Decisions are being made today that may alter a healthcare organization’s trajectory for years to come. The pandemic has revealed how unprepared we are as an industry to use real-time and predictive data to tell us “what is happening”, “what will happen” and “how do we make it happen.”
COVID-19 has upended conventional leadership thinking and challenged even the most astute to admit “we don’t know what we don’t know.”
We Must Think Differently
In recent years, the healthcare industry has made a significant investment in advanced analytics and encouraged a transition to insight driven decision making. A survey of healthcare executives conducted by Black Book in January 2020, indicated that the vast majority (93%) feel data analytics is crucial to helping meet future healthcare demands and make strategic decisions. Yet, utilization of advanced analytics was described as “negligible” by 80% of the respondents. 71% of surveyed executives said they were too busy to learn such systems. In our conversations with healthcare leaders, they indicate they prefer to delegate analysis to others, aren’t really aware of what data analytics options they have, and often prefer to rely on their instinct – after all, it’s what made them successful.
For many, they have relied on the hundreds of static spreadsheets and score cards providing weekly, daily, monthly, and quarterly reports on “what happened” to validate these instinctual decisions. Yet, in today’s world much of this history is not pertinent. Comparative benchmarks, based on pre-COVID operating models, are no longer valid. Even the most sophisticated data scientists cannot take this historic data, identify new patterns and build a model to predict the future based on our current circumstances in a rapid fashion. Even the fastest computer processor can’t generate the algorithms we need when the situation changes as rapidly as it does today. Advanced analytics tools such as machine learning and predictive modeling are at their best when the future environment is similar to the historic environment – and that’s not the case today!
Healthcare decision makers must think differently about the role of data in their decisions and their approach to making decisions.
Agile Analytics, Combining Insights & Instinct for Decision Making
In the emerging COVID world, decision makers need practical, short term, results driven answers to their questions. Influenced by interrelated factors such as numbers of positive cases, bed availability, medication and PPE supply, treatment protocols, deployment of virtual tools and the impact of social determinants on population segments, the problems we are trying to solve change constantly.
Agile Analytics is a new paradigm for healthcare decision makers and is focused on rapidly finding value in data.
COVID brings the need for quick turnaround of information and rapid decisions. Historic data trends and traditional, large scale analytics projects are not dynamic enough nor nimble enough to support today’s decision-making environment. Since “we don’t know what we don’t know”, we must learn along the way. Jumping to solutions, based on traditional best practice or the play books of the past may lead us down the wrong path. Yet, complex architectures and advanced analytics platforms may not be responsive enough to meet the challenges of the current environment.
Agile Analytics is a style of working and problem solving. Originally created by software developers in 2001, agile is a collaborative approach built on short one to three-week iterations resulting in a data output that can be used to solve a problem or make a decision. Each targeted iteration starts simply, explores key components of the problem and initial hypothesis, and provides decision makers directional insights to drive data stories and resulting conversations.
The Minimum Viable Analysis
A Minimum Viable Analysis (MVA), is similar to the Minimum Viable Product concept developed by Eric Reis of Lean Start-Up fame. “Rather than spending months even years perfecting a product (analysis) without ever showing it to a customer (decision maker)…we start with a simple prototype of the product (analysis) get feedback from the customer (decision maker) and learn, then build it out further through multiple feedback sessions and iterations.”
The MVA starts simply. As in the case of the minimum viable product, an initial problem to be solved or decision to make is identified by a small collaborative team of decision makers and data analysts. Using a travel analogy, rather than building an entire automobile to solve a transportation problem, the team starts with a skate-board as an initial prototype. This prototype defines data output, visualization or presentation expected from the MVA.
For problems the healthcare delivery organization is trying to solve during these times of uncertainty, a minimum viable analysis can be used to answer questions such as:
- When will we run out of ICU beds/ventilators?
- What staffing constraints will we have in acute care? in ambulatory? in post acute?
- What is changes should we make in our care model given the mix of virtual and in-person visits?
- What triggers will change our plans for rescheduling visits and procedures?
- Will we have PPE limitations or other supply chain issues?
Then, as specific questions are answered, an iterative approach can be used to add to the knowledge base and analysis to produce answers to more targeted questions or broader concerns.
We term the gap between the data output from our agile analytics effort and the change in behavior required to solve the original problem as the “Last Mile.” Unfortunately, the Last Mile is often an afterthought in analytics projects. Frequently, leading edge analytics initiatives don’t generate value or results due to ignoring the last mile. Resistance, lack of trust and transparency, siloed based behaviors, and a variety of last mile issues can often be anticipated and planned for early as problems and hypotheses are defined. Decision makers have a unique understanding of the environment where the desired insight-driven changes should occur. Instinct driven decision making plays an important role in defining Last Mile issues, early in the decision process.
COVID-19 brings a great deal of uncertainty, and decision makers can’t delegate data analysis as they did in the past. Multiple perspectives, judgement and experience are needed to collaboratively define the problems to be solved, potential hypotheses, explore the implications of analyses findings and communicate insight implications.
While data driven insights can provide new “aha’s”, they are best when combined with the decision maker’s instinct to navigate these uncharted waters.
Uncertainty brings opportunity for change. Throughout the COVID-19 crisis, healthcare leaders showed remarkable agility and worked collaboratively to deploy new virtual care models, innovate solutions to supply chain issues, and evaluate declines in revenue. As the healthcare industry continues to traverse through uncharted waters, analytics has become an essential navigational tool.
Conventional wisdom and the playbooks of the past may no longer be relevant. Decision makers must deal with uncertainty and think differently. Rather than relying on historic score cards to report “what happened”, leaders are using advanced analytics to explore “what-if” scenarios and model “what will happen” and “how do we make it happen”.
Decision makers should not defer this work to data scientists. They must play a central role in determining the problems to be solved, exploring what and how to analyze, and defining what the numbers mean to key decisions. Healthcare operations, financial, clinical, and business leaders must be able to engage, communicate and act using data driven insights.
During this webinar we examine:
- The Time Is Now for Advanced Analytics
- Five Game Changers for the Healthcare Decision Maker
- Continuing the Conversation: The Last Mile
Over the past few months, hospitals and health systems have made tremendous transformations. They’ve had no choice. Rather than make decisions by committee and consensus, they’ve been forced to be agile, innovative and creative. Pam Arlotto, President and CEO of Maestro Strategies, is encouraging healthcare leaders to maintain that agility using data tools that enable prediction as they continue to navigate through uncertainty.
On July 28th, Pam Arlotto spoke with Don Seamons on episode 36 of the podcast, The Healthcare Solutions Project, on the topic of “Lessons hospitals and health systems have learned from COVID 19”
Article by Mark Hagland on May 28th.
Pam Arlotto, CEO of the Atlanta-based Maestro Strategies consulting firm, notes that, “In our new book, Orchestrating Value: Population Health in the Digital Age, we suggest that part of the ‘two feet’ challenge is that value-based care and population health have been tacked onto the existing bricks and mortar delivery system. Our silo-based culture, hierarchical organization structures and conflicting incentives have created roadblocks and barriers to the transition.”
In that regard, Arlotto says, “Interestingly, times of crisis and chaos, force innovation and creativity. Rather than going back to business as usual, the healthcare industry has an opportunity to think differently as we go forward. COVID19 and its challenges drive collaboration across government, community, economic, care delivery and social sectors – ultimately, the very definition of population health. Arlotto notes that, “A recent survey by the National Association of ACOs (NAACOS) indicates that 94 percent of Medicare ACOs are “very or somewhat concerned” with COVID19’s impact on organizational performance. Many at-risk ACOS are weighing whether to quit the MSSP or Next Generation models. This could portend a very different business or operating model for the future.”
Indeed, Arlotto says, “Telehealth and digital health, for example, have already driven dramatic change in the ‘flatten the curve’ stage of the COVID19 crisis. As we move to the next stage, health systems will have to intentionally design hybrid (digital-plus-onsite) care delivery models in concert with regional plans that integrate public health, economic and social strategies to mitigate, manage and support patients and the broader population.”
Asked how she sees the issue playing out among hospital-based integrated systems in the next few years, Arlotto says, “We are working with a number of health systems to use advanced analytics strategies to inform their next stage hybrid strategies. Data provides insights on emerging patterns which can drive design of services, patient experiences and revenue implications. For most of our clients, this means combining traditional score cards with real time analytics and eventually moving into the predictive and prescriptive space – ultimately creating a new data ecosystem and platform.”
Pam Arlotto speaks on episode 24 of the podcast The Healthcare Solutions Project, on the topic;
Using health IT to get healthcare stakeholders working together
Pam Arlotto, a past president of HIMSS and a healthcare consultant with nearly 40 years of experience, has a unique perspective on the healthcare industry’s response to the COVID-19 crisis. While the industry has made great strides in improving performance, the pandemic is showing that our data are still too siloed. The silver lining is that the pandemic is showing that when we break down regulatory and cost barriers, we can apply a tech solution like telehealth to a very specific problem like quarantining COVID-19 patients.
Pam’s latest book–“Orchestrating Value: Population Health in the Digital Age”–is available for listeners at a 20% discount. To get the discount, go to CRCPress.com and enter the promo code SOC20 at checkout. Shipping is free.
The Healthcare Solutions Project features interviews with healthcare innovators working to improve quality, reduce cost and increase patient satisfaction. Hosted by Don Seamons.
“The system is not really geared to what we need right now… let’s admit it,” said Dr Anthony Fauci from the National Institute of Allergy and Infectious Diseases.
The outcry for testing from patients and the media has challenged the US government, public health leaders and clinicians in primary care and hospital emergency rooms as they the battle the COVID19 pandemic. It is clear, the complexities of test development and deployment are only the tip of the iceberg as our fragmented healthcare system ramps up our response.
In an ideal world, the public health, care delivery, and payment systems are all components of a unified system – a three legged stool of sorts, guaranteed not to wobble and each carrying its respective weight in managing the health of the US population. Yet, in reality the three legs of the stool rarely collaborate. Each with their own ingrained cultural, political, regulatory and economic incentives. In this world, distinct responsibilities, bureaucratic processes and information systems burden decision making and slow down response.
COVID19, knows no boundaries. In just a few short days, it is smashing the complicated mixture of federal, state, local, public and private organizational siloes and accomplishing more than many of us who have spent our careers trying to improve the system.
The March 17th expansion of telehealth benefits for Medicare recipients by CMS provides a tangible example. Relaxation of HIPAA rules gives the country’s older population access to medical care (both virus related and for other services) without having to leave their homes. Providers can use personal video chat applications like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype. Rather than deploying technology for technology’s sake as we have done in the past, this step demonstrates:
- Coordination across the silos of public health, care delivery and payment
- Design of a new way of working – based on the needs of the at-risk population and their care providers
- An agile decision that simultaneously untangled the complexity of the current system
- Rapid communication of the change through multiple media channels
- Quick tools forwarded to patients and their clinicians from health care industry associations, data and technology partners and advisors
The 9-11 Commission reported, “The 9-11 attacks revealed four kinds of failures: in imagination, policy, capabilities, and management’ (National Commission on Terrorist Attacks upon the United States 2004, p.339). Today, as we face this threat each step we take provides an opportunity to untangle the complexity, remove barriers and set the course for more agile and unified decision making. What other steps should we take?
by Pam Arlotto
Contributors: Susan Irby
Orchestrating Value: Population Health in the Digital Age focuses on the leadership thinking and mindset changes needed to transition from brick and mortar healthcare to digital health and connected care. The fourth industrial revolution, with convergent disruptions in biology, business models, computer science, and culture, has the potential to transform the healthcare system like never before. Digital health startups, Big Tech and progressive health systems will change the way health and healthcare are delivered to increasingly digitally savvy consumers. This book challenges readers to rethink the role of data and technology in creating and designing the future. Rather than hooking value-based care and population health management onto traditional healthcare business models, it focuses on the emergence of digital ecosystems.
Using the analogy of an orchestra, the book introduces the importance of platforms in the formation of communities and markets with network effects to allow participants to collaborate, create, and innovate. With quotes from healthcare industry leaders and change agents, it helps the strategist understand the three stages of the transition from volume to value. As conductor of the orchestra, the CEO must navigate important leadership pivots to move beyond silo-based thinking. Finally, the Care Management Platform is described as a new operating model for population health in the digital age. As the next generation beyond foundational EHRs, capabilities such as interoperability, analytics, care management and patient/consumer engagement will fundamentally change the way healthcare enterprises operate and deliver value to customers.
Pam Arlotto was interviewed about the HIMSS20 conference cancellation due to the coronavirus in the March 5th issue of Modern Healthcare.
Article by Jessica Kim Cohen.
The cancellation could have a significant financial impact not just on HIMSS, but also on participating companies.
“This is going to have a huge economic impact, for both big companies and small companies,” said Pam Arlotto, president and CEO of healthcare consultancy Maestro Strategies. “For a lot of people, this is where they touch base with their customers and do a lot of their business development.”
This will be the first year Arlotto hasn’t attended the conference since 1982.
“I wish we had all known this about a week ago, ” she said of the cancellation. “It probably is the right thing to do, but I think a lot of us were going to go and risk it.”
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- Why healthcare organizations should consider implementing a data analytics center of excellenceNovember 3, 2020 - 3:33 pm
- Webinar Recording: Navigating Uncertainty: What’s in Your Analytics Playbook?July 31, 2020 - 2:33 pm
- Lessons hospitals and health systems have learned from COVID 19July 29, 2020 - 1:29 pm
- Using health IT to get healthcare stakeholders working together – PodcastApril 3, 2020 - 9:41 am