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Value-based Purchasing. Jude Odu Senior Business Analyst, Health Care DataWorks Detlev “Herb” Smaltz, PhD Co-Founder & CEO, Health Care DataWorks September 27, 2012. Speaker. Jude Odu Senior Business Analyst and Healthcare Subject Matter Expert at Health Care DataWorks

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value based purchasing

Value-based Purchasing

Jude Odu

Senior Business Analyst, Health Care DataWorks

Detlev“Herb” Smaltz, PhD

Co-Founder & CEO, Health Care DataWorks

September 27, 2012

speaker
Speaker

Jude Odu

  • Senior Business Analyst and Healthcare Subject Matter Expert at Health Care DataWorks
  • Former Supervisor for Clinical Analytics and Decision Support, University Hospitals Case Medical Center, a multi-hospital health system in Northeast Ohio
  • 14+ years in long-term care, in acute care, and on the payer side
  • Instructor in healthcare informatics at Ursuline College
  • Master’s degree in Health Science, The George Washington University
speaker1
Speaker

Detlev H. (Herb) Smaltz, Ph.D., FHIMSS, FACHE

  • Co-Chairman and CEO, Health Care DataWorks
  • 21+ years experience in healthcare management
  • Former CIO of The Ohio State University WexnerMedical Center
  • Fellow of the Healthcare Information & Management Systems Society (FHIMSS)
  • HIMSS Board of Directors (2002-2005) and Vice Chair (2004-2005)
  • Fellow in the American College of Healthcare Executives (FACHE)
  • Bachelor’s degree in MIS, University of Tampa, MBA, The Ohio State University, and Ph.D. in Information & Management Science,Florida State University
today s webinar
Today’s Webinar
  • Value-based Purchasing (VBP)
    • What is it?
    • Who came up with it?
    • When does it happen?
    • Who does it affect?
    • Why should I care?
    • How do I recover reimbursements withheld through this program?
vbp final rule
VBP Final Rule
  • VBP was established by the Affordable Care Act of 2010 (ACA)
  • Budget neutral payment changes begin October 1, 2012
    • Reduce base operating payments for each discharge by
  • Rewards for achievementorimprovement
2 ways to earn back
2 Ways to Earn-Back

ImprovementHospital Performance Standards

Baseline: Hospital performance for all 20 metrics during the Baseline Period

Performance: Hospital performance for all 20 metrics during the Performance Period

timeline
Timeline

Final Payment

Adjuster Delivered

Hospitals will be informed of VBP payment at least 60 days in advance of the payment year

Estimated Payment

Adjuster Delivered

Nov

Aug

2009

2010

2011

2012

2013

July

March

July

March

FY 2013 Performance Period

FY 2013 Baseline Period

2 ways to earn back1
2 Ways to Earn Back

or

ImprovementHospital Performance Standards

Baseline: Hospital performance for all 20 metrics during the Baseline Period

Performance: Hospital performance for all 20 metrics during the Performance Period

Achievement

CMS Performance Standards

Benchmark: Mean of top decile performance (95th percentile) nationally

Threshold: 50th percentile performance nationally

Floor (HCAHPS only!): Minimum performance nationally

the questions
The Questions
  • Do you know your VBP score?
  • Do you know how much is projected to be withheld?
  • Can you get to the data to understand your score?
  • Can you pinpoint which measure is costing you most?
  • Can you build a plan to improve your score?
  • How can you maximize your earnback?
the people
The People
  • Financial Management
    • Wants to earn back the money CMS withheld
  • Quality & Clinical Management
    • Needs to understand VBP scores
    • Take action to improve processes that target nurses, doctors, housekeeping staff, nursing units, etc.
the challenges
The Challenges
  • Hospitals and their technology solutions have evolved as siloed point solutions
the challenges1
The Challenges
  • Data, systems and technologies are virtually everywhere with limited commonality in format and accessibility
the challenges2
The Challenges
  • So you can’t get the information you need when you need it!
the opportunity
The Opportunity
  • Get as much money back as possible
  • Improve hospital performance across measured areas
common approaches
Common Approaches

Hospitals vary in their approach:

  • Implement stand-alone solution
  • Retain consulting firms
  • Manage compliance manually
  • Figure it out later
there s a better way
There’s a Better Way
  • Unified VBP Application
    • Automate the collection of all data required
    • View the organization across all 20 measures
    • Evaluate root cause of positive or negative results
    • Calculate how score improvements increase reimbursements
typical health system
Typical Health System

Thousands of hours of manual labor

Nursing

Dashboard

ED

Dashboard

CBO

Dashboard

Surgery

Dashboard

VBP

Dashboard

ICU

Dashboard

Reports

Dashboards

Access

Manual &

Semi-Manual

Departmental Analytics

Initiatives

Exploring

Crimson

Surgery

Compass

Essbase

Diver

Cerner

Insight

Cognos

Invision

Ad hoc

Signature

Ad hoc

DM

Hyperion

Signature

Surgery

TSI

Premier

Lab

Cerner

eClinical

Invision

ERP

Lawson

Cerner

Kronos

Morrissey

Vision

VisionW

Prism

slide22

Analytics at Many Hospitals

and Health Systems

Transactional Systems

Islands of Data

End User Reporting

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W

External Systems

22

unified analytics via an edw

Ad-hoc Query

Unified Analytics via an EDW

Internal

Systems

Transformation and Mapping

EDW

End User Reporting

Clinical Trial Screening

Multi-Dimensional Analysis & Data Mining

SOA/Web Services

GL

PA

Cleanse

Validate

Standardize

Transform

Aggregate

Geo Code

Data Profile

Data Model

Meta Data

Load

HR

Revenue

Cntrct

Rejection

Encounter

EMR

Pt Sat

Text Mining, NLP

Time

SIS

Meds

PM

Lab

Web Scorecards & Dashboards

Cost

Orders

Predictive Modeling

SIS

Census

De-identified Data

Errors

Unified data Model

Readmits

W

Benchmarking

Registries

Research

META DATA

External Systems

DATA GOVERNANCE

additional value
Additional Value

Effective VBP management will lead to positive change:

  • Improve the quality of patient care as a result of operational enhancements
    • Increase management visibility
    • Increase accountability across the organization
    • Decrease workforce burden
  • Estimate and manage financial implications
takeaways summary
Takeaways/Summary
  • The CMS VBP program is here and will continue to evolve
  • A portion of your CMS reimbursements will be withheld starting Oct. 1 and will increase through 2017
  • In the absence of a unified solution, managing VBP will require heavy lifting
questions
Questions?

Herb Smaltz, Ph.D., FHIMSS, FACHE

877 979 4239

herb.smaltz@hcdataworks.com