Performance Data, Dashboards, & Metrics-Based Management

www.openminds.com

Performance Data,

Dashboards, &

Metrics-Based

Management

The NYAPRS Collective in Collaboration with the Managed Care Technical Assistance

Center (MCTAC)

Monica E. Oss, Chief Executive Officer, OPEN MINDS

Agenda

Performance Data, Dashboards, & Metrics-Based Management

I. Performance Matters II. Using “Big Data”

III. Using Your EHR Dataset To Support Executive Decision Making

The execution or

accomplishment of

work, acts, or feats

The fulfillment of a

claim, promise, or

request

1. Organizational or program sales or revenue

2. Organizational or program cost 3. Organizational or program

profit/margin

4. Program market share 5. Cash flow

6. Consumer clinical outcomes 7. Consumer functional

outcomes

8. Consumer satisfaction 9. Community tenure 10. Emergency room use

11. Readmission rates – hospital, residential facility, jail

12. Reunification with family 13. Payer satisfaction

14. Cost per consumer care episode

15. Annual cost per consumer 16. Contract compliance

17. Productivity of clinical team members

18. Yield (occupancy) of facility-based care

19. Staff retention and turnover 20. Service volume

Many Kinds Of Performance Measures In The Field Can

Seem Confusing

Organizational Performance Communication

Market

Positioning

&

Competitive

Advantage

Guideline: Where You Focus Performance Improvement

Investment Depends On Strategy For Competitive

In a commodity market, where all products or services are viewed as ‘identical Otherwise, performance matters In a monopoly market, where there is no competition

When Does Organizational Performance Not

Matter?

• Previous relationships with payer changing

– Role of mission-based, tax-exempt organizations evolving

• More competition

• Technological substitution reducing price point on

rates

The Challenge

Strategic Advantage & Market Positioning Payer Performance Expectations Consumer Performance Expectations Contract Performance

Accreditation & Licensure Performance

Metrics-Based Management

Strategic Management & Business Process Management

Strategy Evolution Operational Execution Strategy Development

• Large pools of data (and getting larger

each year) that can be captured,

communicated,

aggregated, stored, and analyzed

“Big Data” Is The “Silver Bullet” Of Executive

Decision-making

“Big Data” defined by

• Velocity: speed of data creation, how much data is recorded each minute of each day

• Variety: many stakeholders

recording different types of data from different sections of industry

• Volume: natural consequence of velocity and variety, pushes

existing storage infrastructure to its limits

Analytics 1.0: Business Intelligence For Management Teams Analytics 2.0: Big Data For Management Teams Analytics 3.0: Data-Enriched Services For Consumers & Front-line Staff

The Evolution Of Analytics

The Past The

Present

The Future

Analytics 1.0: Business Intelligence For Management Teams Analytics 2.0: Big Data For Management Teams Analytics 3.0: Data-Enriched Services For Consumers & Front-line Staff

The Evolution Of Analytics

The Past The

Present The Future We’re not here yet This is a few years off

Retrospective “What Happened” Directive “What Is Happening & Where Are We Headed” Predictive “What Will Happen”

What Is Business Intelligence?

Tools enabling analysis of organizational information to optimize management

decisions and performance. BI technologies provide historical, current and predictive views of business operations.

• Elemental data available for decision making

• State data sets highly variable – and few are connected outside of “departments”

• Health insurers traditionally focused only on

claims management, and not on ‘health system’ or ‘outcomes management’

Where Are We With Business Intelligence Among

Payers & Care Management Organizations?

• The percent of physicians using EHR system was just 17 percent in 2008 – now more than 50 percent

– 45 percent with EHRs say they routinely access clinical data from outside their own organization

• For hospitals, just nine percent had adopted EHRs in 2008 – now more than 80 percent have demonstrated meaningful use of EHRs

– 17% of hospitals using comprehensive functionality

• Non-profit health/human service organizations – other than hospitals – far behind the EHR adoption curve

Where Are We With Business Intelligence In

Service Provider Organizations?

8 Core EHR Functions 1. Health information and data 2. Result management

3. Order management 4. Decision support

5. Electronic communication and connectivity

6. Patient support

7. Administrative processes and reporting

“Big Data” Is The Goal For Interoperable EHRs

– But Is Far From “Here”

Bioconnectivity

Single Real-Time Clinical, Admin, &

Cost Data Set

EMRs & EMR Data

(National Health Information Network of the future)

Connection Of & Access To All Data Sets Via Web Tools - For Consumers,

Professionals, Health Systems

Clinical Metrics From Telehealth Clinical Data From New Diagnostics & Neurotech

Anatomy Of Big Data In Health & Human

Services

• Billing, personal health records, electronic health records, registries, meaningful use requirements, etc.

Inputs

• Health information exchanges (HIE)

Exchange

•

BIG DATA

Database

• Dashboards and decision support

• Postponing the cultural changes involved in metrics-based management – and some hard decisions. . .

• The challenges of the evolving health and human service market are not waiting for “big data” to arrive

• Organizations need to manage both strategy and business processes with the information that they have

– The KPI of strategic management

– The KPI of business process management

Management Teams Are Waiting For "Big

Data" To Arrive & Be Perfect!

Neither a wise man nor a brave man lies down on the tracks of history to wait for the train of the future to run over him.

Bioconnectivity Roadmap For U.S. Health &

Human Service System

Bioconnectivity Single Real-Time Clinical, Admin, &

Cost Data Set

Clinical Data From New Diagnostics & Emerging

Neurotech

Clinical Metrics From E-Health &

Remote Consumer Monitoring

Connection of All Data Sets Via Web Tools (With Consumer & Professional Access)

EMRs & EMR Data (NHIN of

The Challenge is to Get Maximum Leverage Of Your

Investment in Bioconnectivity Requirements

Strategic Decision-making

Informatics -- Analysis of data gathered through bioconnectivity

with tools to support decisions

Bioconnectivity -- Comprehensive, web accessible data set of all health and human services activities

Using Tools Is

the

Differentiator

• Ability to use tools separates man from animals (theoretically, at least)

• Ability to use data separates the ‘thriving’ from the ‘surviving’ in current health and human service environment

The Failure To Get Leverage

• Investment in electronic health recordkeeping system

• As a compliance cost (cost only)

• As a process or efficiency improvement model (operations ROI)

• As a source of strategic decision support tool (priceless)

Key Strategic & Market Information

You Need To Make Critical Business Decisions

1. Development of organizational strategy

– using data to assess internal resources against external environment

2. Design of operating unit plans to support strategy implementation –

using data to conduct operational business unit gap analysis and set performance standards

3. Management of performance – using data to manage the organization’s operations to the performance metrics required for success

4. Evolution of market positioning – using data to compare organizational performance against competitors to gain competitive

advantage

5. Participation in performance-based contract arrangements

Metrics Needed For Optimal Strategic

Planning

1. Income/revenue, by source and service line

– Allocated charitable income/revenue, by service line

2. Profit/loss by service line without charitable allocation (if NFP) 3. Total profit/loss by service line

4. Total number of consumers served, by service line and payer 5. Total number of service units delivered, by service unit type, by

service line and by payer

6. Staff/facility productivity or yield, by service line and/or operating units

7. Total direct cost per service unit, by service unit type

– Total indirect cost per service unit

– Total cost per service unit 8. Profit/loss per service unit

9. Consumer satisfaction and performance, by service line 10. Charity/subsidy as % of total unit cost (if NFP)

Strategic Decisions Supported By These

Service Line Metrics

• Service line/portfolio management decisions

– Markets to pursue – and service lines to offer

• Revenue and return required for each service line

– Target costing decisions

• Assessment of organizational competencies required for success in specific scenarios

#2. Plans For Each Business Unit Or Program

• Tie to objectives and strategies in organizational plan – and assign accountabilities

• Have quantitative metrics that define ‘success’ of unit operations: – Turnover – Productivity – Claims paid – Process measure – Revenue – Cash flow

#3. Building Metrics-Based Management

Competency

1. Establish performance standards for each operating unit 2. Develop standard reporting of performance (dashboards,

etc.) appropriate to each operating unit

3. Modify management and supervision approach to integrate metrics-based approach

4. Use internal and external benchmarks, where possible, to identify best practices and improve operating processes 5. Within each operating unit, link performance appraisal

#4. Market Positioning Requires Metrics

Comparing Your Organization To Your Competitors

• The relationship of a service, or an organization, to the competition in a specific market

• Positioning is

– Comparative to competitors

– Defined in terms of perception of customer

• Limited positioning options

– Price

– Performance attributes

#5. Participating In Emerging Risk-Based,

Pay-For-Performance, & Value-Based Purchasing Initiatives

• Application of EBP and comparative effectiveness models to service delivery

• Move from FFS to bundled case rates and global payment models

• More Medicaid managed care – particularly for consumers with disabilities

– Medicaid plans adding value-based purchasing initiatives

• CMS Value-Based Purchasing program

III. Using Your EHR Dataset To Support Executive Decision Making

Data Elements Linked Via Your EHR

• Consumer service and clinical history data

• Customer relationship management (CRM) data

• Outcome and performance measurement data

• Employee activity data

• Personnel data

• Financial data

– Revenue (billing, collections, etc.)

Purpose of Creating Key Performance Indicators Is

to Leverage Value of Existing Data

• Data: raw symbols with no

significance beyond its existence

• Information: data that are processed to be useful and provides answers to "who", "what", "where", and "when" questions; given meaning by way of relational connection

• Knowledge: application of data and information that answers "how" questions; the collection of

information with the intent to be useful.

Creating Management Dashboards To

Support Executive Decision-Making

What is A Dashboard?

A computer interface that organizes key

performance indicators in an easy to read format, displaying the information that executives need to run an organization.

Features Of An Effective Executive Dashboard

1. An intuitive graphical display that is thoughtfully laid-out and easy to navigate

2. A logical structure that makes information easily accessible 3. Little or no user training is required

4. Data displays that can be customized and categorized to meet the specific needs of each user.

5. Regular and frequent updates of dashboard information for accuracy and relevance to current conditions

6. Information from multiple sources, departments, or markets can be viewed simultaneously

Framework For Executive Team

Performance Management Dashboards

1. Determine critical performance outcomes for success of organizational strategy (starts with the strategic plan)

2. Distill from these performance outcomes the specific measures (leading and lagging) that would best enable the management or measurement of success

3. Determine which of the data to create these measures are

available in current data systems – and identify proxy data and measures where not available

4. Design dashboard based on available measures

– For each measure, create an appropriate display and measurement and reporting specifications

5. For long-term planning, identify data not currently available in system for necessary measures and conduct ROI of costs to

Five Step Process To Creating The Dashboards

Needed To Maximize Organizational Performance

1. Identify and quantify what ‘performance’ means for your organization

2. Create an overarching organizational strategic dashboard for the board and executive team based on strategic vision,

mission, and objectives

3. Develop an executive team dashboard of leading indicators of organizational success

4. Design a dashboard at the business unit/program level that provides managers with the tools to measure and maximize unit performance

5. Leverage operational performance within programs with functional dashboards

Step #1: Identify & Quantify What

‘Performance’ Means For Your Organization

• Mission, vision, and objectives of your strategic plan

• Customer (consumer and payer) measures of value and performance

• Regulatory or legal performance measures

Step #2: Create An Overarching

Organizational Strategic Dashboard

• For use of the board and executive team

• Based on strategic vision, mission, and objectives

• Minimalist approach with focus on key board responsibilities and strategic objectives

Step #3: Develop An Executive Team Dashboard Of

Leading Indicators Of Organizational Success

• Real time organizational performance metrics to allow ‘strategic navigation’

• Based on the board’s strategic dashboard

• Facilitates management through ‘management by exception’

Prototype of Executive Team

Customer Operational Excellence

Learning and Growth Financial

Strategic Intent: The leader in translating research into effective practice solutions.

F1. Diversify

revenue streams _{system of care through growth.}F2. Develop a stronger

C3. Preferred provider of services

L4. Hillside is a destination for diverse talent. L5. Behaviors consistent

with COI values. L1. IT systems add value

and ease complexity

W10. We understand Strategic Partners’ needs.

L3. Research infrastructure supports HFA system of care.

W9. Strong parent and youth advocacy S1. HFA’s system of

care produces positive outcomes

Stakeholder

W3.EB s practices are delivered according

to design Partnerships Innovation S2. Local communities experience a sense of ownership of Hillside C1. EB practices achieve effective outcomes W2. User-friendly systems provide accurate data

L2. Organized system shares

W7. Service growth includes research grants.

W4. Hillside has research partnerships. W5. Service models

are based on research.

C2. Create customer solutions.

W8. Communication exceeds customer expectations.

Internal Work Processes

W6. We infuse innovation across our value chain. W1. Efficient standard work

processes drive productivity.

Step #4: Design Dashboards At The Business

Unit/Program Level

• Provides managers with the information needed to measure and maximize unit performance

• Focus on leading indicators that allow management intervention early in

Step #5: Leverage Operational Performance

With Functional Dashboards

• Tracks the performance of specific functions

• Can automate and improve efficiency of specific tasks

• Allows early identification of operational fail points

• Basis for performance assessment of individual teams and team members

Prototype of Billing Unit Performance

Management Dashboard

Prototype of Service Professional

Performance Management Dashboard

Prototype of Intake Department

Create KPI Dashboards Appropriate to Level

of Organization

Operating Unit Performance Indicators Organization Strategic

Plan & Objectives

Operating Unit Plan & Objectives Program Plan & Objectives Overall Agency Organization-Wide Performance Indicators Program-Specific Performance Indicators

Dashboard Development Rules

1. Agreement on ‘performance’ is the starting point 2. Brevity is key

3. Only ‘automated’ data is allowed (no hand tallies) 4. Leading indicators preferred – but lagging indicators

essential in some areas

5. Perfect data is not always available – use of proxy indicator data is the solution

6. Dashboard display design must be done with the users 7. Where data not currently available, ROI on data collection

Using benchmarks and performance targets to

challenge and drive continuous improvement

in service quality and operations

Some Thoughts About Benchmarking &

Performance Targets

Allow your organization to

•Compare with other firms in your industry •Develop cross-industry comparisons

•Develop points of reference or standards of practice

•Make best-in-class determinations •Develop best practices

A Collaborative Approach

• Develop group of organizations to initiate benchmarking process

• Agreement of organizations about process, goals, and measures to benchmark

• Collect data and analyze

• Create data collection instrument • Reality check and refinement

• Publish benchmarks

Purchase or Acquire Benchmark Data

• Compare it to your organization’s measures

Benchmark program and individual performance with other programs and individuals

Make performance reporting a key part of managerial and clinical supervision

Use dashboards as a means to keep your staff’s eyes on the performance targets

Use performance-based job descriptions and evaluation processes

#1. Think deliberately about how to combine and use the information you have now – what data, what data management options, etc.

Keys To Performance Management

#2. Create an executive team that accepts the fact that the analytics of the future don't belong to "IT" and it’s not ‘network management’ – create cross-disciplinary teams for managing and using data

Keys To Performance Management

#3. Build tools to bring data to managers and front-line staff – imbed analytics into services, systems, and processes –

which makes it harder for “decision makers” to avoid metrics-based management

Keys To Performance Management

#4. Prepare for the human

resource issues that come with a new way of managing

organizational performance

• Big brother is watching – technology reports on

activities of front-line staff and consumers immediately

• Decisions pushed to

consumers & front-line staff

• Decisions are frequent & fast – real-time service line

changes with real-time

management adjustments "reading the digital smoke signals“

Keys To Performance Management

• Why competitive advantage? It is what differentiates you from your competition – and makes

consumers/payers select your organization.

– A superiority gained by an organization when it can provide the same value as its competitors but at a lower price – or can charge a higher prices by providing greater value through differentiation.

• Without planning, prioritization of investments of time and resources (and identification of

“performance” requirements) not possible.

Keys To Performance Management

Keys To Performance Management

• Metrics-based management sounds easy

• Organizing processes and systems, teams, and resources to achieve metrics required by the

market is hard work – and a huge culture change

• The new role of supervision

• The new executive team responsibility

Keys To Performance Management

"Data are becoming the new raw material of business.“

- Craig Mundie, Head Of Research And Strategy, Microsoft

"Data is the new oil!"

- Clive Humby, ANA Senior Marketer's Summit, 2006

"Information is the oil of the 21st century, and analytics is

the combustion engine."

- Peter Sondergaard, Senior Vice President At Gartner

The market intelligence to navigate.

The management expertise to succeed.