Cutting Costs and Scaling Service While Improving Quality of Care
This white paper discusses how organizations are leveraging a hybrid cloud strategy, mixing public and private clouds to realize significant cost savings for their organizations while expanding telehealth and remote patient care offerings to ensure revenue sustainability across the organization.
HealthIMPACT WHITE PAPER
Table of Contents
What We’ll Cover in This White Paper
Efforts to cut costs and increase revenue generation.
Radical distribution of the workforce caused a rapid scaling of online services.
IT needs to support seamless transition between onsite and remote care delivery.
5G and the technology to support quality improvements to remote care delivery
Abstract
As healthcare IT organizations grapple with reduced budgets, increased regulation and the disruptions created by a global pandemic, leadership faces the challenge of how to continue providing patient care with continuity to the business in the face of disaster while endeavoring to reduce costs. This white paper discusses how organizations are leveraging a hybrid cloud strategy, mixing public and private clouds to realize significant cost savings for their organizations while expanding telehealth and remote patient care offerings to ensure revenue sustainability across the organization.
What We’ll Cover in This White Paper
Changing revenue demands post-Covid and outlook for next 6-12 months
Ways to drive revenue, cut costs and improve patient experience and outcomes
Adapting to a hybrid cloud offers to scale quickly and expand digital infrastructure while cutting costs
Methodology
HealthIMPACT Live held a webinar panel discussion in November of 2020 with Theresa Meadows, SVP and CIO, Cook Children's Health Care System; Josh Peacock, Healthcare Solutions Advisor, Sirius Healthcare; and Bill Russell, Managing Editor and Host, This Week in Health IT. This white paper is the output of that discussion and surveys of the audience of over 100 Health IT leaders.
Results
Introduction
Healthcare systems can’t serve their communities without generating positive cash flow. In that sense, they are just like any other business. Without a positive margin, there is no ability to invest. Instead, cuts often have to be made, and those cuts affect the quality of healthcare, the patient experience, and—of course—the healthcare workforce. But the truth is that many healthcare providers are operating on negative margins. Prior to the COVID pandemic, 33% of provider systems in the U.S. had more money going out than coming in. Since the advent of COVID, that number has risen to 49%, despite a massive infusion of cash resulting from the CARES Act. Aggravating factors for that increase are many and varied, but the major issues have been the costs associated with shutting down elective procedures, peaks and valleys in patient loads as the pandemic has spread, escalating labor costs and the expenses associated with adapting what is traditionally a hightouch, in-person service delivery model to remote service methodologies. On top of these is the fact that the fixed costs of medical facilities are high, so when they are underutilized, the financial model breaks. Health systems are under financial pressure at the exact same time that they are under unprecedented pressure to perform, so they are focusing hard on economy, efficiency, and the development of new ways to perform medical services.
Efforts to cut costs and increase revenue generation.
In surveys taken during the HealthImpact Live webinar titled “Cutting Costs and Scaling Service While Improving Quality of Care,” 83% of respondents reported that subsequent to COVID, they’ve come under business imperatives to cut costs and/or increase revenue generation. Only 12.5% reported that the situation had not affected their perspective on how to exploit the public Cloud to this end, and those responses orbited around two centers of gravity: the first consisted of providers who were already very mature in their Cloud adoption strategies, with greater than 50% of their workloads already running in the Cloud; the second consisted of providers who had no significant Cloud adoption. From this, it seems very clear that Cloud strategies are central to efficiency, scalability, and quality improvements for most providers. Theresa Meadows is the CIO for Cook Children’s Health System and served as a key panelist for the Webcast. She commented that the public Cloud has obvious advantages and that she is prepared to exploit them, doubting the value of having 50 specialized servers and specific hardware requirements for users when she is able to move workloads to the Cloud where they cost less, have better mobility, and are more secure. The immediate obstacle she perceives is that many major Healthcare Application providers aren’t mature enough in the Cloud at this point, but she also thinks that as they become more Web-based, there will be a rapid acceleration in Cloud adoption for Healthcare. For Theresa, the principles that are inherent in Cloud service delivery have more immediacy. “We were a well-oiled machine…” she commented. She notes that since COVID, “…we’ve learned to be more agile, failing fast and moving on to something else if that doesn’t work.”
Radical distribution of the workforce caused a rapid scaling of online services.
Josh Peacock, a Principal in the Sirius Healthcare Practice, agrees with Cook’s CIO, but also says that there are immediate opportunities to drive down Healthcare provider costs by using the public Cloud for Business Resilience and Disaster Recovery. His experience has also been that the radical distribution of the workforce caused a rapid scaling of online services, which Healthcare providers are now optimizing for efficiency, trying to balance performance and cost as they approach a steady-state where a remote workforce is integrated with onsite workers in clinical settings. He comments that end-user computing in the Cloud exploded with COVID. Business “took the handcuffs off IT,” he says. And this is because expediency was a bigger issue than cost in the enablement of remote workforces, but that now the situation is becoming normalized. Cook’s IT department has roughly 400 employees, 300 of whom are now remote. “We were not a culture that worked remotely at all,” the CIO reported, “but I expect that we will become an organization that permanently works remotely and only comes into the workspace when necessary.” Some of those occasions are likely to be project kickoff meetings and planning and strategy sessions because—with a years’ experience—it’s clear to her that some work is simply not as effective when it’s done remotely. For meetings that require a lot of interaction, there is no replacement for in-person collaboration.
IT needs to support seamless transition between onsite and remote care delivery
With the increase in Telehealth (remote medical service delivery), the ability to scale has never been more important. Most observers, including Cook’s CIO, expect that requirement to persist for as long as reimbursement for the services is eligible for payment. Theresa related that Cook’s mental health workload is now 80% served remotely and that they have no intention of returning to predominantly in-person appointments. This isn’t just an issue of the technology having made it possible or COVID making it essential during the pandemic, but because it is a superior user experience. Patients are very content not to have to go to a clinic and wait, providers can observe patients in normal surroundings and gain better insights, and—particularly for acutely ill patients—Telehealth means they don’t have to be transported someplace in an ambulance for a regular appointment. This, of course, means greater investments in technology, but it also means that there are opportunities to shift costs to pay for it. For example, Cook’s has building plans in development that optimize the use of space to facilitate the integration of in-person and remote care. Caregivers will be able to operate from pods where they can seamlessly move between onsite activities and Telehealth delivery.
In another case, Cook’s is building a new facility 50 miles away from the main campus. The ability to staff that facility with specialists during its ramp-up period is enhanced by these improved remote delivery technologies. But remote delivery places other demands on the system, the most important of which is increased stress on networks and bandwidth. Josh Peacock reported that during the first days and months of workforce distribution, bandwidth was stretched to the limit for home providers. He said that there was a radical difference in testing between data delivery for remote workers over regular ISP networks and ATT’s FirstNet, which sets aside bands for emergency and first responders.
5G and the technology to support quality improvements to remote care delivery
Theresa believes that further deployment of 5G technology mitigates the problem, which is proven in the primarily urban areas where 5G is available; she encourages more rapid deployment by all providers for similar performance across the country: “This is the real use case for 5G,” she says, “If I have to look at a radiology exam on my phone (or mobile device), having that data transfer rate is highly critical.” Analysts seem relatively unified in their belief that financial pressure on Health systems isn’t temporary. If half of them operated at negative margins throughout 2020 (which they did), and if those providers were to close down (which red ink will cause), the quality of life in the U.S. will be profoundly affected. This makes it incumbent on Health systems and their partners alike to figure out how to create efficiency through technology.
Conclusion
Demands on IT teams and the technology have increased as have the revenue and operational demands on hospital leadership
Cloud services continue to be a way to drive revenue, cut costs and improve patient experience and outcomes
Adapting to a hybrid cloud offers to scale quickly and expand digital infrastructure
Decision Making Post-COVID - Use the Data You Have to Drive Efficiency and Quality
Data is generated at every point in the patient’s healthcare journey. How this data is protected, shared, governed, and used is paramount both to patient and business outcomes.
HealthIMPACT WHITE PAPER
download “Decision Making Post-COVID” as a PDF
Abstract
Data is generated at every point in the patient’s healthcare journey. How this data is protected, shared, governed, and used is paramount both to patient and business outcomes. As data continues to drive business and services, healthcare systems must employ the talent and skill sets necessary to make the most of this data and ensure its security. Additionally, decision makers must implement a strategy and business culture with a data focus to be effective. Join us as we explore how health systems can help develop the data skills to thrive in the digital era.
What We’ll Cover in This White Paper
Addressing disparities in data exposed by the pandemic
Improving data governance to ensure quality data collection and management
Leveraging predictive analytics to overcome challenges presented during and after the pandemic
Methodology
HealthIMPACT Live held a webinar panel discussion in November of 2020 with Rebecca Mishuris, MD, MS, MPH, CMIO, Boston Medical Center Health System, Deb Muro, CIO, El Camino Hospital, Scott Harrison, VP, Chief Data Officer, Parkland Health, Lee Pierce, BS, MIS, Healthcare Chief Data Officer, Sirius Healthcare; and Bill Russell, Managing Editor and Host, This Week in Health IT. This white paper is the output of that discussion and surveys of the audience of over 100 Health IT leaders.
Results
Health Systems across the country have been overwhelmed with the demand for data resulting from the COVID pandemic. State and local public health agencies, hospitals, clinicians, and media need that data to understand the evolving state and impact of the virus on patients, populations, and communities and respond effectively.
A panel of healthcare CxOs expressed just how severely the demand has been felt by their organizations in a recent HealthIMPACT panel discussion, “Decision Making Post-COVID. “The last 9 months have felt like 9 years,” said Dr. Mishuris, CMIO at Boston University School of Medicine. “We've been building the plane while flying it," said another panelist. The panelist discussed a variety of topics during this panel discussion, but three topics in particular made the opportunities for improvements in data and analytics apparent: disparity in data capabilities, data governance, and predictive analytics.
Addressing disparities in data exposed by the pandemic
The conversation addressed the fact that there are “haves” and “have-nots” when it comes to even “sufficient” data capabilities in provider organizations across the country, never mind really good ones. These disparities have always existed in healthcare, but our ability to respond to COVID really brought this problem to the fore for healthcare leaders and data experts. In the early days of the COVID outbreak in the US, all healthcare organizations had to rally their data resources to meet the initial demand in order to understand how the looming pandemic was going to impact them. Some were at an advantage, having already largely invested in the technology and skill sets that could support such an exploding demand for COVID related data and analytics, but just as many found themselves not knowing where to start or looking to their EMR vendors for help with even the most basic data and reporting capabilities. Such data needed to include the supply and availability of PPEs and ventilators, ICU bed availability, number of COVID tests performed, test results, and number of COVID related deaths, to name a few. Some organizations stood up COVID command centers and included their data leaders as part of their COVID response leadership, while others struggled to just identify who to reach out to for getting answers to basic questions. Even today, the means by which COVID data is documented and reported, and the quality of the data generated, differs so broadly that it is hard to know what to trust or not. What all of the panel discussion participants agreed on was the existing opportunity to establish a more solid foundation on which to build analytics—data governance.
Improving data governance to ensure quality data collection and management
Data Governance is a program of decision-rights and accountabilities to treat data as a strategic asset, including managing, leveraging, and protecting it accordingly. COVID brought to light the lack of data governance maturity that exists inside health systems, payors, and government health agencies. Areas of focus for data governance include metadata management, data stewardship, data quality, and data literacy, among others. Not being able to merely define and document who is accountable for data-related decisions (data stewardship), data inventory and data/metric definitions (metadata management), and data quality processes and metrics represents a gap in foundational data capabilities. This gap has impacted all of COVID data reporting, predicting, and response. Establishing disciplines around all areas of data governance is necessary to ensure all data supply chain stakeholders and health-systems decision makers are armed with better data and data capabilities in order to respond effectively to future events. A rising tide must lift all boats, instead of some sinking because of holes in their data foundation.
Leveraging predictive analytics to overcome challenges presented during and after the pandemic
Where organizations do have the ability to provide good descriptive analytics, most healthcare organizations and agencies lack the means of predicting what impact COVID will have on their patients, operations, and bottom line. Predictive analytics is the statistical discipline of using data from the past to prepare for what is likely to happen in the future, or to determine the probability of future outcomes and trends. Predictive algorithms are developed through statistical means and modeling such as linear regressions, decision trees, and neural networks. All of these models require data, or factors, that the predictive models use to capture and calculate relationships. In the HI panel discussion, panelists noted factors for predictive algorithms related to COVID outcomes included the following:
Social determinants of health
COVID test results (number of positive tests)
Patient zip codes
Gender
Waste-water data
Employee sick call-ins
Number of people wearing masks and social distancing
Patient co-morbidities
Death rates
Data from communicable diseases from the past
Data on vaccinations has become a critical focus for organizations and will certainly be a predictive factor to add to the algorithms being developed.
What became clear as panelists discussed the issue is that many are trying, but few are succeeding to generate reliable, meaningful predictive algorithms that could provide a foundation for important decision making in navigating both the pandemic and future events. To start using data predictively, healthcare systems must invest in their own data discipline and capabilities, and work together with county and state public health agencies as well as EHR vendors.
Conclusion
There are many efforts underway in healthcare organizations of various sizes to use data to drive efficiency and quality in their organizations. But as a whole, the industry has much to do to bridge the chasm between the haves and have-nots in terms of data and analytic capabilities. An unfortunate pandemic forced cooperation and sharing among health systems to enable effective response. It now demands the continuation of that trend in addition to improving data literacy, data governance, and healthcare data standards into the future so that we’ll be equipped to collectively handle whatever widespread healthcare challenges arise going forward.