Regional Information for Shared Excellence (RISE) Initiative · PidtR lldf ti lPresident Reagan...

Regional Information for Shared Excellence (RISE) Initiative

Dashboard Overview Webinar

Jerry Lassa, MS Statistics

May 15 & May 17, 2012

Do You Ever…

• Spend a lot of time reviewing data trying to make sense out of it?• Wonder how you did last month, last quarter or last year as a reference

point?• Wonder how well you’re doing compared to your colleagues, y g p y g ,

competitors, the state or the country?• See a change in data from one month to the next and wonder whether

you should take action or not?you should take action or not?• Make a decision based on gut instinct or prior experience because you

don’t have data to support the decision?• See a relationship between clinical care and operational functioning of

your clinic but can’t quantify it?• Feel knowledgeable about performance data in your organization but g p y g

others don’t?• Wonder whether the priorities you have set should really be priorities?

CALIFORNIA HEALTHCARE FOUNDATIONwww.chcf.org

Agendag

RISE Background 1Baldrige Performance Excellence Framework2Dashboard Reporting & Use: Best Practices3Data Validation Basics

Beginner Dashboard Design

45 Beginner Dashboard Design5


Big Changes in the Industryg g y

Vendor selection- Vendor selection - Workflow redesign - Hardware/software

N t k- Network- Training- Implementation

- Data-driven culture- Performance measures- Link to EHR fields

EHRCha

nge - Optimization - System use, data integrity

- Reports, dashboards- TrainingEHR

Implement Data Management

C Training- Optimization

Management& Analytics

TiCALIFORNIA HEALTHCARE FOUNDATION

www.chcf.org

Time

4

Then and NowThen and Now

Then:

Physician DOS Patient ID Avg A1c BP LDL Foot ExamSmith 4/12/2011 2949983 6 YES YES YESSmith 4/12/2011 9851498 4 YES YES NOSmith 4/10/2011 3134878 10 YES YES YES

Now:

Smith 4/10/2011 3134878 10 YES YES YESSmith 4/12/2011 8866369 6 NO NO YESSmith 4/12/2011 2007528 7 YES YES NOSmith 4/13/2011 9070925 6 YES YES NOSmith 4/13/2011 1438507 8 YES YES NOSmith 4/13/2011 4871361 8 YES YES YESSmith 4/10/2011 8549370 7 YES NO NOSmith 4/10/2011 2458352 4 YES YES YESJackson 4/13/2011 6187972 4 YES YES YESJackson 4/13/2011 305191 6 YES YES YESJackson 4/13/2011 554553 7 YES YES NOJackson 4/13/2011 554553 7 YES YES NOJackson 4/12/2011 4968186 5 YES YES YESJackson 4/12/2011 7947836 10 YES NO YESJackson 4/12/2011 8331051 10 YES YES NOJackson 4/13/2011 1320313 6 YES YES YESJackson 4/13/2011 7647899 6 YES YES NOJackson 4/10/2011 7724504 8 YES NO NOJackson 4/10/2011 5041785 7 YES YES YES


5

Is Your Organization Ready f th T i f D t ?for the Tsunami of Data?


RISE InitiativeBackground

Over the past decade, clinics have worked to enhance qualityOver the past decade, clinics have worked to enhance quality improvement efforts, transform culture, information systems, and care delivery Significant work in tracking and reporting key performance measures toSignificant work in tracking and reporting key performance measures to assess the quality of patient careSeveral statewide projects have supported this work

AQICC Tools for Quality other regional effortsAQICC, Tools for Quality, other regional effortsResults: definition of standardized clinical and operational measures, enhancement of quality improvement processes and implementation of HIT, including registries, to collect and report on quality dataincluding registries, to collect and report on quality data

RISE Initiative:Runs October 2011 to December 2012Continued data collection reporting and use work with a focus on DataContinued data collection, reporting and use work with a focus on Data Sharing Communities and accelerating improvement of clinical and operational performance by supporting data-driven management Added emphasis on enhancing the patient experience


p g p p

RISE InitiativeProject Description

Data Sharing Communities (DSCs):Data Sharing Communities (DSCs):

Super Region Data Sharing Communities

North North Coast Clinic Network (Super Region Lead)Alliance for Rural Community HealthHealth Alliance of Northern California

Bay Area Redwood Community Health Coalition (Super Region Lead)y y ( p g )Community Health Center NetworkCommunity Health PartnershipSan Francisco Community Clinic Consortium

Central Valley Central Valley Health Network (Super Region Lead)DSCs organized by measure

South Community Clinics Health Network (Super Region Lead)Coalition of Orange County Community ClinicsCommunity Clinic Association of Los Angeles County


RISE InitiativeProject Description cont.

1. Regional Learning Communities1. Regional Learning CommunitiesData analytics, including data validation, analysis, reporting and sharing data with providers through the use of dashboardsEnhancing the patient experienceg p pTeam approaches to care deliveryPatient panel managementStaff engagement/culture changeStaff engagement/culture changePatient self-management supportHealth coachingOperational changes to increase accessOperational changes to increase access

2. Data AnalyticsThe collection, review, and reporting of key metrics across project participants Quarterly sharing of data and using it to improve patient careparticipants. Quarterly sharing of data and using it to improve patient care with reporting to CHCF every six months Measures sets contain three to six measures with at least one measure in each of the clinical, operational and patient experience measure domains


p p p

RISE InitiativeProject Description cont.

3. Dashboard Use3. Dashboard UseEach DSC will use a standardized dashboard in various forums to display data, and facilitate discussionsA standardized dashboard template is available but each DSC and Super p pRegion has the flexibility to customize the dashboard to suit their needs (e.g., different measure sets, display of blinded and unblinded data, variety of audiences) Need to ensure the dashboard is populated appropriately and accurately, and disseminated to various audiences in an effective and meaningful way

4. Plan for Improved OutcomesEach community or region has committed to improvement on at least one measure in the first year, and at least two measures in the second year of the grant


RISE MeasuresClinical Measure Meaningful

useUDS North Super Region Bay Area Super Region Central

Valley SRSouth SR

ARCH HANC NCCN CHCN CHP RCHC SFCCCARCH HANC NCCN CHCN CHP RCHC SFCCCHypertension: BP Measurement

CORE T7 (control of HTN) ✔

Tobacco Use Assess & Tobacco Cessation Interv.

CORE Table 6B✔ ✔

Adult Weight Screening & Follow‐Up

CORE Table 6B✔

Childhood Immunization Status

Alternate CORE

Table 6B✔

Diabetes: Hemoglobin A1c Additional Table 7Diabetes: Hemoglobin A1c Poor Control

Additional Set

Table 7✔ ✔ ✔ ✔ ✔ ✔

Diabetes: Low Density Lipoprotein (LDL) Management and Control

Additional Set

Table 7✔ ✔ ✔

Controlling High Blood Pressure

Additional Set

Health Out/ Disparity ✔ ✔ ✔ ✔

Cervical Cancer Screening Additional Set

Table 6B✔ ✔

Percent of patients without a✔

Percent of patients without a PCP visit in last 12 months ✔

+ Operational: Third Next Available Appointment (TNAA), % No-Show Rate+ Patient Experience: TBD (RISE year two focus)


+ Patient Experience: TBD (RISE year two focus)

RISE Linked with BSCF CCAP Initiative(Blue Shield California Foundation(Blue Shield California Foundation

California Comparative Analytics Project)

• Purpose:Purpose: • Support adaptation of i2i's PoplQ software to serve the data

collection and analytic needs of community clinics and other safety net providers who use BSCF’s self-assessment toolnet providers who use BSCF s self-assessment tool

• The adapted software will help community clinics and other safety net providers collect, compare, and share data related to clinical quality financial operational and patient experiencequality, financial, operational, and patient experienceperformance indicators generated by the tool.

• Finance measure focus: • Operating margin or net margin, Days cash on hand, Current ratio,

Revenue mix, Average cost of clinic visit, Average cost of clinic visit by payer, Net revenue or loss by payer or Net operating margin by payer, Collections ratio, by payer, Benefits as % of total salary or wages, Claims quality


Importance of Smart Data Display p p y

Good

44% (Medicaid National Best)

51% (Commercial National Best)

35% (Medicaid National Average)

What’s the measure?What’s the measure? Time period? Which direction is good? Benchmark? Goal?

Is performance level a priority? If so, what do we do? Who’s responsible? What resources are allocated? Who and how to hold accountable for improvement?


Importance of Balanced Measuresp

Measures from multiple “domains” (e.g., clinical, operational, financial)


tell a much richer story than a single measure and better inform decisions.

So many more measures to manage…need to have efficient reportingneed to have efficient reporting

1. HTN blood pressure2. Tobacco use, cessation

24. Oncology breast cancer: hormone therapy25. Oncology colon cancer: chemo for stage III

All Clinical Measures:

3. Weight screening4. Flu vax for older adult5. Diabetes: HbA1c poor control6. Diabetes: LDL mgmt and control7 Diabetes: BP mgmt

26. Prostate cancer: avoidance of overuse of bone scan27. Smoking and tobacco cessation, medical assistance28. Diabetes: eye exam29. Diabetes: urine screening30 Diabetes: foot exam7. Diabetes: BP mgmt

8. HF: ACE/ARB for LVSD9. CAD: beta-blocker for prior MI10. Pneumo vax for older adult11. Breast cancer screening

30. Diabetes: foot exam31. CAD: drug therapy for lowering LDL32. HF: warfarin therapy for atrial fib33. IVD: BP mgmt34. IVD: use of aspirin or other antithrombotic

12. Colorectal cancer screening13. CAD: oral antiplatelet therapy14. HF: beta-blocker for LVSD15. Anti-depressant med mgmt16 POAG: optic nerve eval

35. Initiation and engagement of alcohol and other drug dependence tx

36. Prenatal care: screening for HIV37. Prenatal care: anti-D immune globulin38. Controlling high BP16. POAG: optic nerve eval

17. Diabetic Retinopathy: docum of macular edema18. Diabetic Retinopathy: communication with physician

managing diabetic care19. Asthma pharmacologic therapy20 A h

g g39. Cervical cancer screening40. Chlamydia screening for women41. Use of appropriate meds for asthma42. Low back pain: use of imaging studies43 IVD l li id l d LDL l20. Asthma assessment

21. Appropriate testing for children with pharyngitis43. IVD: complete lipid panel and LDL control44. Diabetes: HbA1c control (<8.0%)

+ Operational Measures + Finance Measures


+ Operational Measures + Finance Measures

So Are You Ready? y


Baldrige Can Helpg p


Baldrige National Quality Programg y g

P id t R ll d f ti lPresident Reagan called for a national study on productivity in October 1982 in response to declining US productivityp g p yThis resulted in a National Quality Award signed into law in 1987Baldrige Program promotes excellence in organizational performance,

i th lit d f Malcolmrecognizes the quality and performance achievements and publicizes successful performance strategies

Malcolm Baldrige

1922-1987 p g


Baldrige National Quality Framework

H f t

How your key strategic objectives address your strategic challenges. How you ensure strategic and operational plans are achievable and adequately scoped. How you develop and deploy action plans throughout the organization to

H i How you foster an employee culture conducive to high performance. How

d

p y p g gachieve objectives.How your senior

leaders communicate with and engage th ti you manage and

develop your staff to utilize their full potential.

the entire workforce and encourage frank, two-way

i ticommunication throughout the organization Measurable

results you achievedachieved.

H

How you “Listen and Learn” from your key stakeholders How you manage

and improve your organizations’ key processes.

stakeholders including Customers, Community, Partners and


How you turn data into information in your organization. How you use that information to improve performance.

Partners, and Payers.

Random Organizational Activityg y


Activity vs. Organizational Directiony g


Improving Random Activityp g y


Aligned Organizational Activity & Direction


How It All Fits Togetherg


ASQ, 2004

Example Plan

Strategy Objective MeasurableStrategy“Pillars”

ObjectiveStatements

MeasurableIndicators


Create a strategy that fits your organization—Don’t piece one togetherDon t piece one together

Accountable CareAccountable CareOrganization Organization

Meaningful Use Patient Centered Medical Home


Baldrige as a Guide for Dashboard Designg g

• Provides balanced model for organization performance

• Used heavily in health sector • Since 2005, > 50% of Baldrige award applicants are health

carecare

• Provides context for data management• Measures should “align” with the industry• Measures should align with the industry

• e.g., NQF or P4P at local, state, national

• Dashboard measures should “align” with organization t tstrategy

• Dashboard measures should be “balanced”• e.g., clinical, operational, financial, patient experience measures


g , , p , , p p

Dashboard Reportingp gBest Practices

Dashboard FormatsTrend/time charts with internal goals and external benchmarks or normsStoplights (red, yellow, green coloring to indicate measure status)Stoplights (red, yellow, green coloring to indicate measure status)

Dashboard DeploymentUse to track strategy and annual plan executionUse same dashboard format

HorizontalAcross sites, divisions, departments/specialties, , p pUse similar measures as relevant (e.g., TNAA applies to all clinical departments)

VerticalVerticalBOD, senior leadership, management, staffMeasures should “roll up” with selected “core” strategic

t t


measures at top

Basic Dashboard Format


Stoplight Dashboard for Individual Providerg


Review of Dashboards in Meetingsg

Best PracticesReview dashboard results

R i iRecognize improvementsScan trends across all measures, look for potential issuesDiscuss and prioritize opportunities p pp

Develop a plan to address; establish goals for improvementAssign responsibility Allocate appropriate resources to achieve goal


Accountability for Resultsy

A bl S i d O i Pl i h i• A measurable Strategic and Operating Plan is the main reference point for accountability in outcomes achievement

• Need alignment of goals between governance leadershipNeed alignment of goals between governance, leadership, management, and staff

• Assign responsibility for specific strategy objectives and goals to appropriate governance and management committees (e.g., clinical quality, finance, IT)

• Incorporate performance goals and incentives into board• Incorporate performance goals and incentives into board, leadership, and staff performance management plans and reviews; incorporate goals into provider contracts


Public Accountability and Transparencyy p y“The good will earned by accountable and transparent nonprofits is

one of, if not the most important, of its assets.”p--National Council of Non-Profits

Health reform throughHealth reform, throughAccountable Care Organizations,will make accountability andwill make accountability and transparency a business imperative for communityhealth centershealth centers


Data Validation BasicsUnderstand the measures (you and everyone else)

Numerator, denominator, exclusion criteriaHistorical data requirements for selected measures

Sample (paper charts) vs. Population data (EHR) Sample data requirementsSample data requirements

Ensure representative and random samplingEnsure appropriate sample size for achieving desired margin of errorUDS requirements: n=70UDS requirements: n=70

Population data requirementsAppropriate use of EHR queries and report writers when selecting data

follow inclusion/exclusion criteria in measure definitionsEnsure data are accurate and reliable

Run frequency tables to cross validate patient totals and system use Identify clinical content, screen flow issues to inform EHR optimization roadmapEnsure reliability of interfaces (e.g., lab, pharmacy)Address leadership/management issues (e.g., compliance with using EHR)


Examples of System Use Measures

These types of ypmeasures help you monitor data validation issuesvalidation issues


Beginner Dashboard Designg gExcel basics

Worksheet tabs and optimal use of the “real estate”Appropriate use of columns and rows with data for chartsCommon commands: formulas, cell formatting

Excel graphsExcel graphsRationale: Visual presentation of data improves user ability to interpretApproach: Various types of charts; use column or line charts with time across x axisx-axisApplication: Creating a column chart with a goal lines; formatting title and axis labels, column series color, data labels, y-axis

Dashboard report formattingRationale: Create an efficient layout of graphs for effective use in sharing data in various forums Approach: Alignment with organization strategy, use of internal goals and external benchmarksApplication: Arranging multiple graphs on a single page; formatting page setup including margins header/footer fitting to one page


including margins, header/footer, fitting to one page

Be Sexy with Data

“I k i th t th j b i th t 10“I keep saying that the sexy job in the next 10 years will be statisticians,” said Hal Varian, chief economist at Google “And I’m not kidding ”economist at Google. And I m not kidding.


Questions?

[email protected]@

www.chcf.org/rise


Regional Information for Shared Excellence (RISE) Initiative · PidtR lldf ti lPresident Reagan...

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