Value Project Webinar Positioning for the Unknown by Transforming Organizational Culture and Management Structure

7/28/2019 Value Project Webinar Positioning for the Unknown by Transforming Organizational Culture and Management Struc

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HFMA WEBINAR

Sponsored By:

Value Project Webinar: Positioning for the Unknown by Transforming

Organizational Culture and Management Structure

Date: February 21, 2013

Time: 2:00 3:30 p.m. Central(12:00 1:30 pm Pacific/1:00 2:30 pm Mountain/3:00 4:30 pm Eastern)

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Positioning for the Unknown by TransformingOrganizational Culture and Management Structure

Peggy Deming, FHFMA, CPA

Executive Vice President and CFOUniversity Health System

Value Project Webinar

February 21, 2013

2:00 3:30 pm Central/3:00 4:30 pm Eastern

Sponsored By:

Organization Overview

Uncertain Environment

Transformation Strategy

Transformation Partnership

Increasing Complexities Value Results First Year

Accountability and Sustainability

What We Achieved and Learned

Agenda

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http://www.medassets.com/Pages/default.aspx


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Learning Objectives

How to assess your organizational challenges

How to indentify changes that can be made to become

not only more efficient but more effective

Learn steps to develop a culture of accountability and

sustainability

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Organization Overview

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Mission Driven Health Care

The Bexar County Hospital District was established in 955by the voters of Bexar County (d.b.a. University HealthSystem)

Core mission is to provide for the needy and indigent of BexarCounty

Primary teaching partner of the University of Texas HealthScience Center in San Antonio since 1968

Supports mission of Patient Care, Medical Research and Teachingthe next generation

Bexar County Commissioners Court

Appoints Bexar County Hospital District

Board of Managers; Sets the annual Hospital District tax rate; andapproves the annual capital, debt service and operations budgets

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A Higher Level of Inpatient Care

University Hospital in

partnership with UT Medicine

Level I Trauma Center

Joint owner of San Antonio AirLife

Level II Pediatric Trauma Center

Pediatric burn program University Transplant Center

Level III Neonatal ICU

Heart Vascular Lung Institute

Certified Stroke Center

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A Comprehensive System

Medical Homes across the community The right level of care in the most

convenient location

ExpressMed 5 urgent care centers Texas Diabetes Institute Community Medicine Associates

Nonprofit provider practice with 52 PCPs,

50 mid-level providers & 30 specialists

Community First Health Plans Nonprofit HMO with 118,000 at risk lives &

12,000 ASO lives

CareLink program to better managesponsored care

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How we Serve our Patients:Right Place at the Right Time

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Awards for Organizational Capabilities

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CNOR StrongCompetency &

Credentialing Institute

SILVER Learning in PracticeAwardChief Learning OfficerMagazine

2009-11

People / Culture

Staffing

Skills

Performance Improvement

Patient Safety

High Risk Care

Business IntelligenceUS HHSC2009 - 2012

Platinum AwardNational Cardiovascular Data Registry

Growing to Serve our Community Better

New 10-story tower at UniversityHospital

Flexible single-patient rooms

New & larger Emergency Center andoperating suites

New parking garage

New 6-story building at the RobertB. Green Campus downtown

Advanced outpatient diagnostic & treatment

On target to achieve LEED Goldstatus

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http://www.facs.org/cancer/


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University Health SystemOperating Perspective

Regional Reach

22 county trauma region

Serve as the Regional Health Partnershipanchor for 20 Counties

$1B operating revenue 24%

covered by property taxes

5,900 employees, medical staff of 1,300 & 600

residents

Operating margin of 4% in 2012

AA+ bond rating

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*


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The Texas 82nd Legislative Session

The Problem: $27 Billion State Budget Shortfall

Cost Cutting Measure: Expand Medicaid Managed Care

Negative Impact: Two billion Dollars ($2 Billion) in annual

Upper Payment Level (UPL) payments to Texas hospitals

lost

What is UPL?

Historic supplemental payments made to certain hospitals

and providers to make up the difference between whatMedicaid actually paid for Medicaid clients and what

Medicare would have paid for the same services

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Mitigation Strategy

Texas requested an 1115 Medicaid Waiver

A waiver under section 1115 of Social Security Act is avehicle states can use to test new or existing ways to deliverand pay for Medicaid health care services

New Supplemental Funding: Worth $29 billion (all

funds) over five years

Waiver Term - 5 federal fiscal years (October 1, 2011 toSeptember 30, 2016)

CMS approved the waiver December 12, 2011

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University Health SystemMarket Dynamics

Strong economy in Texas and City of San Antonio /Bexar County

Below National unemployment rates

Friendly competition

Texas ranks 50th in uninsured

Medicaid pays less than 60% of cost

Governor does not want to expand Medicaid under

the Accountable Care Act

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Transformation Strategy

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Strategic Vision:Invest in Care Transformation

Improve the PatientExperience

Improve Quality andOutcomes

Improve Efficiencies

Triple Aim plus

Plus

Improve Access in light of the

anticipated growth in insuredlives under the AccountableCare Act (ACA)

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Right People on the Bus

CEO aligned executive team

Hired strong COO focused leading culture change

Hired CMO with preventive and population managementexpertise

Hired hospital and ambulatory leaders focused on samestrategy with different objectives

Hired VP of Care Coordination to assure coordination ofhospital & ambulatory care

Promoted a strong CIO to provide tools and training

Repositioned VP focused on translational research toimprove care and quality

Commitment made to create an overarching data governancefor business intelligence

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The Case for Transformation

Position of Strength

Ambulatory / preventive focus key

Medicaid 1115 Waiver

Positioned to succeed


ACA & implications in Texas

Not enough providers

Expertise needed quickly

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Increasing Complexity

Regional responsibilities

Waiver implications

Address more difficult efficiencies

Transformation

Clear strategic vision

Dedicated executive team on bus

Seek transformation partner

Transformation Partnership

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How UHS Selected Its

Transformation Partner

Anticipated Legislative cuts in 2010 & set a targetimprovement goal of $15M

Reached out to GPOs for additional savings

Requested a comprehensive solution

Requested a savings guarantee with a fee structure

Wanted shared accountability for savings and on-siteexperts

Wanted to include a sustainability plan with focusedperformance improvement & integrated analytics

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Project Structure

Project lead fully accountable to UHS for success

Subject matter experts report to Project Lead

6-10 experts on-site 3 days/week or as dictated by project

activities

Year 1 focus on driving cost savings

Year 2-3 focus on knowledge transfer and sustainability

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Knowledge

transfer

Cost

savings

Behind-

the-scenes

Staff Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Project Lead x x x x x x x x x x x x

Clinical Expert x x x x x x x x x x x x

Labor Expert x x x x

Purch Svc Expert x x x x x x x x

Non-labor Expert x x x x

Proc Impr Expert x x x x x x x x x x x x

Sustainability Expert x x x x x x x x

Project Manager x x x x x x x x

Analytical Support x x x x x x x x x x x x

2012 2013 2014


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Solution for UHS Sustainability &Financial Performance

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Clinical

Quality and Evidence Based Medicine Physician / clinician alignment

Reduce over utilization of ancillary

Decongesting ER

Use of OR preference cards

Labor Reduce OT for staff on 12-hr shifts

Set productivity standards

Review PRN models and pooling

Evaluate flex compensation for coders

Purchased Services

Standard maintenance contracts

Parking and transportation costs

Use of referral lab testing

Transcription cost management

Supply Expense Mgmt

Maximize use of 340b program

Review contents of custom packs Inventory Mgmt

Reduce use of expense supplies Value Analysis refinement

Clinical Solution:

LOS and Utilization

Labor Solution:

Staffing and

Premium Pay

Supply Expense

Solution:

Supplies

Purchased Services:

Contracts and

Utilization

A Comprehensive Approach

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$22M (4%)Targeted Savingsin 12-16 months

FutureSustainability

$520 M

UHS: 1/1/10 - 12/31/10

Employee Compensation 299,738,000

Supplies 114,988,000

Purchased Services 106,181,000

Clinical Solution:LOS, Quality, Evidenced

Based Medicine,Utilization, Patient Flow,

Quality/Outcome

Labor Solution:

Staffing, PremiumPay, Productivity,

Pools

Supply ExpenseSolution:

Supplies, 340B, ValueAnalysis, PPI, Blood

Purchased Services:Contracts and

Utilization

All Around Lean Process Improvement & Technology

Enabled

Revenue CycleCash Acceleration, Charge Master Review, Denial Management


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Project Timeline: Three Years

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2012: Savings, roadmap, labor, clinical,purchased services, supplies

2013: Utilization, process improvement,change management, analytics

2014: Best practice, process improvement,sustainability, strategic planning

Technology Platform: Service Line Analytics + Labor/Staffing Tool +

Dashboard for Process Improvement, Outcomes, KPIs

Performance Platform: Process Improvement in focused areas, plus LEAN,

Kaizen, Six Sigma overlaid as applicable to projects over time

Increasing Complexities

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Waiver Pool Payments

The Uncompensated Care (UC) Pool

UC Pool Payments replace UPL payments & are designed to help offset

the costs of uncompensated care provided to Medicaid eligibles or to

individuals who have no funds or third party coverage for services

provided by the hospital or other providers.

The Delivery System Reform Incentive Pool (DSRIP)

DSRIP Pool Payments are available as incentive payments to hospitals

that develop programs or strategies supporting hospitals efforts to

enhance access to health care, increase the quality of care, the cost-

effectiveness of care provided and the health of the patients and families

served. Payments are outcome based.

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Improving the Patient Experience

Expand Care Transitions Programs

Measure & improve patient experience

Establish an ambulatory patient care navigation program

Expand Interpretation Services for culturally competent care

Establish an interactive health promotion program for kids

Improving Efficiencies

Apply Lean Process Improvement to Improve Quality/Efficiency

Enhance Medication Management to avoid medication errors

Develop a Mental Health Crisis Stabilization Service

Develop a Crisis Intervention Unit and Intensive OutpatientProgram

Meeting the Triple Aim Plus:

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Improving Quality and Outcomes Implement a chronic disease management registry

Implement a Palliative Care Program for end-of-life care & needs

Implement Evidenced Based Disease Prevention Program

Establish care coordination team to support chronic care and education

Development a Psychiatric Emergency Service

Implement/expand care transitions programs

Expand FQHC dental clinics

Improving Access

Expand adult & pediatric primary / specialty care providers & capacity Improve access to specialty care

Expand Mobile Clinics to schools

Expand Patient Centered Medical Home

Meeting the Triple Aim Plus:

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Value Results

First Year

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First Year Results

$13.4M in Savings and $14M in Cash Compression

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2012: Savings, roadmap, labor, clinical,purchased services, supplies

2013: Utilization, process improvement,change management, analytics

2014: Process improvement,sustainability, strategic planning

Technology Platform: Strategic Information, Service Line Analytics, Labor Staffing Tool, ProcessImprovement Dashboard, Protocols, KPIs, Claims Management, Charge Capture Audit

Performance Platform: Strategic Sourcing, Construction, Process Improvement in clinical & nonclinical areas; Transforming culture with LEAN

MonthApril/May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

Front Line andMgmt Training and

Coaching*

Cultural MaturityAssessment/

Exec Coaching,Strategy & Progress

Reviews

Facilitated ProcessImprovement

Activities

Course 1 Course 2

First 11-MonthAccomplishments

Developed Internal Champion Demonstrated Success with Methodologies Training for Facility Leadership Completed 16 Rapid Improvement Activities (96-160

participants) Clinical and Operational

Held Two Lean Foundations Courses w/32 Participants Developed Internal Training Capacity (2 instructors) Participant at a Lean Healthcare Certificate Program Conducted Cultural Maturity Assessment (Stage One)

Course

Project Strategy

Meeting and

coaching

opportunities

For head Executive to

attend 2 of these

meetings

Lean Foundations Course

w/ Internal Facilitator

Dev.

Rapid Improvement Activity (5 day),

with Prep, Plan, Follow-up, Coaching Week

Potential Lean Foundations

Course (Internally Facilitated)

1 2 3 4 5 6 7 8

Project Leadership

On Site (Kickoff & Leadership Training)

Course 3 Course 4

Course

P

P 5Exec or Management Rapid

Improvement Activity (5 day), with

Prep, Plan, Follow-up, Coaching Week

P P

P

5 9

16

P 15P P

P P

1 3

6 8P P

P

P2 4

7

10

P 11

P 12

P 13

P

CMA Cultural Maturity

Assessment (Stage One)

CMA

Kickoff and Assessment Meeting Leadership Training: Includes Lean Simulation Preparation for Events: Competency And Leadership Matrix, Training Room Loca tion, Order

Materials, Schedule, Travel Arrangements

Planning for First Event: Value Diamond, SIPOC, Team Participants, Roles/Responsibilities

Project

Kickoff and

Start-Up

Activities

Project

Kickoff

and Start-

Up

Activities

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Transforming Culture to ImprovedQuality and Reduced Cost

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Accountability and Sustainability

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Transformation Project Goal:Position for Accountability and Sustainability

Focus in specific areas for maximum impact

Experts on-hand to fast-track savings

Coordinated, systematic approach

All technology tools provided

Assure accountability in place

Process improvement and quality management for long-term sustainability

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Key for Accountability:Accountability Education

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Key for Accountability:Financial Management

1654 NEONATAL ICU

2012

Projected

2013

Budget

Request Variance % Var

UOS or Activity) 12,614 13,979 1,365 10.82%

Expenses

Salaries $6,689,419 $6,845,911 ($156,492) -2.34%

Benefits $497,788 $523,712 ($25,924) -5.21%

Medical Services $810,456 $898,446 ($87,990) -10.86%

Purchased Services $72,054 $76,253 ($4,199) -5.83%

Medical Supplies $530,285 $587,651 ($57,366) -10.82%

Non-Medical Supplies $688,221 $768,132 ($79,911) -11.61%

Total Operating Expenses $9,288,223 $9,700,106 ($411,883) -4.43%

Salaries per UOS $530.30 $489.70 $40.60 7.65%

Medical Services per UOS $64.20 $64.30 ($0.10) -0.04%

Purchased Services per UOS $5.70 $5.50 $0.30 4.50%

Medical Supplies per UOS $42.00 $42.00 $0.00 0.00%

Operating Expenses per UOS $736.30 $693.90 $42.40 5.76%

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Key for Accountability:Project Management

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How do we change our culture?

We have to have absolute faith that we can and

w il l prevail . .. At t he same time, we have to

con front the most bru ta l facts of our current

reality whatever they might be.

Jim Col l ins Good to Great

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That was then

- This is now

-I am th e one

Key for Sustainability:New Customer Service Program

My Pledge

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What We Achieved and Learned

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What we Achieved

Reduction to LOS of .4 days

Reduced days in AR by 6

Significant increase in cash collections $48M

Real expense savings bent cost curve

Change in culture

Lean Thinking

New U

4141

What we Learned

Executive visibility and support is key

Lean rocks for construction & Joint Commissiontoo!

Take advantage of technology

Accountability is everyones responsibility Sustainability needs to become an expectation

Learning is forever

Get wrong people off the bus

Change is never easy

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A Chinese Proverb States:

When the wind is blowing:

Some people curse the wind

Some people build walls

While others build windmills

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Questions?

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Peggy Deming, FHFMA, CPAExecutive Vice President & [email protected]

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Remember to Complete the Program Evaluation

If you have any questions or do not know your id # you may contact Member Services 800.252.4362, ext 2

CPE InformationTo receive CPE Credits for this webinar. You must complete it within 2 workingdays.

The URL below will take you to HFMA on-line evaluation form.You will need to enter your member I.D. # (can be found in your confirmation emailwhen you registered)

Enter this Meeting Code: 13AT6

URL: http://www.hfma.org/awc/evaluation.htm

Your comments are very important and enables us to bring you the highestquality programs!
mailto:[email protected]://www.hfma.org/awc/evaluation.htmhttp://www.hfma.org/awc/evaluation.htmmailto:[email protected]:[email protected]:[email protected]

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Value Project Webinar Positioning for the Unknown by Transforming Organizational Culture and Management Structure