networks Home health
facilities, skilled nursing facilities
 VBP performance data relatively new and evolving
rapidly which will limit ability to generalize about
future situations
 Dependent on secondary databases not under control of
investigator
 Control variables, organizational characteristics, and/or
environmental characteristics
 Scalability
 Examine individual departments, not entire hospital?

19. SIGNIFICANCE TO HEALTHCARE COMMUNITY
 Healthcare Executives & Management
 Limited data available linking HIT to VBP performance
 Healthcare industry is fragmented (Porter & Tiesberg,
2006), but so is HIT within individual hospitals.
 Several studies have already examined relationship
between the number of HIT systems and financial
performance (FFS not P4P)
 First study that looks at performance through pay-for-
performance reimbursement instead of traditional
DRG-based payments
 This study will shed some light on how effective these
changes have been at achieving the National Quality
Strategy’s strategic objectives and triple aim of better
care, better health, and lower costs.

20. REFERENCES
 Briggs, B. (2003). The main event: Best-of-breed vs. single-source. Health Data Management,
11(6), 41-4, 46-8. Retrieved from
http://search.proquest.com/docview/219533182?accountid=34899
 Burke, D. E., Yu F., Au, D., & Menachemi, N. (2009). Best of breed strategies: Hospital
characteristics associated with organizational HIT strategy. Journal of Health Information
Management, 23(2), 46-51.
 Creswell, J. (2009). Research design: Qualitative, quantitative, and mixed methods approaches,
(3rd ed.). Thousand Oaks, CA: Sage Publications.
 CMS. (2013). FY-2013 Frequently Asked Questions About Hospital Value-Based Purchasing
Program. Retrieved from http://www.hospitalcompare.hhs.gov
 Ford, E. W., Menachemi, N., Huerta, T. R., & Yu, F. (2010). Hospital IT adoption strategies
associated with implementation success: Implications for achieving Meaningful Use. Journal of
Healthcare Management, 55(3), 175-188.
 Helton, J. R. (2011). Assessing the impact of electronic health record technology adoption on
hospital labor efficiency. (Order No. 3459837, The University of Texas School of Public Health).
ProQuest Dissertations and Theses, 153. Retrieved from
http://search.proquest.com/docview/875816135?accountid=34899. (875816135).
 Kazley, A. S., & Ozcan, Y. A. (2007). Organizational and environmental determinants of hospital
EMR adoption: A national study. Journal of Medical Systems, 31(5), 375-84.
doi:http://dx.doi.org/10.1007/s10916-007-9079-7
 Lind, D. A., Marcha, W. G., & Wathen, S. A. (2010). Statistical Techniques in Business and
Economics (14th e.d.). McGraw-Hill Companies, Inc., New York, NY
 Menachemi, N., Shin, D. Y., Ford, E., & Yu, F. (2011). Environmental Factors and Health
Information Technology Management Strategy. Health Care Management Review, 36(3), 275-
285
 Pfeffer, J., & Salancik, G. R. (1978). The External Control of Organizations. Stanford University
Press, Stanford, CA.

21. APPENDIX
Follow Up Question & Answer

22. SIGNIFICANT / IMPORTANT TERMS
 HIT Management Strategies
 Single-Vendor
 Best-of-Breed
 Best-of-Suite
 Hospital Value-Based Purchasing (VBP) Program
 Total Performance Scores
 Process of Care Measures
 Outcomes Measures
 Patient Satisfaction
 Efficiency Measures (Medicare Spending per Beneficiary)
 American Recovery & Reinvestment Act (ARRA)
 Patient Protection & Affordable Care Act (PPACA)
 Health Information & Management Systems Society (HIMSS)
 Health Information Technology for Economic and Clinical
Health (HITECH Act)

23. METHODOLOGY – DATA ANALYSIS
 Hypothesis 1
 One-way Analysis of Variance
 Post hoc pairwise comparisons
 Scheffe’s Tests
 Hukey’s Test
 LSD
 Bonferri’s test
 Pearson’s Correlation Coefficient
 Hypthesis 2
 Chi-Square & Simple Regression (Goodness of Fit)
 Analyze HIT management strategy proportion over time

24. PURPOSE & RESEARCH QUESTION
 Hospitals & Providers
 HIT Investments
 IT Resources
 Purchasing Strategies
 Return on Investment
 Payers & Reimbursement Reform
 Value-Based Purchasing (VBP) Programs
 Pay-for-Performance Contracts
 Accountable Care Organizations
 Bundled Payment Contracts
 Do HIT investments lead to better quality and
efficiency outcomes for hospitals and patients?

25. PROBLEM BACKGROUND
 2009 ARRA legislation increased hospital & provider
investment in health information technology (HIT)
 Massive adoption of HIT application and systems through
EHR Incentive Program “Meaningful Use”
 2010 Affordable Care Act introduced new
reimbursement method – Value-Based Purchasing (VBP)
Program
 Significant departure from traditional fee-for-service
reimbursement to one based on quality, outcomes, &
performance
 Hospital, Providers, & Payers
 Improve patient quality & outcomes by restructuring
payment system
 Reliance on HIT to deliver efficiency and coordination
necessary to achieve quality & performance objective while at
the same time lower out-of-control healthcare expenditures

26. PROBLEM & BACKGROUND INFORMATION
 Healthcare Reform
 Reimbursement Model Experiments
 Quality or Value-based Care Concept
 Affordable Care Act (2010)
 Hospital Value-Based Purchasing Program
 American Recovery & Reinvestment Act (2009)
 The Health Information Technology for Economic & Clinical
Health (HITECH) Act
 The Office of the National Coordinator of Health Information
Technology (ONCD)
 $20 Billion toward HIT
 CMS EHR Incentive Program “Meaningful Use”
 ACA & ARRA Combined Objective & Outcomes
 Quality & Efficiency Improvement
 Care Coordination & Information Sharing
 Data Analytics: Predictive Modeling
 Workflow & Process Redesign

27. PROBLEM & BACKGROUND
 Hospitals Costs
 Quality of Care
 Efficiency
 Cost Containment
 Health Information Technology (HIT) Investments
 Value-Based Purchasing
 Care Coordination
 Pay-for-Performance
 Accountable Care Organizations
 Bundled Payment Contracts