strategies to increase profitability in...
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Strategies to increase profitability in HospitalsDipl. Betriebswirt
Heinz Jörg Schwarz, MS ISGlobal Business Development Director Regional Health, AGFA HealthCare, Mortsel, BelgiumSr. Adjunct Professor, Ageno School of Business, Golden Gate University, San Francisco, CA
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Agenda
� Focus on Continuum of Care� What is it� Why it will change Hospital business models � How to thrive in the new paradigm
� Manage new Service Lines to increase market share� The glass is half full, not half empty
� Outsourcing Services� IT Infrastructure as a managed Service� Specialist services cost efficiency
� Reduce Supply costs� The model of shared risk and reward
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Agenda
� Focus on Continuum of Care� What is it� Why it will change Hospital business models � How to thrive in the new paradigm
� Manage new Service Lines to increase market share� The glass is half full, not half empty
� Outsourcing Services� IT Infrastructure as a managed Service� Specialist services cost efficiency
� Reduce Supply costs� The model of shared risk and reward
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Integrated Care is here to stay
� Care Coordination shows results� Initial results of accountable
care organizations show double digit cost reduction and quality improvement
� Shift from acute care to preventive care� More prevention saves cost� Less revenue for Hospitals
(fewer acute care episodes), more revenue for GPs and Specialists (more preventive care)
The end of the fee for service era?
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Outcomes based payments require integrated care
Source: McKinsey
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The Dilemma
� Payer View
� More Quality = Lower Cost!� Why? Shift to low-cost preventative care saves high-cost acute
care
� Hospital View
� More Quality = Lower Revenue?� Why? Loss of revenue from ICU, interventional medicine
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The Solution
� Build business model for a care continuum� Deliver “episodes of care”, not fragmented services� Become a partner that delivers patient specific health & wellness
management
� Information Technology is key� Integrated information flow within Care “team”
� General Practitioner� Specialists (Cardiologists, Radiologist)
� Wellness consultants (Nutrition, Exercise, Mental Health)
� Analytics and clinical Business Intelligence� Descriptive Analytics (identify high risk patients)
� Predictive Analytics & Clinical Decision support (care path ways)
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March of Progress
Level 1 - MessagingLevel 2 - Sharing
Level 3 - EHRLevel 4 - Analytics
Level 5 – Smart CareLevel 6 – Integrated Care
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AGFA Maturity Model – Integrated Care
Maturity
Level
Objectives Characteristics
1 Messaging • Simple pnt-to-pnt messaging (e.g. email) to send orders and to receive results (push only – the
data is stored in the edge systems)
2 Sharing • Query and retrieve results, stored at different locations (push-pull model, central / federated
data storage ). Example XDS
• Data is structured and non-structured with various levels of data quality
• Tracking of orders / referrals (status monitoring, task management)
3 EHR • Use semantics (e.g. NLP, master data, tagging) and data quality management mechanisms (e.g.
validation, normalization) to ensure that the data is structured and of guaranteed data quality
(complete, consistent and correct)
• Provide longitudinal view on clinical results of patients (virtual patient record), stored at
different locations
• Support secure electronic communication (e.g. chat, secure email) among different members of
care team
• Access to clinical guidelines in applications
• Provide patient level alerting
4 Analytics • Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level
• Search and navigate through the data in interactive way
• Support secondary data usage for clinical trials
5 Smart Care • Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism
(e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning
• Generate knowledge from information (e.g. using predictive analytics, community authoring)
• Integrate high variety of data sources, including sensors, genomics
6 Integrated
Care
• Support clinical pathways (process workflow) for disease / health management
• Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums,
social media,
• Provide population level alerting
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Agenda
� Focus on Continuum of Care� What is it� Why it will change Hospital business models � How to thrive in the new paradigm
� Manage new Service Lines to increase market share� The glass is half full, not half empty
� Outsourcing Services� IT Infrastructure as a managed Service� Specialist services cost efficiency
� Reduce Supply costs� The model of shared risk and reward
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Manage new Service Lines
The Glass is half full,Not half empty
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Source: Maffei, Burciago, Dunn, (2009) Determining Business Models for Financial Sustainability in Regional Health Information Organizations (RHIOs): A Review, Population Health Management, 12 (5) 2009,
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Integrated information for Outpatient Care
Specialty Domaini.e. Radiology,
Cardiology,Pathology
Regional Community
RIS/PACSDICOM Archive
DICOMViewer
Clinical Documents
Portal
Image Enabled HIEs-Provide Clinical Information to Radiologists
-Provide Ordering and Results Delivery to Physicians
-Provide an integrated clinical community view (Maturity level 2)
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Integration of clinical documents & imaging
HYDMedia as IHE document consumer
HYDMedia as IHE document consumer + ICIS View
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Pre- and post- acute coordination
Hospital Domain Regional Community
HISXDS-I Archive
DICOMViewer
DCM
Portal (Orion or AGFA OEM)
Extend Hospital EMR to Community-Provide Clinical Information to Hospital (pre acute)
-Provide Clinical Information and Results to Community Physicians (post acute)
-Provide an integrated clinical community view
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Patient activation and involvement
Radiology or Cardiology Domain Regional Community
RIS/PACS ICISXDS-I.b
ICIS VIEW
Provider Portal
Value Proposition-Patient Activation & enpowerment
-Regulatory Requirement or condition (such as Meaningful Use)
HYDMediaREM+
Patient Portal
Information FlowInformation Flow
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Post acute integration
Hospital Domain Regional Community
Extend Hospital EMR to Community
-Provide Clinical Information and Results to Community Physicians (post acute)-Provide an integrated clinical community view-Prevent early readmissions
ORBIS / HIS HYDMedia
Provider Portal
Information Flow
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Pre- and post acute integration
Hospital Domain Regional Community
Extend Hospital EMR to Community-Provides Clinical Information to Hospital (pre acute)
-Provides Clinical Information and Results to Community Physicians (post acute)
-Clinical improvements in acute care and early-readmission prevention
-Provides an integrated clinical community view (Maturity level 2)
ORBIS / HIS HYDMedia
Provider Portal
Information Flow
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Clinical and Imaging integration
Hospital Domain Regional Community
Extend Hospital EMR to Community-Provides Clinical Information to Hospital (pre acute)
-Provides Clinical Information, Images and Results to Community Physicians (post acute)
-Clinical improvements in acute care and early-readmission prevention
-Provides an integrated clinical community view (Maturity level 2)
Information Flow
ORBIS ICISXDS-I.b
ICIS VIEW
Provider Portal
HYDMedia
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Patient activation
Hospital Domain Regional Community
Extend Hospital EMR to Community-Provides Clinical Information to Hospital (pre acute)
-Provides Clinical Information, Images and Results to Community Physicians (post acute)
-Clinical improvements in acute care and early-readmission prevention
-Provides an integrated clinical community view (Maturity level 2)
ORBIS ICISXDS-I.b
ICIS VIEW
Provider Portal
HYDMedia
Patient Portal
Information Flow
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AGFA Maturity Model – Integrated Care
Maturity
Level
Objectives Characteristics
1 Messaging • Simple pnt-to-pnt messaging (e.g. email) to send orders and to receive results (push only – the
data is stored in the edge systems)
2 Sharing • Query and retrieve results, stored at different locations (push-pull model, central / federated
data storage ). Example XDS
• Data is structured and non-structured with various levels of data quality
• Tracking of orders / referrals (status monitoring, task management)
3 EHR • Use semantics (e.g. NLP, master data, tagging) and data quality management mechanisms (e.g.
validation, normalization) to ensure that the data is structured and of guaranteed data quality
(complete, consistent and correct)
• Provide longitudinal view on clinical results of patients (virtual patient record), stored at
different locations
• Support secure electronic communication (e.g. chat, secure email) among different members of
care team
• Access to clinical guidelines in applications
• Provide patient level alerting
4 Analytics • Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level
• Search and navigate through the data in interactive way
• Support secondary data usage for clinical trials
5 Smart Care • Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism
(e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning
• Generate knowledge from information (e.g. using predictive analytics, community authoring)
• Integrate high variety of data sources, including sensors, genomics
6 Integrated
Care
• Support clinical pathways (process workflow) for disease / health management
• Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums,
social media,
• Provide population level alerting
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AGFA Maturity Model – Integrated Care
Maturity
Level
Objectives Characteristics
1 Messaging • Simple pnt-to-pnt messaging (e.g. email) to send orders and to receive results (push only – the
data is stored in the edge systems)
2 Sharing • Query and retrieve results, stored at different locations (push-pull model, central / federated
data storage ). Example XDS
• Data is structured and non-structured with various levels of data quality
• Tracking of orders / referrals (status monitoring, task management)
3 EHR • Use semantics (e.g. NLP, master data, tagging) and data quality management mechanisms (e.g.
validation, normalization) to ensure that the data is structured and of guaranteed data quality
(complete, consistent and correct)
• Provide longitudinal view on clinical results of patients (virtual patient record), stored at
different locations
• Support secure electronic communication (e.g. chat, secure email) among different members of
care team
• Access to clinical guidelines in applications
• Provide patient level alerting
4 Analytics • Provide outcome reporting (KPIs) and dashboards on financial, operational, clinical level
• Search and navigate through the data in interactive way
• Support secondary data usage for clinical trials
5 Smart Care • Improve clinical outcome and reduce clinical risk by using Clinical Decision Support mechanism
(e.g. reasoning, predictive analytics) for ordering, diagnosis and treatment planning
• Generate knowledge from information (e.g. using predictive analytics, community authoring)
• Integrate high variety of data sources, including sensors, genomics
6 Integrated
Care
• Support clinical pathways (process workflow) for disease / health management
• Create patient/case centric virtual care teams using advanced collaboration tools (e.g. forums,
social media,
• Provide population level alerting
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New Services Summary
� Integration of Information is possible at different levels� Legacy Systems can be integrated
� Paper, HL7, IHE
� Different integration levels and efforts
� Value creation at every level� Level 2 solutions offer already great benefits
� Vertical Integration = Revenue opportunity� Hospitals expand care delivery instead of waiting for patients to
show up� Integration can be organized virtually using Information Systems
� Not necessarily rip-and-replace of systems
� Not necessary to replicate existing services
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Agenda
� Focus on Continuum of Care� What is it� Why it will change Hospital business models � How to thrive in the new paradigm
� Manage new Service Lines to increase market share� The glass is half full, not half empty
� Outsourcing Services� IT Infrastructure as a managed Service� Specialist services cost efficiency
� Reduce Supply costs� The model of shared risk and reward
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Outsourcing Services = IT & Clinical
� IT Infrastructure� Leverage Standards such as
DICOM, XDS, and IHE� Define SLAs
� Response times� Up-times� Security / Privacy
� Imaging as-a-Service� VNA� Distributed Reading� Shared Workflows� Pay per study
� HIE Services � Regional Provider Portal� Integration of Paper based
processes and documents� Alerts, Reminders
� Leverage Economy of Scale
� Clinical Services� Leverage IT Infrastructure to source
specialist services, i.e. Pathology Primary Reading
� Consultations / 2nd opinion � Low frequency hours� Sparsely populated areas
� Focus on things you do really well� High frequency usually allows better
training� Lower cost
� Partner for things others do better and cheaper� New Supply chain paradigm� If you do it only once a month, maybe
someone else can do it better?
� Leverage Economy of Scale� IT and Regional Health is an enabler
for better cost structure sourcing!
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Agenda
� Focus on Continuum of Care� What is it� Why it will change Hospital business models � How to thrive in the new paradigm
� Manage new Service Lines to increase market share� The glass is half full, not half empty
� Outsourcing Services� IT Infrastructure as a managed Service� Specialist services cost efficiency
� Reduce Supply costs� The model of shared risk and reward
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Reduce Supply cost
1. Identify Areas of excellence1. Usually requires Business intelligence data 2. Quality Metrics (Clinical outcomes)3. Cost Metrics (i.e. DRG costs)
2. Identify Areas of lower performance1. BI data2. Quality metrics (Clinical outcomes)3. Cost metrics (i.e. DRG cost)
3. Provide Services beyond hospital in areas of excellence1. Leverage quality and cost advantage2. Leverage eHealth Infrastructure to integrate with other providers and
payers (compare slide 12, sustainable business models) to provide integrated care as an outsourced service
4. Contract Services into hospital in areas of lower performance1. Leverage other providers superior cost and quality for your patients2. Leverage eHealth Infrastructure to integrate ….
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The New Supply chain within an Integrated care conti nuum
ReferringServiceProvider
ReferringSpecialist
Core Clinical Services
Referring GPS
In-SourcedSpecialist In-Sourced
Service
eHealth IT Infrastructure For integrated Care Delivery,Bundled Payments,Shared Risk/Reward=New Business Model for sustainable growth
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Don’t ask if you can afford to invest in eHealth.
Ask if you can afford not to invest in eHealth Technologies!
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Heinz Jörg [email protected]