Tech For Success: How To Assess Current Tech Functionality Readiness For Future Growth

By Joe Naughton-Travers, Ed.M.

With my work at OPEN MINDS, I’m often asked by my specialty health care provider organization clients which type of technology is the most important. My answer is always the same: it’s not about the individual technology itself, it’s about how all of the technology platforms come together and “play nice” to manage and optimize overall clinical and financial performance. Without the integration across all platforms, each are merely working in silos without the ability to use each platform’s data as decision-making guides for the organization.

In response, I’ve worked with our team of senior advisors to develop a technology platform framework for specialty provider organizations to aid in planning technology needed for the future. This framework has six domains:

#1 Electronic Health Record & Billing System — The functionality of a comprehensive electronic health record (EHR) software application.

#2 Human Resource Information System & Financial/General Ledger System — These are the two other key software applications for administrative operations. The Human Resource Information System (HRIS) is the software that maintains, manages, and processes detailed employee information and human resources-related policies and procedures. The Financial/General Ledger System is the software that tracks all financial transactions and is used to generate a company’s financial statements.

#3 Hybrid & Community Based Service Delivery Platform — Technology tools that support virtual and community-based service delivery.

#4 Consumer Experience & Engagement Platform — Technologies for enhancing consumer engagement in the health care experience and optimizing consumers’ experience with the system of care.

#5 Value-Based / Risk-Based Reimbursement Platform — Technology capabilities that support measuring value in terms of customer experience and engagement and of the cost and quality of services.

#6 Integrated Analytics & Service Performance Optimization — Software applications for aggregating and analyzing the data from all the other software systems and databases to manage and optimize clinical and financial performance.

Domain #1: A Whole Person Care Record: Comprehensive EHR Software

The first requirement is a comprehensive EHR software application for all the consumers your organization serves, and all the service lines delivered. The EHR must record the demographic and clinical data for consumers, the services they receive, and the corresponding clinical documentation. Additionally, the EHR must:

  • Document all referrals and referral dispositions
  • Support tracking performance and clinical quality metrics
  • Include standard functionality for medical services (e.g., e-prescribing, laboratory orders, and electronic medication administration records)
  • Provide support for the delivery of routine primary care services

Mobile access to the EHR (both on- and off-line) is a must, and clinical decision support for medical necessity, clinical appropriateness for care, evidence-based practices, and payer-mandated clinical pathways is highly desirable. The EHR should be interoperable with the EHRs of other provider organizations to facilitate care coordination. Lastly, the software must handle all of your organization’s billing and accounts receivable operations (including fee-for-service, bundled, case rate, and VBR payment models) and have tools for maximizing revenue collection.

That covers the technical details—the functionality of a good electronic health record. The essential questions to ask about any EHR system are:

  • Does the EHR help you manage whole person care for the consumers you serve?
  • Does it have functionality to monitor physical and behavioral health as well as social determinants of health (SDoH)?
  • Does it aid in care coordination with other provider organizations to achieve the best health outcomes?

If your EHR software application is not addressing these key service management functions, it is time to consider a change.

Domain #2: Managing Administrative Functions: Human Resource & Financial Management Software

The second domain helps provider organizations ensure that key administrative operations—human resources and finance—have the right software applications to meet your organization’s needs. The HRIS (human resource information system) must do more than track employees, salaries, and benefits. The HRIS also should include functionality for job applicant tracking and position control, time and attendance tracking, employee self-service capabilities, and a learning management system. A final requirement is comprehensive support for employee appraisals and development plans.

The financial management software (sometimes called the general ledger or accounting system) should have all the basic capabilities: budgeting, financial reporting, payroll, accounts payable, and fixed asset management. To support VBR contracts, the financial management software also needs to have the capability to aid in the management of the cost-of-service delivery—overall—and for individual health plan contracts. (It will need access to the service delivery data in the EHR to do this.) Lastly, this software application should have functionality for monitoring and managing health plan contracts and other payer contracts.

Domain #3: Delivering Care Conveniently: Hybrid & Community-Based Service Delivery Capabilities

This domain is more than just the telehealth services that your organization has become proficient at delivering during the COVID-19 pandemic. It includes other technologies that support and enhance your community- and home-based care delivery. Telehealth capabilities must be integrated into the EHR itself and should also be available on mobile devices so that community-based staff can bring in additional staff virtually when needed. Electronic visit verification (EVV) is needed to report that staff were physically present at consumer service delivery sites during community-based care. Smart home and remote health monitoring technologies can be used to ensure the health and safety of consumers. Secure communication between staff and consumers should be available in multiple formats (text, email, telephone, and video). Ideally, you would also have technologies that aid in route optimization for staff travel in the community as well as tools for managing these field and remote-based staff.

Domain #4: A Focus On Customer Service: Consumer Experience & Engagement Tools

Technology in this fourth domain is new to many specialty provider organizations. Consumer experience is the subjective response consumers have with any contact with your organization. Questions you might consider when evaluating for consumer experience include:

  • Are your services convenient and easy to access?
  • Are communication and other interactions smooth and painless?
  • Is there a personal touch to service delivery and an impression of quality?

Consumer engagement is when individuals take action to become more informed and more proactively involved in his or her health and the health care services received. There are numerous technology tools to help with both consumer experience and engagement, including:

  • 24/7 centralized access to care
  • An easy to navigate website with the ability to access care and schedule appointments
  • A consumer portal for communication, bill payment, and health record access
  • Web- and app-based self-directed consumer health and well-being technologies
  • Enhanced social media presence
  • Net promoter scoring integrated into all aspects of care delivery
  • Appointment and health check-in reminders via telephone, text, and email

As provider organizations expand their focus on consumer experience and engagement, a key focus is to determine which technology tools they may already have to support these efforts and which they will need to acquire and implement.

Domain #5: Managing Care & Costs:  A Value-Based Reimbursement Platform

The fifth domain of the technology platform framework is technology tools for managing service performance and cost. Provider organizations should assume that most, if not all, of their health plan contracts in the future will be value-based, with both upsides and downsides in terms of payment models. You’ll need technologies that monitor clinical quality metrics in comparison to contract requirements. Will these be in your EHR? In other software applications? In analytic dashboards?

You’ll also need to monitor other contract performance metrics. Examples include metrics to monitor access to care, treatment engagement, telephone and referral response time, and other industry standard metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and Certified Community Behavioral Health Clinic (CCHBC) requirements. You may also be required to track and monitor SDOH and adherence to evidence-based practices.

Other key questions you’ll want to consider about managing care and cost include:

  • What other technologies can better facilitate your ability to manage care and cost?
  • Can you accomplish this with your EHR and financial management software alone?
  • Do you need to invest in a better telephone system and website?
  • Should you implement separate technology tools for quality and performance tracking that your EHR cannot handle?

This leads to Domain #6—does your organization need business intelligence and data analytic technologies to aggregate, analyze, and present the data in a meaningful way to your staff?

Putting It All Together With Domain #6:  Analytics & Optimization

The last domain uses technology for aggregating your data in a meaningful way to proactively manage your organization. This is accomplished by utilizing business intelligence (BI) or other data analytic software applications that aggregate data for analysis and performance optimization. This is the ‘holy grail’ of performance measurement and optimization, having meaningful data to report your organization’s financial strength and operational performance and to monitor progress towards strategic objectives.

Most commonly, provider organizations begin with using these technology tools to manage and optimize clinical quality and performance metrics through reporting. The next step is to implement the use of dashboards for the board of directors, the executive team, department managers and individual staff. The most sophisticated use of BI software applications for specialty provider health care organizations is for population-health management. Here, BI software applications are used to provide the analytics to improve the health of the overall population of consumers served, to enhance consumer experience, and to reduce costs through consumer segmentation and analytics.

Where To Start In Building A “Next Generation” Technology Platform

The question is how to proceed with planning for and implementing the technology functionality needed to support future growth plans. There is a two-step process—addressing both immediate functionality needs for success in the current market and assessing the technology needed to support your strategic plan.

For the first, addressing immediate functionality needs, we have created a short assessment of ‘must have’ current tech functionality—The OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success. To see how your organization stacks up in this preliminary list, go through the checklist.

OPEN MINDS’ Technology Requirements Checklist – Eighteen Must-Have Capabilities For Specialty Provider Organization Success   Yes   No   Working
    On It
#1 Electronic Health Record & Billing System
Does your EHR handle all your health record documentation and billing requirements?
Does your EHR have the capability to share data with other provider organizations (interoperability)?
Does your EHR have mobile access (both on-line and off-line)?
#2 Human Resource Information System & Financial/General Ledger System
Does your HRIS include functionality for job applicant tracking, position control, and employee self-service?
Is your Financial/General Ledger System chart of accounts set-up so that you can report the unit cost and case costs of all the services you deliver?
Does your Financial/General Ledger System include contract management functionality?
#3 Hybrid & Community Based Service Delivery Platform
Do you have secure telehealth technologies in operation?
Do you have electronic visit verification (EVV) in operation?
Do you have technologies in place to monitor or report consumers’ health status (e.g. blood pressure, body mass index, lab levels, etc.)?
#4 Consumer Experience & Engagement Platform
Do you have centralized scheduling or other tools that make it easy for consumers, their families, and referral sources to access care at your organization?
Can consumers communicate securely with their care providers through a web portal, text, or other technologies?
Have you implemented net promoter scores, or a similar measure, to routinely measure consumer experience?
#5 Value-Based / Risk-Based Reimbursement Platform
Does your team have a system for reporting payer-centric and consumer-centric performance metrics?
Do you have technologies in place to report timely access to care and hospitalization readmission performance metrics?
Do you have a system to report other value-based and risk-based reimbursement contract performance measures such as follow-up after hospitalization, emergency room utilization, and use of evidence-based care protocols?
#6 Integrated Analytics & Service Performance Optimization
Do you have software technologies in place that can aggregate data from your EHR, HRIS, and Financial/General Ledger System to report on key strategy metrics?
Do executives and managers have access to real-time dashboards for key performance and operational metrics?
Does your staff know how to interpret and use the data that is available to them for performance management (data literacy)?

This checklist provides an assessment of basic technology-enabled management capabilities. Where there are gaps in these management capabilities, management teams should develop a plan to meet these functionality basics. If there are functionality deficiencies in Domain #1 and #2 (the EHR, HRIS, and GL systems) these should be an area of immediate focus.

Beyond these basic areas of tech-enabled management capabilities, executive teams need to also crosswalk their strategic plans with the tech requirements to support those strategic initiatives. For more on that process, see From Strategic Plan To Tech Strategy: Building Your Crosswalk.

Looking ahead, every executive team member—and not just the CIO or CTO—need to focus on the coming digital transformation of the health and human service field—and the strategy and technology needed to succeed.

Metrics-Based Management: Using Analytics For Strategy Implementation & Business Optimization

By Joe Naughton-Travers, Ed.M.

If you have great staff and great infrastructure, your organization still needs a strong management team—and management practices—to make sure that organizational plans to deliver great performance becomes reality. To do this, management teams need well-designed, real-time performance metrics. In successful organizations, metrics-based management happens in two contexts: managing strategy implementation and optimizing business operations. The key is to ensure you have the right data and the right analytical tools to report these performance metrics.

Managing Strategy Implementation

The use of metrics in implementing a strategic plan is considered a core element of strategic management built around key performance indicators (KPIs). Simply put, KPI’s are the ‘metrics’ that measures progress towards your strategic objectives, as well as whether your organization has achieved them. Some metrics are a direct measures of success. For example, if a strategic objective is to operate at a 10% positive financial margin, then the KPI for this objective is the margin, which is reported at least monthly. In other instances, you may choose process or proxy metrics that measure progress made in various initiatives to accomplish a particular strategic objective.

There are four important steps to selecting these KPIs and managing strategy implementation:

Step #1: Start with your strategic plan.  It should have a short list of quantifiable strategic objectives, initiatives for accomplishing them, timelines, assignments, and budgets.

Step #2: Select metrics for success. These are your key performance indicators (KPIs) calculated from obtainable data that indicate organizational performance in progressing toward and accomplishing strategic objectives. An effective KPI is specific, measurable, and actionable. Use a ‘balanced scorecard’ framework that includes metrics that report financial performance, customer performance, organizational innovation, and effective internal operations.

Step #3: Create a KPI reporting system. Ideally, this is from a business intelligence (BI) or data analytics software application that includes management dashboards to report the metrics, showing a comparison to the performance trend from past to present. Minimally, the KPIs are reported monthly with the trend data as well as against performance targets. This reporting system and its use communicates the importance of the organization’s strategic objectives and the executive team’s focus on them. As Peter Drucker said, “You can’t improve what you don’t measure.”

Step #4:  Coach your staff to use the KPIs. Engage in ongoing monitoring and proactive management using the KPIs with your executive team and staff. Modify the KPI metrics if needed to ensure progress in implementing your organizational strategy.

Much has been written about the development of KPIs and models for selecting both leading and lagging financial and non-financial indicators of performance. The challenge, beyond selecting the measures, is two-fold: developing the ability to routinely report the measures using data from existing software systems or databases (or expanding current information systems to collect the data) and analyzing the KPIs monthly to develop or update organizational strategies to improve performance.

Optimizing Business Operations

Metrics-based management also plays a key role in optimizing business operations for specialty provider organizations. What exactly is business process optimization? It is the management discipline that promotes efficiency and effectiveness of organizational process—employing methods, policies, management practices, software tools, and metrics to optimize an organization’s activities across the business process life cycle.

Optimizing business operations is critical for provider organizations. All aspects of service delivery (referral, admission, routine services, and discharge or transfer) and administrative operations need to run smoothly. Processes should be standardized to be effective and consumer and staff friendly. Data and analytics are critical tools for doing this.

Organizations that have superior process management performance share a few key competencies—corporate strategy that is connected to performance indicators as described above, process and project management expertise, deliberately designed process models that promote service quality, access to information, support of management for process improvement initiatives, and incentive-focused employee compensation.

It sounds simple. But if business process management is so simple, why do so many organizations have bad performance from bad processes? Author Janne Ohtonen, in an article titled, “Enabling strategic growth and improved performance through Business Process Management,” offered some interesting insights. His list of the ten key capabilities needed to be successful with business process management and optimization include:

  1. Co-workers have confidence and trust in each other
  2. There is open communication between employees and managers
  3. Managers share vision and information with employees
  4. The organization is able to respond to changes in markets quickly
  5. Senior management has confidence and trust in managers
  6. There are efficient communication channels for transferring information
  7. The organization has appointed people responsible for processes
  8. The organization extensively uses information systems
  9. No one has to worry about losing his or her job because of process changes
  10. Managers support changes in processes

How does your organization stack up in terms of using data and analytics to drive strategy and to optimize operations? Your team can’t perform or manage without the metrics to support both of these. In fact, I would argue that, beyond strategy, metrics and metrics-based management competency are the most fundamental ingredients for organizational success for providers in today’s market. Why?

I’ve seen executive teams of organizations with all sorts of other competencies—but with no access to timely performance metrics or the ability to use them—fail to optimize performance. Without real-time performance metrics for your management team:

  • Identification of performance issues is often delayed
  • Organizational performance relative to competitors is more a matter of opinion than a measured achievement
  • The identification of performance problems requires constant observation—and is often anecdotal
  • The “causes” of poor performance are harder to identify (and often the subject of disputes between team members)
  • It is difficult to sort out persistent performance problems and separate “trends” from short-term issues
  • It is challenging to prioritize operational improvement initiatives and investments

I could go on…

If current performance data is not the focus of your management team meetings, it will be more difficult for your team to respond to evolving consumer and payer demands, a rapidly changing health care market, or emerging competitive threats. I liken it to flying blind; the airline pilot without the dashboard.

Key elements of an organization with metric-based, performance-driven culture:

  1. Visible metrics—both customer-centric and organizational—and the data and analytical tools for reporting them routinely
  2. Actionable insights based on rich data and identification of the actions needed to improve performance
  3. Clear team member accountability for specific performance metrics
  4. Real-time performance feedback at all levels of the organization
  5. Targeted coaching based on performance data with individualized goals to improve team member performance
  6. Recognition of great performance
  7. An interactive strategy and budgeting process
  8. Nimble and data-driven service line reengineering and development

So, collect the data and teach staff how to use metrics and analytics to improve your business operations and achieve your strategic objectives. Metrics-based management is one of those “must develop” competencies for health and human service organizations. Organizational performance—including financial, service, quality, compliance, etc.—matters more to the sustainability and success of organizations every passing year.

The 2021 OPEN MINDS Technology & Analytics Institute

Stop by our booths (212, 214, 215, 216, and 217) on October 25-28, 2021 in Las Vegas, Nevada, for The 2021 OPEN MINDS Technology & Analytics Institute! Our team would love the chance to speak with you as you try your luck at one of our claw machines. We look forward to seeing you there!