As healthcare shifts to value-based care, the need to combine clinical and operational data has become an organizational imperative. Mr. Lehr explains, “They’re not separate, at all, anymore. …the days of being able to change the way you’re coding or do some simple changes in denials management and have that make a huge impact to your bottom-line—I think those days are gone. And really, the biggest ways that you can, as an organization, change your bottom-line is through clinical optimization and clinical innovation. …Whether it’s the VP of Revenue or the CFO or—of course—the doctors and nurses, everybody is focused on clinical innovation.”
Dr. Berg described a similar shift in focus at North Memorial Health, “Historically, before my time at the organization, it was a very siloed old-fashioned structure, like most healthcare environments are. …And so I think like most places, within a fairly short period of time, that became very heavy on finance analysis and light on meaningful clinical analysis. …In the last few years, as we’ve tried to re-orient this work around clinical stuff, we’ve developed a home-grown analytics platform.”
Likewise, Dr. Flood emphasized that UW Health’s program has largely focused on clinical quality and clinical effectiveness projects. And while the program at Mercy does focus on operational issues, many of the issues they have tackled such as clinical documentation, clinical charge capture and case management have significant clinical workflow implications.
From the selection of the data visualization front end, to the program governance, the analytics program at Anne Arundel Medical Center is clinically focused and led. “It was really the physicians and nurses that drove it. But that’s the way to do it, right? We’re a clinical enterprise,” argued Ms. Baldwin.
None of this should be surprising. When you focus on clinically-driven analytics, it’s about efficient and effective care. If you have a clinical focus to what you are trying to accomplish, by definition, you start to meet the needs of value-based care and the challenges of managing a population’s health.
Robust Analytics Governance Ties Priorities to Strategy
Dr. Berg described the challenges many organizations face in trying to prioritize competing analytics and process improvement projects: “I think historically that has been a lot of what happens in healthcare environments is that you’ve got a handful of people at the top and they garner a lot of buy-in because of the positions they are in. Something bubbles up to their attention and then they kind of sic the whole team on it and the whole team works on it for some period of time and it is unclear what the real goal was or what the payoff is.”
At North Memorial Health, they have developed a rigorous, evidence-driven methodology to prioritize projects. “We’ve tried to have a fairly diligent up-front methodology. …We have used an application in QlikView that we developed, that we call a Cohort Explorer…that aggregates claims and billing and Epic clinical information from all of our sites…and then we rank different clinical conditions.” By combining clinical data, the volume of charges associated with various DRG groupings, and a fairly robust cost accounting methodology in Cohort Explorer, North was able to quickly identify the top diagnoses in terms of both clinical and financial impact. “As we ranked those, not surprisingly, sepsis was far and away the top…Since the time of sepsis, we’ve gotten all the way down through number 5,” said Dr. Berg. Let’s be clear, North actually uses analytics to drive the prioritization of their analytics program!
At UW Health, a QlikView Governance Dashboard is used to monitor the use of the program’s other dashboards. This serves as an important feedback loop for the members of QlikView Leadership Team and the Integrated Analytics Team that oversee the program.
Mercy uses a priority matrix and a scoring system to prioritize projects. But, because of the specific focus of their program, they spend several weeks working with the project sponsors to define the scope and refine the possible solutions before a project is finally ranked. Dr. Mathew: “Where we focus is on high value business problems that, historically, Mercy has struggled with or they know that it is super-high-value and we need to take it on. … we prioritize based on a composite score of quality, service and cost savings.
Anne Arundel Medical Center’s Data Stewardship Council is chaired by a physician and has strong nursing and physician representation that reflects the program’s solid clinical focus. Ms. Baldwin describes the governance challenge this way, “One of the things that is critical for governance to look at is balancing how we want to use our valuable-but-limited analytics resources. You can spend it clearing the decks of low hanging fruit, which can feel satisfying, but is often unproductive. Or you can take valuable resources and actually determine how do I get the bigger stuff done …which may take longer, but has a better payoff.”
Data Governance Should Not Be an Afterthought
Like most healthcare organizations across the country, the majority of the analytics programs described here describe their data governance process as a work in progress. Dr. Flood went so far as to identify the need for strong data governance as one of her top three lessons learned stating, “Data governance is often an afterthought. It should be a top priority. The lack of strong data governance is one of the biggest road blocks to ensuring consistency across dashboards.”
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