IT Strategy – Maestro Strategies

What Got Us Here, Won’t Get Us There: Strategic Planning for the Transition

Information and technology is becoming pervasive in all aspects of clinical care delivery and financial management of the health care enterprise. Healthcare business, clinical and information technology leaders agree that IT is critical to population health management and value based reimbursement. Yet, for many, day to day problems often keep IT leadership in a fire-fighting mode. Many CIOs and healthcare business and clinical leaders find it difficult to find time to focus on the future.

Traditional healthcare information technology strategic plans were primarily consisted of a list of vendor applications and infrastructure to be deployed. The bottom line for most healthcare organizations is that tactical IT road maps will not position the organization for tomorrow. Segmentation of the IT strategic plan and portfolio into four primary programs can be useful in transitioning IT from a “keep the lights” on functional role to a strategic partner for the transition from volume to value. Each quadrant has a unique role in maximizing the value IT contributes to the organization.

See below our thinking on each quadrant and key take-always for senior leadership

1 – Rethinking IT Organization Design & Operating Model: Traditional IT organization structures, processes and operating models should be reconfigured to consider the healthcare enterprise of tomorrow. Many IT organizations were founded within hospitals and those models no longer work given the level of consolidation, the requirements to support clinical integration networks, and the expectations of affiliates and partners. New customer support functions, shared services centers and economies of scale are needed for today’s contemporary information technology services. Collaboration with informatics, analytics, quality and security professionals is challenging traditional IT cultures and operating practices.

Key Take-Aways: Have you redesigned the IT, Informatics, Analytics and Quality leadership and organization structure? Do you have a plan for building new competencies? What is the 2.0+ operating model?

2 – Support Performance Improvement in Acute, Ambulatory & Post-Acute Care: As pressure on healthcare costs increases and margins become more dependent of value, not volume, clinical and operations leaders will increase their collective focus on the Triple Aim, or care, health and cost. Health systems will critically examine the clinical process, patient experience, outcomes and efficiency of care each with financial implications. A myriad of reimbursement programs and contracts from payers will create new incentive and penalty structure for hospitals, physicians and post-acute providers. From shared savings contracts, to bundled payments to direct to employer, each year additional measures and programs will be added. Health systems need to improve their capabilities in business intelligence, real-time data access, and effective chronic care management

Key Take-Aways: Have you transitioned from departmental or point enterprise performance improvement systems? Do you have a plan for creating an analytics center of excellence? What distinct business intelligence strategies are in place for enterprise performance improvement and population health management?

3 – Enable Health System Growth: Consolidation, New Markets & Partnerships

Horizontal and vertical consolidation, new geographies, service lines and points along the continuum, and partnerships with other health systems, payers and new market entrants such as retail health are blurring the lines of what it means to be a health system. Each market is different and each enterprise is different. One size fits all strategies, or rip and replace with one core vendor are no longer viable strategies. HFMA’s Value-Based Payment Readiness Survey ranks interoperability readiness as the weakest competency for most respondents. Yet, it also indicates that 70 percent of financial executives anticipate their organizations will need to be extremely capable in data exchange to support value based reimbursement requirements and new market strategies in the next few years.

Key Take-Aways: Have you developed an interoperability strategy based on the unique makeup of your enterprise, affiliates and partner readiness? Do you have a plan for identify management, access and referral management, and care coordination? What is IT’s role in extending the enterprise and connecting the community?

4 – Drive Innovation & Transformation

Cloud computing, mHealth, patient activation and consumer engagement all come to mind when Digital Health Strategy is mentioned. Billions of dollars have been invested in innovative start-ups and new transformative tools. Yet, security risks are increasing daily. Well beyond portals, initiatives such as virtual visits, home monitoring, self-service scheduling and bill payment, open notes, wearables, social health communities, and the list goes on. A recent Surescripts Survey finds “patients prefer digitally savvy doctors and demand a connected healthcare experience.”

Key Take-Aways: Have you developed an integrated patient and consumer engagement strategy? Do you have a patient advisory council? What are the unique characteristics of key patient populations that could drive innovation?

The Pivot: From Compliance to Strategy

HIMSS16 – billed as the largest and most important healthcare IT conference in the United States occurred last week in Las Vegas. The message was loud and clear – something is different; the government mandate is over. Strategy is the new, new.

For years the HIT world has encouraged alignment of enterprise strategy and the IT plan. Alignment suggests two distinctly different things creating a linkage or connection. Healthcare enterprise strategy decisions such as which markets do we enter, who do we acquire, which service lines do we emphasize, and what capital investments do we make are explored at executive and board levels. Operations and financial decisions to support our hospitals and physician practices are made within organizational silos. Sometimes IT is at the table, but more often than not information systems professionals are called in after the fact to “implement” selected systems and tools. Sophisticated IT organizations have created IT Strategic Plans, IT Governance structures, IT Road Maps, and IT Champions/Customer Relationship Managers. Our challenge – separate, sometimes aligned but rarely one.

Uncertainty is the new normal. Strategies that take years to implement, vendor partners who are all vying for the same space and the challenges of mergers and acquisitions are driving us from 1.0 healthcare – where business as usual no longer is sustainable. We are at a cross roads. Those of us in transition must “pivot” our viewpoint from 1.0 volume based thinking to 2.0 and beyond.

We need fresh, new perspectives regarding the relationship between enterprise direction and the digital strategies required for the future. New harmonized strategies will:

Vary by geographic market and depend on community progress toward clinical integration
Necessitate partnerships, alliances and consolidations – no one can fund the investment alone and no one vendor will have all the solutions
Require governance models that address horizontal, vertical and virtual decisions making and integrate change across multiple systems of care
Move from an applications focus which emphasizes feature, functionality to a platform focus, producing highly configurable systems which will drive standardization and enable business strategies simultaneously
Redesign our organization structures, leadership competencies and operating models in IT, Informatics, Analytics and Quality
Acknowledge our work to create systems of documentation was foundational but not the end goal; systems of insight and behavioral change are the next stages in the evolution
Result in convergence of people, process, information, change and technology to rationalize costs, manage risks, realize value and activate patients to become involved in their care

Business Plans for Affiliated Provider Solutions & Services

Despite the healthcare consolidation trend and the health system strategy to build a “System of Care” across the healthcare continuum, affiliated providers continue to be an essential element of the care delivery process in most communities. Even with strong referral management processes and systems, physicians will still refer patients to providers outside the “owned assets” of the IDN, patients will self-refer and primary care providers and specialists will create orders to be delivered outside the integrated delivery network. While most health systems are developing strategies to actively manage referral practices, even the most horizontally integrated health systems will be on a constant search for high-quality and low-cost affiliated providers to compete effectively in a value-based environment.

Affiliated provider programs at many health systems have struggled, even with the relaxation of the Stark Laws through the Safe Harbor provisions. Simply offering a donated EHR often fails to address the expanding scope of provider organizations (e.g., practices, skill nursing facilities, home health agencies, etc.) and often ignores the evolving demands of clinical integration and accountable care models which place greater emphasis on services and technologies that complement the EHR. Providers need effective application support services, enabling technologies such as telehealth, and a health system who is continually evaluating new innovations such as wearable technologies, mHealth, analytics, etc. that work with a myriad of EHR environments including donated EHR, web/portal/HIE, call centers, cloud based scheduling, fax and direct.

Developing a Business Plan that includes services and solutions for your affiliated providers doesn’t need to be overwhelming.

Suggested steps include:

Step 1 – Recognize that your provider solution and service offering may start with physician practices, but will grow to include other provider settings. This may take time. While most markets share several similarities, there are unique factors that will determine when the business conditions of your market will support expanding the business plan and associated strategies to include additional care settings
Step 2 – Develop a standardized services and solutions catalog that your customers need, is easily understood and can be delivered with a high degree of reliability. The services and solutions may be tiered or packaged to appeal to specific groups and level of integration, and specific variations may be designed-in to allow “localization” of based on unique requirements of specific entities, markets and specialties. Yet, the important point is that it is standardized, which by definition will produce a modest set of services and solutions. When a health system allows customizations, the services and solutions catalog expands and operating costs soar
Step 3 – Resign yourself to the fact that your organization can’t do it all. Sourcing selected services and solutions from the catalog to value added resellers, Internet Service Providers, hardware providers, etc. will be important. The goal is to create a variable model that reduces risk, creates economies, and ultimately provides exceptional service
Step 4 – Determine the business (i.e., operational, organizational, & financial) model that is right for your organization. There are a number of different models that can be used. What is right for your organization will depend on its operating strategy. Key questions include:
o Do you provide services through existing IT departments or management services organizations?
o How are the services provided to employed providers and owned entities?
o Is a separate services organization necessary to provide the services? Do you run the business as a profit center or cost center?
o Are multiple entities using the services and how do you share oversight and management?
Step 5 – Create the go-to-market plan. Communicating the value proposition and earning the trust of customers can be the most challenging component of any business plan. This is particularly true if previous attempt to align with affiliated providers have not been successful at your organization or neighboring health systems. Pre-emptively addressing concerns, demonstrating how services have been tailored to better meet needs, illustrating the executive support, and painting a long-term vision are all required for the program to thrive.

Maestro Strategies uses our collective experience gained assisting health systems with their provider programs as well as our work launching new companies, affiliations and agencies to help explore key strategies and associated operating implications to create a vision, build a business plan and design a road map for affiliated provider services and solutions. Please contact us a insights@maestrostrategies.com to discuss the unique needs of your provider community and how the steps above could be tailored to create a Business Plan for Affiliated Provider Services and Solutions to benefit your health system.

Organization Design – Emerging Models for IT, Informatics, Analytics & Quality

“IT in healthcare is no longer a hero’s game” indicates one executive. CIO in healthcare stands for “Chief Infrastructure Officer” and in the future it must stand for “Information, Integration and Innovation” says a CIO who comes from outside the healthcare industry. Our “clinical informatics leaders must think more strategically” indicates a CEO. All quotes from recent interviews of executives from 60 leading health systems conducted by Maestro Strategies CEO Pam Arlotto. CEOs, CMOs, CIOs and CMIOs all indicate new leadership and organizational models are needed as the industry transitions from volume to value. As senior leadership teams tackle consolidation, clinical integration, population health management and a variety of new strategies. Traditional silo based organization structures will not drive value in tomorrow’s health and healthcare enterprise. Emerging themes include:

The ability to work across entities, geographies, points in the continuum, service lines, etc
Clinical integration is driving new organizations structures and operating models
Informatics is being formalized and is pivoting from a focus on technology adoption to information, people, process and change
Analytics skills and competencies while not new to healthcare, must evolve to meet the demands of today’s enterprise
Convergence of informatics, analytics and quality is needed to manage the health of populations

See a short video (~15 minute) Research Summary of the emerging organization design trends for IT, Informatics, Analytics and Quality. A more in-depth virtual or in person briefing is available for leadership teams.

Two Canoes … and Four ‘I’s

Change: No two healthcare provider organizations experience it the same way. Some actively pursue development of clinically integrated networks and accountable care organizations, others double down on traditional healthcare practices. Many are paralyzed, not knowing what to do or how. The transition from volume to value has been described as “stepping from one canoe to another midstream.” Although the analogy clearly depicts the challenge, it doesn’t instruct healthcare executives how to successfully execute the step without falling in. The American Hospital Association has tackled this task by publishing a series of white papers describing the journey as moving from “first curve” to “second curve” healthcare. The most recent, Your Hospital’s Path to the Second Curve: Integration and Transformation (January 2014), provides 10 strategies, necessary organizational capabilities and potential paths for hospitals. It depicts a number of case study organizations that are actively “living in the gap” between volume and value, and describes various integrated delivery programs to improve care coordination, physician alignment, performance measures and patient outcomes. While most volume to value publications rarely address healthcare information technology, except to say “implement EHRs” as part of clinically integrated care, this white paper takes it a step further. It encourages health systems to “conduct information exchange” and use information systems to:

Implement electronic health records
Enhance health information system interoperability across sites of care
Use existing data to facilitate analysis and reporting for process improvement and behavioral change
Use predictive modeling for population health management
Use data analytics for care management and operational management

Yet, many health systems and providers are challenged to successfully execute these recommendations. In fact, we find the operational, clinical, financial, technological and legal unintended consequences of HITECH often undermine the potential benefit. Many clinicians still ask “why” and have not incorporated needed workflow changes. Healthcare executives question what value they have received for their multimillion-dollar investments. To a certain degree, the focus on Meaningful Use and its incentives has been the “technology tail wagging the dog.” Rather than leading with the business strategy we wanted these systems to enable, the healthcare industry focused on the technology. So while healthcare strategists are actively living in the gap and planning the next step on the journey to value, clinicians and other users of information technology are struggling with the day-to-day impact these systems have left on care delivery. Rather than rushing to select health information exchange applications, layer on business intelligence systems and purchase care management systems, we suggest an alternative approach focused on value creation and realization. It starts with one letter – “i.” My friend Praveen Chopra, Executive Vice President and Chief Information Officer at Thomas Jefferson University and the TJU Hospital System, started his career outside healthcare in retail and supply chain. “Rather than focusing on technology, the healthcare industry should focus on three “i’s” – information, integration and innovation,” Chopra says. At Maestro Strategies, we also want to focus on one more “i” – insight. We believe that a focus on these four words will help drive more value as we take the next steps on our joint transformation journey. Our “i-men” characters help us tell the “why,” and with this new website, we plan to bring our clients and friends specific strategies and tactics to help execute on the change and close the gap between the two canoes.

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