Effective Healthcare Data Governance Strategy Propels Data Transformation
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Data governance often has negative connotations, such as contention, complexity, or tedium. In addition, the challenges associated with effective data governance—including breaking down long-existing data silos, a lack of trust in the data, and executive buy-in—can further thwart progress. There are, however, better ways to perform healthcare data governance. Join this webinar with Phillip Rowell, Vice President of Clinical and Business Intelligence at Carle Health and Bryan Hinton, Chief Technology Officer at Health Catalyst, to learn how proven approaches and a shared vision for data governance allow health systems to maximize data, their greatest asset. Participants will learn the following: • The common pitfalls of data governance and how to address them. • How to use the momentum from the data procurement stage to develop an effective data governance strategy. • The positive results health systems can achieve from effective data governance.
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Effective Healthcare Data Governance Strategy Propels Data Transformation
- 1. Effective Healthcare Data Governance Strategy Propels Data Transformation Phillip Rowell, M.J., Vice President of Clinical and Business Intelligence, Carle Health Bryan Hinton, Chief Technology Officer, Health Catalyst
- 2. Agenda © Health Catalyst. Confidential and proprietary. • Why executive governance ensures data focus and success • Three steps to achieve executive governance • Key takeaways • Results
- 3. © Health Catalyst. Confidential and proprietary. Learning Objectives Define executive governance Explain how executive governance is critical for successful data governance Describe three steps to achieve executive governance Share results and recommendations from successful executive governance
- 4. © Health Catalyst. Confidential and proprietary. Carle Health To be your trusted partner in all healthcare decisions. Mission: Our Reason for Being To improve health by providing highly accessible, world-class care & service. Vision: Our Ambition
- 5. © Health Catalyst. Confidential and proprietary. Carle Health Carle provides a broad spectrum of healthcare services to a large and predominantly rural area across 28 counties in east-central and southern Illinois. A Leading Integrated Healthcare Delivery System
- 6. © Health Catalyst. Confidential and proprietary. Poll 1 • Yes – 92% • No – 8% Have you ever witnessed failure(s) in a governance process?
- 8. © Health Catalyst. Confidential and proprietary. Executive and Data Governance Executive Governance: A common agreement about how to leverage analytics and data in everyday operations. Data Governance: A standard approach to calculating key metrics (e.g., length of stay) and applying disciplined quality and financial and/or clinical improvement methodology. How Executive Governance Affects Data Governance: When all levels of the organization agree on priorities and resources to achieve those priorities, they can agree on standard definitions and an approach to efficiently reach their goals. Definitions and Interplay
- 9. © Health Catalyst. Confidential and proprietary. The Problem: No Governance = No Progress Causes of ineffective executive and data governance include the following: • Lack of shared vision. • Wavering sense of purpose. • Divergent pursuit of objectives. • Arguments over data. • Series of iterative failures: – Enterprise data warehouse ownership. – Sepsis improvement program.
- 10. © Health Catalyst. Confidential and proprietary. Solving the Problem: A Learning Process • Identify strategic goals: value, growth, excellence. • Garner support from executives. • Define a value-based care imperative. • Create a culture of change and define expectations. • Realize the need for an analytics partner with specific criteria: – Experience establishing executive and data governance. – A robust data platform that supports real-time data aggregation and integration with external and internal data sources. – Lay the groundwork to scale outcomes improvement efforts. – Enable education to support internal expertise.
- 11. © Health Catalyst. Confidential and proprietary. Poll 2 • Hard – 17.8% • Boring – 0% • Tedious – 20.5% • Stressful – 2.7% • All of the above – 58.9% Governance is…
- 13. © Health Catalyst. Confidential and proprietary. 2021 Achieving Top Decile Financial Summary Length of Stay Reduction $1M Observation Length of Stay Reduction $5.5M Labor Savings-Clinical Staff $6.5M Labor Savings-Locums Analysis Pending Readmission Reduction $3.3M Case Mix Index Improvement $1.4M Denials Improvement $6.5M Home Care Optimization $1M Supply Chain Discipline $2.1M Pharmacy Optimization $150K BEST Program Analysis Pending Mitigation of Out of System Migration $6M Shared Service Optimization Analysis Pending ACO Analytics Transition $160K HAC Reduction Program $68K E&M Coding Enhancement (ED) $2.9M Zoom to Microsoft Team Conversion $50K Operational Cost Savings $1M 2020 Disproportionate Share Appeal $7M Program Total $44.6M Program Goal $35M Step #1: Define a Vision and Common Goals Every initiative should support achieving top decile performance: • Identify and eliminate low-value care. • Support the transition to value-based care. • Access social determinants of health data. • Redefine medical education. • Develop a source of truth. • Create Population Health Services Organization. • Reduce observed deaths/expected deaths mortality rate. • Improve efficiency in ambulatory care.
- 14. © Health Catalyst. Confidential and proprietary. Carle Health System Board Quality Scorecard Tracked Year Over Year Positive Variance Negative Variance
- 15. © Health Catalyst. Confidential and proprietary. Step #2: Establish Organizational Structure Data Governance Group Quality & Patient Safety Shared Governance Steering Committee COVID-19 Revenue Cycle 15 ACO/Population Health CBI Operations Finance & Accounting Outcomes Improvement Team(s) Drives innovation & adoption GUIDANCE TEAMS Provides domain oversight and drives priorities Clinical and Business Intelligence team (CBI) Supports across all domains Workgroup(s) Innovates Provides governance of infrastructure, tools, and teams needed to ensure data quality, build data literacy, maximize data utilization, and ensure data security and privacy. Supports the development and dissemination of prioritized content and analytics needs across domains. The Guidance Team is a dedicated team, usually formed around a prioritized clinical program or service domain (e.g., Cardiovascular Care). The Guidance Team may create one or more dedicated Outcomes Improvement Teams to lead improvement efforts in key process areas (e.g., Heart Failure). Guidance or Improvement teams may assign specific discovery and intervention- design work to ad-hoc workgroup(s) (e.g., a heart failure risk stratification tool). Executes and operationalizes the vision set forward by the executive governance group. Manages the development and dissemination of prioritized content and analytics needs across domains. Executive Governance Group (representatives from Carle Health, Alliance, and analytics partner) Creates a vision, determines decision-making and improvement methodologies, prioritizes opportunities, oversees the establishment of improvement teams, and provides ongoing oversight and guidance to extend and sustain improvements.
- 16. © Health Catalyst. Confidential and proprietary. The Journey to Executive and Data Governance Spreadsheet Silos • Silos or pockets of analysis. • Conflicting spreadsheet reports and interpretations of data. • Battles over data ownership. • Most time spent on hunting for and gathering data. • Focus is on is the data “right.” Centralized Reporting D iab et es S ep sis R ead m issio n s C o m m o n , lin k ab le v o cab u lar y F in an cial S o u rce M art s Ad m in ist rat iv e S o u rce M art s D ep art m en t al S o u rce M art s EM R S o u rce M art s P at ien t S at isfact io n S o u rce M art F IN A N C IA L S O U R C ES (e.g . EPS i, Peo p leso ft , Law so n ) A D M IN IS TR A TIV E S O U R C ES (e.g . A PI Tim e Tr ack in g ) EM R S O U R C Es (e.g . C er n er , A llscr ip t s, N ex t G en ) D EPA R TM EN TA L S O U R C ES (e.g . A p o llo ) Pt . S A TIS F A C TIO N S O U R C ES (e.g . N R C Pick er , Pr ess G an ey ) • Centralized single source of truth established in the data platform. • Significant time spent on standardizing definitions. • Data begins to be trusted. • Report queue begins to build. • Focus is on requirements for dashboard applications and reports. Executive and Data Governance • Improvement teams use analytics to accelerate best practice adoption. • Data drives decisions and actions. • Focus is on growing and sustaining outcomes improvement through variation reduction leveraging analytics.
- 17. © Health Catalyst. Confidential and proprietary. Prioritize Initiatives with Care Process Variation
- 18. © Health Catalyst. Confidential and proprietary. X How to Evaluate Improvement Initiatives Financial Clinical Experience Improvement Type: Value Effort High Light High
- 19. © Health Catalyst. Confidential and proprietary. Step #3: Execute Project Portfolio • Not all projects have financial impact, but many do. • Savings lives is as important as saving money – track both. • Create healthy mix of projects that are long and short term, hard and easier to achieve, those with big value and those with smaller but intrinsic value because of an enthusiastic group of providers wants to explore ways to improve. Prioritize Projects Selected and Estimate Effort over Value • Review issues and opportunities surfaced in your initial assessment. • Determine method for evaluating initiatives (and vote on them). • Assemble a portfolio of projects across the dimensions of quality, utilization and literacy. • Select demonstration projects. • Set up measurement and monitoring processes. Standard Approach for Project Selection
- 20. © Health Catalyst. Confidential and proprietary. Our Delivery is Aligned to Enterprise Goals Objective: Provide an enduring, contemporary analytic delivery capability. Robust Data Precise Delivery Enterprise Partnerships Enable the rapid flow of information across the enterprise. Identify areas for process improvement and automation. Enhance and develop the knowledge capital of the organization. Provide inputs to validate the established checkpoints for our enterprise operational strategy. Ensure compliance with state and federal guidelines. Ensure Projects Align to Enterprise Goals
- 21. © Health Catalyst. Confidential and proprietary. The Role of Clinical and Business Intelligence Clinical and Business Intelligence Guidelines and Regulations Strategic Goals (Enterprise) Departmental Priorities Industry Best Practices Technological Innovation
- 22. © Health Catalyst. Confidential and proprietary. Executive Governance in Action: Sepsis Then Patient days by attending provider for sepsis focused on the year 2019.* Results: • 51% of the total Sepsis encounters are in the lower-risk tiers. • 42% of those attending providers have a 30-day all-cause hospital readmission rate greater than the overall mean. • 6-9 days average length of stay. • 16% all-cause readmissions. *Using unvalidated test data based on ICD Diagnosis Codes.
- 23. © Health Catalyst. Confidential and proprietary. Executive Governance in Action: Sepsis Now Patient days by attending provider for sepsis focused on the year 2021. Results: • 40% (vs. 51%) of the total Sepsis encounters are in the lower-risk tiers. • 29% (vs. 42%) of those attending providers have a 30-day all-cause hospital readmission rate greater than the overall mean. • 3.3 days (vs. 6-9 days) average length of stay. • 11.66% (vs. 16%) all-cause readmissions.
- 24. © Health Catalyst. Confidential and proprietary. Current Project Portfolio Increase Revenue • Improve population health management. • Close care gaps. • Grow membership of insured members by differentiation with FHIR interoperability. Decrease Cost • Access population health analytics (drop in cost per member per month). • Improve access to self-service analytics (avoid staff report writing costs and save time). • Compare expense of robotic cases to non robotic cases. • Decrease cost of refills in ambulatory care. Quality Improvement • Leverage COVID-19 Demand Forecasting model. • Reduce sepsis mortality by improving adherence to 3-hour bundle, improve early detection of sepsis patients (used KPA to prioritize). • Reduce admissions for heart failure patients. PRIORITY: Align Initiatives with Achieving Top Decile (ATD) Goals
- 25. © Health Catalyst. Confidential and proprietary. • Medication Renewal Center (MRC) established 2014 - Focus Primary Care. • Goals: – Improve provider and employee satisfaction. – Improve patient safety. – Improve standardization – Protocol contains 396 medications. • Average turn around time (TAT) 48-72 hours. • Modes to submit an MRC request: • Telephone encounters. • MyCarle messages. • Faxes. • Pharmacy to Carle interface. 0 5000 10000 15000 20000 25000 30000 35000 40000 2013 2014 2015 2016 2017 2018 2019 2020 2021 MRC Encounters Executive Governance Presentation Example Medication Refill Management MRC Encounters Processed:
- 26. © Health Catalyst. Confidential and proprietary. MRC Program Benefits and Value • Improved patient experience and satisfaction. • Reduced renewal turnaround time to < 24 hours leads to more timely care. • Proactive care gap closure allows for consolidated patient trips to a clinic. Improved Patient Experience and Satisfaction • Closing care gaps leads to higher patient safety and compliance. • Improved quality measurements can be seen across the health system. Enhanced Care Delivery • Closing visit and lab care gaps identifies new or missed revenue streams. • Increased in free provider and staff time allows more patient engagement or visits. Increased Revenue Opportunities
- 27. © Health Catalyst. Confidential and proprietary. Case for MRC Program: Carle Current State Annualized prescription (Rx) renewal encounters completed by Carle’s MRC FTEs (RNs, LPNs, & Medication Renewal Specialists) Time per renewal/encounter Turnaround time 373,000 18.6 6-7.5 minutes < 24 hours (48%) < 48 hours (61%) < 72 hours (99%)
- 28. © Health Catalyst. Confidential and proprietary. MRC Program Expected Value and Key Metrics Staffing (373,081 renewals) Mins/RX Renewal Estimated Staff Annual Salary Current State at Carle 6.0 18.6 $1,542,646 Potential Future State at Carle 2.0 6 $514,182 Potential Savings: • 12.6 FTEs • 24,872 hours • $1,028,364 annually Turnaround Time < 24 Hrs < 48 Hrs < 72 Hrs Current State at Carle 48% 61% 99% Potential Future State at Carle 80% 95% 99%
- 29. © Health Catalyst. Confidential and proprietary. MRC Program Implementation Proposal • Initial investment required for implementation: • Client resources: 60+ hours. • Required champions: project sponsor, executive, physician, pharmacy/nursing, and IT. • Work with Best Practices Committee to prioritize ambulatory care. • Vetted paper-based protocols currently at Carle (375+) and will implement approximately 600+ more from provided library. • Increase time to value to accomplish cost savings by using the existing protocol approval process. • Create a plan for any excess nursing staff ahead of time to ensure early buy in and support (e.g., re-appoint, move to top of license).
- 31. © Health Catalyst. Confidential and proprietary. Poll 3 • Yes – 100% • No – 0% I have a better understanding of some of the steps that I can take to improve governance
- 32. © Health Catalyst. Confidential and proprietary. Four Governance Principles • Principle 1: Stakeholder Engagement Starting at the top, engage all stakeholders around a common vision. • Principle 2: Shared Understanding Have a common understanding of organizational needs, capabilities, and readiness. • Principle 3: Alignment Adopt a consistent improvement methodology, align incentives, and balance polarities. • Principle 4: Focus Practice disciplined decision making to prioritize, fund, organize, and sustain initiatives. Our emphasis is on principles, not prescriptions.
- 33. © Health Catalyst. Confidential and proprietary. Results FOCUS • Prioritized the most impactful clinical programs (e.g., 50% sepsis reduction LOS). • Improved alignment across system (e.g., Population Health Services Organization). 1 RESOURCE • Gained efficiencies through use of data vs. manual work and leveraged existing workgroups (saved > 2,000 hours in one year). • Focused resources to achieve ROI. 2 WIN • COVID-19 Demand Forecast enabled appropriate staffing and ensured patient access. • Increased team member access to actionable data. 3 BUY-IN • Governance committee heavily weighted by physicians. • Included CNO and CQO. • Selected projects that had physician support. 4
- 34. © Health Catalyst. Confidential and proprietary. Key Learnings and Recommendations Establish executive governance as a priority. • Highlight as a key attachment in the contract. • Regular meetings. Focus on, and resource, key initiatives. • Vote on a few projects and ensure support/FTEs/$ to achieve success. Use a consistent improvement framework. • Select model (e.g., DMAIC and PDSA) and stick with it. Communicate and celebrate program success. • Review progress at governance meetings. • Publish success stories and results with improvement.