ROI and Vendor Sales Strategies

Maestro Strategies has worked with numerous vendors over the years to measure and document return on investment (ROI) to support vendor and service company sales efforts. Our approach has focused on providing an objective, independent and analytical perspective on the value of the solution from the view of the healthcare customer – health system, clinician, financial executive, etc. Typically, we validate hypotheses developed in conjunction with the company, in a number of real-world customer settings and create a model that can be used to project quantitative and qualitative benefits for prospective customers. Much of our work has been focused on expanding the conversation to examine both financial return on investment as well as strategic and process value – tangible and intangible. As one would imagine, over the years we have seen products implemented that were not used by their customers, solutions implemented on top of broken processes, systems whose users resisted mandated components of the applications, and complex modules whose capabilities were only partially configured and deployed – along with products and services that drove significant value for their customers. However, in all cases, potential benefits of the solutions and ROI were not fully realized. The reasons were many – health systems implemented without redesigning processes, executive sponsors didn’t remove barriers, projects weren’t managed well, and oh yes, sometimes the products didn’t deliver promised results.

The transition from volume to value by the healthcare industry will change the rules for both solution companies and their customers. Features, functionality and demonstrations will no longer be enough to drive sales, industry consolidation will reduce the number of customers, and ultimately solutions companies that don’t produce value over the entire life cycle of their product or service (e.g. beyond sales to include implementation and support) will be replaced by those who drive value creation, realization and results. Many solutions companies are developing ROI and value realization measurement tools and methodologies. Maestro’s experience in working tells us that often solution companies and their healthcare provider clients have different goals for the relationship, different perspectives on the value question and different language in explaining benefits.

Presentation1 Different Definitions of Value

 A Joint Value Management Plan that maps out agreed upon initiatives, value targets, milestones and accountabilities is essential to drive successful adoption, use and value creation/realization. Sometimes separate initiatives are occurring in parallel with the implementation and attribution becomes challenging.  Maestro works with both the solutions provider and their client to define common definitions of value and ROI, validate actual realization, understand key levers and accountabilities that will ensure ongoing value.

White Paper — From the Playing Field to the Pressbox: The Strategic Role of the Chief Health Information Officer

Based on dozens of interviews with health systems across the US and additional research, this report looks at where CHIOs and their teams are headed amid tumultuous change in healthcare. Originally seen as the stewards of CPOE and Meaningful Use — and known as the Chief Medical Informatics Officer — the Chief Health Information Officer is now tasked with ambitious information technology initiatives spanning the health continuum, retail health and consumer engagement, and population health management. Historically, limited in its authority and with few resources for support, this emerging role is a key player who must collaborate with Chief Innovation Officers, Chief Transformation Officers, and CIOs to drive clinical integration, care coordination and value realization.

To download your copy of the white paper, click here:  From the Playing Field to the Press Box.

Ebola and Workflow: Blame the EHR or the Care Providers?

The Wall Street Journal, in their Weekend (Oct. 4-5) OPINION section noted, “It is less than reassuring that (Texas) Health Presbyterian (THP) claims Mr. Duncan’s travels and other early warning signs weren’t transmitted to physicians due to a ‘workflow’ glitch in its electronic medical records.” Within hours after  Modern Healthcare reported that, THP issued another statement backing off that explanation, “As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow,” the statement read. “There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.” Yet, other than care giver error – no other explanation was given. Others have piled on, the Dallas Morning News examined publicly reported readmission, ER wait times and other performance data to draw attention to a larger problem, failures in medical practice and quality of care.  While the attention is focused on THP, the healthcare industry recognizes these issues cross every site, discipline and organization.

Since the IOM’s first Crossing the Quality Chasm report in 2001, part of the promise of EHRs and other advanced clinical systems has been the reduction of medical errors and improved patient safety. The Ebola case and the associated performance data is a finite example. The promise has not been delivered – many are beginning to question if it ever will be. Rather than pointing fingers, let’s start with a general misunderstanding and a visible player in the Ebola case – Workflow.

Understanding Workflow

The concept of workflow is easily understood by healthcare professionals – the flow of work. Fundamentally, it is about the organization of work. The tasks, roles, rules and procedures which allow care providers to complete their care activities.  As early as the 1970s, when information systems began to automate work, initial focus was on automation of the paper forms and documentation and the exchange of this information with others in support of the tasks associated with our daily work. As enterprise systems, such as electronic health records, have become more sophisticated, these workflow tools have expanded to help prioritize and manage work. Multiple workflows, systems and processes all converge to drive the very fabric of day to day operations in most health systems. Yet, as the Ebola finger pointing illustrates, the health care industry and the US government have spent billions of dollars on EHRs and we still struggle with medical errors and patient safety problems.  Basic communication, a “check-off the box” culture, understanding of the value of technology and information to the individual care provider, all seem part of the problem.  Indeed, the way we work is at the heart of the challenge.

Re-Imaging Work

There is little argument that the design of the healthcare system is flawed: too specialized, too fragmented, too silo-ed…. Yet if workflow is about the organization of work, and the organizational model we have used is flawed, then it should not be a surprise when information systems built with workflows that mirror yesterday’s way of working produce the same errors and problems of the past. We all know Einstein’s definition of insanity is “doing the same thing over and over again and expecting different results.” So rather than sending out hordes of teams to “optimize the EHR” and “build workflows”, the healthcare industry needs business model designers and care model architects to re-imagine a future where the singular focus is on creating value. One where the Triple Aim keeps us aligned and where instead of the technology tail wagging the dog, we challenge our thinking about the way we work. Information and technology can then become the platform for that change.  Innovative designs may be based on:

  • Coordinating care processes across distances, times and multiple care team members
  • Stratifying patient groups and designing processes specifically for their unique needs
  • Influencing patient and provider behavior
  • Streamlining and eliminating human labor from processes
  • Monitoring care in real time and providing decision support to clinicians
  • Designing systems to avoid mistakes
  • Simplifying complex work practices; and reducing non value added work steps, waste and the number of intermediaries
  • Synchronizing and allowing care providers and patients to collaborate across multiple processes

The transformational opportunity comes not from implementing systems or improving workflow; it comes from experimentation, imaging and creating new ways of organizing work so that new, more contemporary workflows can support very different ways of working.