Success Metrics

Presenters: Robert Patton, Director, Implementation Services, Qualifacts

Brandi S. Sanders, Manager, Implementation Specialists, Qualifacts

Webinar - Tuesday, April 30, 2013 1:00pm – 2:30pm CST

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Success Metrics – Agenda

• Success Metrics Detailed Review (current)–What they are and how to use them

• Success Metrics Summary –What the data has shown so far

• Success Metrics (future)–C3 Insights–Open Minds Input–Benchmarking User Groups

Success Metrics Detailed Review (current)

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Success Metrics Detailed Review (current)

• There are 4 different “types” of metrics currently available –Go Live/Post go live success metrics–Agency year end with community

comparison–Agency year end with peer comparison–Community year end with monthly

breakdown

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Post Go Live Success Metrics

• Background– Most common reasons for failed implementations:

• Leadership issues– Wrong people driving the project– Lack of good bi-directional communication between leadership and staff

• Workflow issues– Underestimating importance of workflows– Lack of a full workflow walk-thru to identify gaps and bottlenecks

• Provider issues– Absence of strong champions – Failure of staff to understand their role in using the EHR

• Training issues– Underestimating the amount/type of training required– Failure to assure that providers complete training

• Eliminate the emotion of fear with a metric-driven EHR implementation

- Source: White Paper - http://www.healthit.gov/sites/default/files/ehr_implementation_white_paper.pdf - EHR Implementation with Minimal Practice Disruption In Primary Care Settings

- Authored By: Jeff Hummel, MD, MPH & Peggy Evans, PhD, CPHIT – Qualis Health, Seattle, Washington (WIREC consultant team contributing)

- November 2012

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Post Go Live Success Metrics

• Purpose– Designed to measure immediate customer success post go

live– Key indicators for refresher training, effective use of the

system, system configuration adjustments, etc• How Generated– Via the CareLogic system (and Excel) by QSI staff*

• How/When Communicated– 5, 10, 15, 45 days post go live via status calls

(implementation)– 60, 90, 180, 365 days post go live via customers or support

as needed*

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Post Go Live Success Metrics List (27*)

• Active Clients• Active Organizations• Active Programs and Activities• Active Payer Plans• Active Staff• Activity to Service Document signed• First Contact Date to First

Appointment• Appointments by Type and Status• Services Not Authorized• Clients Seen• Failed Activities• Failed Claims• Real Time Productivity• Awaiting Claim Approval

• All Claims / Approved Claims• Claim Batches• Overall Claiming Lifecycle• Activity to Claim Date• Average Daily Billable Services• Total Deposits• Total Deposits Amount• Total Approved Applied Amount• Total Unapproved Applied Amount• Total Unapplied Amount• Total Unposted Amount• Refund Amount• Recoup Amount• Month over Month Number of Claims

Generated and Revenue

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Post Go Live Success Metrics (cont’d)

• Value:– They infuse accountability and visibility (both

QSI/customer)– They allow the identification of issues sooner than later– They remove the emotion from implementation and

provide the data necessary for executive sponsorship (both QSI and customer)

– They set the baseline for “what to expect” post go live (by month) so that customers can measure their performance and so that QSI can know where to jump in and make the customer as successful as possible

– They allow for the celebration of project successes

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Example - Go Live – Appointments by Type and Status

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Example - Go Live – Active Counts, Failed Activities, Failed Claims, Unstatused Appointments

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Example - Go Live – Claims Pending Approval, Claim Batches, Total Deposits, Payments Applied/Unapplied/Unposted

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Example - Go Live – Executive (Project Health Review)

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Post Go Live Success Metrics (cont’d)

• Note:– These are available to all customers post go

live– They are generated by the IS (and put into

Excel for graphing), but have also been made available for customers to run– The PMs create the post go live health report–We are exploring what the longer term

solution is for generating/presenting this data

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Success Metrics

–Go Live/Post go live success metrics–Agency year end with community

comparison–Agency year end with peer

comparison–Community year end with monthly

breakdown

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Agency Year End with Community & Peer Comparison Metrics

• Purpose– Extension of the post go live metrics with additional

measurements and percentile/ranking of customer in comparison to the CareLogic community (all eligible QSI customers)• “Peer” currently is based on total revenue billed through CareLogic (Under 1M, 1M to

5M, 5M to 10M, 10M to 20M, and 20M +)

• How Generated– Via QSI technical resource during off-business hours– Compiled and ranked manually via QSI resource (Excel)

• How/When Communicated– Annually (currently)

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Agency Year End with Community & Peer Comparison Metrics List

• Rank • Community/Peer Average • Community/Peer Median • Active Clients - On 01/01/12 • Active Clients - On 12/31/12 • Clients Seen • Active Staff - On 01/01/12 • Active Staff - On 12/31/12 • % of Service Providers (of

Active Staff) • Total Approved Claims • Total Activities with Payment

(Paid) • Total Expected Revenue • Avg. Expected Rev by

Approved Claim • Claim Lifecycle • Avg Activity to Claim Days • Avg Activity to Batch Days

• Avg Batch to Payment Applied Days

• Medicare - Revenue • Medicare - Claims • Medicaid - Revenue • Medicaid - Claims • Other Payer – Revenue• Other Payer - Claims • Total Billable Activities • Billable Activities/Day (&

Percentage Billable) • Billable Activities/Service

Providers• Non Billable Activities/Day (&

Percentage Non Billable) • Appointments Kept • Appointments CBC • Appointments CBT • Appointments DNS

• Avg Document Signature Time (Hours)

• Avg Scheduled to Kept Days• # of Customer Pentaho Reports • Services Not Authorized • # of Claims by Program • # of Non Billable Activities by

Staff Credential

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Agency Year End with Community & Peer Comparison Metrics (cont’d)

• Value:– They go beyond go live success and allow for

more/better data to drive agency success– Their focus (upon root cause determination) is more

around workflow/process efficiency and system adoption (vs immediate issue/training like post go live)

– They empower high performers and low performers to reach out (and for QSI to reach out to them) for best practices sharing (especially with customers who have “like” business/operational size)

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Example - Agency Year End with Community & Peer Comparisons

QSI Community Peer

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Example - Agency Year End with Community & Peer Comparisons

Agency, Community, & Peer

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Example - Agency Year End with Community & Peer Comparisons

Agency, Community, & Peer

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Example - Agency Year End with Community

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Agency Year End with Community & Peer Comparison Metrics (cont’d)

• Note:– These metrics include customers live during 2012 (but if

they went live late in 2012, there most likely was not enough data to provide peer rankings)

– They were distributed at the conference and were sent to all other eligible customers prior to 4/26

– There are some customers for whom we don’t have the data (do not use the full system – i.e. billing)

– Once we have finished incorporating customer and Open Minds feedback on how to expand the data (i.e. by line of service, further narrowed by payer, etc) we will publish the updated metrics

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Success Metrics

–Go Live/Post go live success metrics–Agency year end with community

comparison–Agency year end with peer

comparison–Community year end with monthly

breakdown

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Community Year End with Monthly Breakdown Metrics

• Purpose– Designed (6 currently) to measure the overall use of

CareLogic by the Qualifacts community; providing visibility into the industry in order to ask the correct questions of their own business practices

• How Generated– Via QSI technical resource during off-business hours– Compiled and graphed manually via QSI resource (Excel)

• How/When Communicated– Annually (currently)– Quarterly (if participate in Open Minds User Group)

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Community Year End with Monthly Breakdown Metrics List

• Expected Revenue by Funding Source• Expected Revenue % by Funding Source• Claim Lifecycle for 2012• Claim Lifecycle January 2011 – December 2012• Clinical Efficiency• Appointment Status Comparison

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Community Year End with Monthly Breakdown Metrics (cont’d)

• Value– They highlight general trends to provide proof of

improvement (and/or areas for improvement) over time (demonstrating the ROI of the EHR investment)

– They are the baseline from which the Open Minds user groups will be conducted (and upon which additional benchmarking measurements will be developed)

– For customers participating in the Open Minds User Group, we will include (graph) their individual performance against the benchmark data

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Example - Community Year End with Monthly Breakdown Metrics

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Example - Community Year End with Monthly Breakdown Metrics

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Example - Community Year End with Monthly Breakdown Metrics

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Community Year End with Monthly Breakdown Metrics (cont’d)

• Note:– These metrics include customers live as of 12/31/11

(*claim lifecycle includes those live as of 2009). – They measure usage over the course of 2012, with

the exception of one (Claim Lifecycle) which measures across two years (2011 – 2012)

– They were distributed at the conference and were sent to all other eligible customers prior to 4/26

– There are some customers whose data was either incomplete or was a significant outlier and therefore were excluded from the benchmark measurement

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Success Metrics Overview – What’s Useful/Relevant When?

• Stage = Existing (Prospect) - this is where/how we can show customers “what to expect” post go live– All example metrics– Percentile summary

• Stage = Building (Implementation) – this is where customers can determine critical success factors and what measurements will prove their success– All example metrics– Percentile summary

• Stage = Emerging (Go Live, 1 – 3 months post) – this is where we are focused on the “must haves” to ensure successful go live– Post go live success metrics– Percentile summary

• Stage = Rising (Live less than 1 year, 3 – 12 months) – this is where we are focused more on workflow/process and other system usage efficiencies– Post go live success metrics– Agency year end with community comparison– Agency year end with peer comparison– Community year end with monthly breakdown

• Stage = Thriving (Live greater than 1 year) – this is where we are focused more on big picture and overall agency success (growth of business/adoption of new functionality, etc)– Agency year end with community comparison– Agency year end with peer comparison– Community year end with monthly breakdown

Success Metrics Summary (What the data has shown so far)

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Success Metrics Summary – What we Know

• In General:– More than we did before• Immensely helpful to implementations

– Positive feedback in the direction we’re heading (data provided beyond post go live metrics is helpful, but need more specific)

– Customers find they are doing better than what they feel they are doing

– Believe longer term that overlay analytics software is the right way to go for dashboards

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Success Metrics Summary – What we Know (cont’d)

• From the Data:–Customers continue to improve over

time (claim lifecycle & clinical efficiency)–No show rates are lower than

industry* –Revenues do increase*

Success Metrics (future)

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Success Metrics (future)

– C3 Insights• Impact of configurability of CareLogic• Need further breakdowns• Need more often (with more trending)• Need “executive” views (dashboards/drill down)

– Open Minds Input• Determination of metrics• Design/development of dashboards• Benchmarking User Groups

– Open Minds led reviews of metrics and how to use for performance improvement and organizational readiness for healthcare reform

– Original 5/22 start pushed in order to refine metrics further

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Success Metrics – Supporting Materials

• Distributed at C3, Emailed (if not at C3), and to be posted to QSI Connect by 5/3 (http://connect.qualifacts.com/page/success-metrics-system-audit-queries)

– Qualifacts Success Metrics (Overview)

– Post Go Live Success Metrics• Quick Reference Guide• Full Guide • Example Spreadsheet • Example Post Go Live Health Report

– Agency Year End with Community & Peer Comparison Metrics• Cover Sheet • Quick Reference Guide• Examples• Percentile Summary

– Community Year End with Monthly Breakdown Metrics• Cover Sheet• Example

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Q & A?