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Scott Wanless

Every day the news is filled with stories about healthcare business intelligence, and the tide is rising. But the business intelligence "connection" may not be clearly visible. Over the next few months, I will use this blog to pass along tangible examples of healthcare business intelligence. I will explain the role of business intelligence in each situation, pointing out the business analytics, performance measures, potential analyses, etc.

This will not be a deep analysis by any means, but hopefully you will find a few ideas that will help you in your efforts.

Thanks for reading!

About the author >

Scott is the Healthcare Analytics Director for Cipe Consulting Group. He has more than 30 years of experience in business intelligence strategic planning, analytics application development and business analysis across numerous industries including hospitals, physician groups, healthcare payers, laboratory research, insurance, lending, manufacturing, retail and state government. Scott can be reached at scott.wanless@cipeconsulting.com.

Editor's note: More healthcare articles, resources, news and events are available in the BeyeNETWORK's Healthcare Channel featuring Scott Wanless and Laura Madsen.

Infection control is as much a business issue as it is a clinical issue.
And infection surveillance is as much a business intelligence process as it is a clinical intelligence process.

Yesterday, an article called Hospital Monitors Infectious Diseases Using Real-Time Surveillance by Cynthia Johnson http://www.healthleadersmedia.com/page-1/TEC-248111/Hospital-Monitors-Infectious-Diseases-Using-RealTime-Surveillance provided a laundry list of business intelligence applications.  

Consider this:
  1. Targeting Interventions.  The central function of an infection surveillance system is to identify patterns and trends in the data in order to target interventions to prevent hospital-acquired infections.  From a commercial perspective, this is exactly what business intelligence does, except the "interventions" are business decisions and the "infections" are lost opportunities to increase revenues, cut costs and waste, improve efficiency, improve customer loyalty, etc.
  2. Improve the Bottom Line.  With the CMS now denying payment for never events and treatment for nosocomial (hospital-acquired) infections, these interventions take on a new financial significance.
  3. Compliance Reporting.  Now that hospitals are required to comply with the Joint Commission's National Patient Safety Goals, the use of business intelligence best practices makes this reporting easier and smoother.  Plus, having the data warehouse backing up the reporting allows the hospital to drill into the numbers by facility, by provider, across time, etc. In addition, this data becomes reusable for the myriad compliance requirements from medical societies, governmental agencies and quality standards organizations.
  4. Sharing Best Practices.  Every facility can learn from sister facilities the practices, process improvements and techniques they are using to prevent infections and keep patients safe.

The parallels between clinical intelligence applications and business intelligence applications are becoming more clear as both sides become increasingly sophisticated.

And the ties between clinical quality issues and financial issues are becoming increasingly tighter.

Of all of the quotes in the article, this one points to the need for business intelligence more than any other...
"From a patient perspective, I would rather go to a facility where someone is gathering information and can look at patterns and trends versus one where they relied on a staff member's memory" 

Thanks for reading!
Scott

Posted March 18, 2010 10:36 PM
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The American Nurses Association announced that it opened up its database of nursing and quality measures called National Database of Nursing Quality Indicators┬« (NDNQI┬«) for research purposes.  More details can be found at https://www.nursingquality.org/

The amount of data for clinical improvement purposes is significant:

  • 11 years of data submitted quarterly
  • 1500 hospitals represented
  • 12,000 individual nursing units
  • 18 key quality measures

The primary goal of research in this area is to essentially show how nursing practices affect patient outcomes.

From a healthcare business intelligence viewpoint, consider the following business questions:

  • Nursing Needs.  What are the different nursing needs for medical specialties, surgical units, clinics, long-term care units, etc.?
  • Nursing Skill Mixes.  o we have the right nursing skill mixes in place?  Why or why not?
  • Staffing.  Are we staffed correctly at the right times of the day?  Of the week?  Of the month/season/year?  Does "correctly staffed" mean financially correct?  Clinically correct?  Operationally correct?  Some mix or balance?
  • Training and Experience.  Do our nurses have the training and experience needed for our patient mixes?  Are they supported with the right blend of equipment, supplies, assistance, etc.?
  • Making a Difference?  Are our nursing improvement efforts making a difference in terms of patient health outcomes?  How do we know?

The NDNQI alone represents a potentially valuable database to mine.

But the point of business intelligence is to combine databases to answer questions that cannot otherwise be answered...profitability, efficiency, effectiveness, quality, satisfaction and value.

I am looking forward to reading more about how the various researchers who subscribe to the database are combining it with other data to answer these types of questions.

Thanks for reading!


Posted December 8, 2009 2:48 PM
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Cooperatives Being Pushed as an Alternative to a Government Plan

 

There are a number of business questions that these healthcare cooperatives will need to answer to survive and succeed.  And each of these questions will require some form of business intelligence. 

 

Some examples:

 

Getting capital and making wise investment decisions.  They will likely be receiving seed money from a variety of governmental agencies, in a variety of forms, and earmarked for a variety of investment purposes.  This requires sophisticated, wide-ranging analytical capabilities.

 

Negotiating favorable rates with providers.  Cooperatives will have to bargain aggressively with hospitals and physician groups to negotiate favorable rates.  They will be at a disadvantage compared with public payers such as Medicare, which enjoys reimbursement rates for doctors and hospitals set by federal law.  As one might imagine, they will meet with opposition from providers.  After all, a payer's cost is a provider's revenue.

 

Enrolling enough people to achieve critical mass.  In order to obtain a large enough market share to survive, cooperatives will need to analyze their offerings, especially to break into markets where insurers are very well established.

 

Determining what services to offer, and why.  As the article states, many will be integrated medical systems, which means that they will have to analyze a wide variety of revenue types, cost structures and operating models.  Many will employ physicians and own healthcare facilities and supporting businesses (e.g. labs, pharmacies, etc.).  All of these require different types of analytical models and applications.

 

Evaluating performance of partners.  Cooperatives won't have the ability to piggyback onto existing government institutions, so they will need to form partnerships with other cooperatives on a state or regional basis.  Plus, they will need to work with a variety of other organizations, public and private.

 

Supporting member and public reporting.  They will be owned by policyholders like mutual life insurance companies and by consumers, who will do comparison shopping.

 

Pricing, rating and determining eligibility effectively.  In order to keep members' premiums competitive, and at the same time serve their members' coverage needs profitably, they will have to support complicated actuarial and eligibility models.

 

Applying lessons from other types of cooperatives.  Cooperatives' boards will require them to learn and apply best practices from other types of cooperatives, such as dairy, rural power, farm supply and retail cooperatives.  In addition, they will need to understand the processes of models from major healthcare organizations such as HealthPartners and Group Health Cooperative.  They will also have to integrate their services with existing informal cooperatives that exist across the U.S. and the rest of the world, especially in large ethnic communities.

 

Supporting regulatory compliance reporting.  This will be a regulated marketplace, so compliance reporting will be required.  Business intelligence can help.

 

Evaluating and defending options for evolution of the business model.  Like Blue Cross and Blue Shield plans and other healthcare organizations that began as consumer cooperatives, these new organizations could try to evolve into for-profit corporations.  Plus, existing healthcare organizations could try to convert themselves into co-ops.  Either way, they will need informaton to defend their moves because of the history of organizations who lost their way and were not really working for the interests of their members, of consumers or the public.

 

Thanks for reading!

Scott

 


Posted August 18, 2009 9:57 PM
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