In a recent McKnight’s Senior Living article, the leaders of Argentum, NCAL, and LeadingAge responded to the question of their respective associations’ agendas for 2016. As I read their responses, I opportunely observed that Business Intelligence (BI) can help them effectively address these. For James Balda, President and CEO of Argentum (formerly the Assisted Living Facilities of America [ALFA]), the top issues are workforce development, quality care, operational excellence, and consumer choice. National Center for Assisted Living's (NCAL) Executive Director, Scott Tittle, reports that his organization’s top priorities involve state regulatory issues, workforce development, and, most significantly, “new tools that will help members accumulate data they can use to communicate the quality of care that they provide and to compare themselves with peer providers” with emphasis on quality outcomes. Katie Smith Sloan, President and CEO of LeadingAge, emphasized payment model changes, “whether it's ACOs or bundled payments or creating a network to negotiate with health plans.” A further concern, according to Ms. Sloan, is the lack of unit inventory, creating long waiting lists, and workforce development needs as well.

Taking license to read between the lines, all would likely agree that effective strategies require further research and that further research requires actionable information from reliable and timely data sources. This requires a robust data mining and business intelligence solution. Such a solution not only allows for the storage of critical data in data warehouses, but the retrieval, aggregation, and dissemination of such data converted to useful Key Performance Indicators (KPIs) which can be used internally or shared with other healthcare stake holders and investors.

Let’s take operational excellence, for example. Whether you call it “operational excellence” or “quality of care” perhaps, or positioning facilities to “negotiate with health plans”, having fresh, up-to-date information about the quality of clinical services, the costs to provide the services, and the labor required creates an advantage. Providers can respond to today’s issues today with an eye on the future. It also fosters the sharing of information that providers and their respective associations need to address these issues effectively. With BI, the information is already available and easily digestible.

How do you eat the elephants of workforce development, compliance, operational excellence, and payment model changes? One “byte” of data at a time. Accumulated and properly served, BI-generated KPIs can sustain such initiatives with energy and focus over the long haul.

Make Business Intelligence part of your 2016 strategic plan! 

In our more recent blogs, we have pushed the benefits of business intelligence (BI). We have especially emphasized its timeliness. With BI, you can know what’s happening practically in real time. Just open the dashboard and you see Key Performance Indicators (KPIs) important to you. But are you aware that you can be alerted via email when certain KPIs are significantly above or below targeted benchmarks?

Let’s say you and your management team have identified specific census benchmarks with given parameters which, when exceeded or fallen short of, the BI tool immediately sends you an emailed alert notifying you that certain regions and facilities are at risk. With that information in hand, you can immediately contact and troubleshoot the situation with the appropriate staff.

This is just as valid with labor KPIs. How about overtime? You are sitting in your office preparing for the next meeting when your email notifies you of an incoming message. You navigate to the message to see that it’s from the Business Intelligence tool alerting you which facilities have exceeded overtime parameters today.

Cash management? Near and dear to any executive’s heart is making sure that collections are keeping pace with targeted collection goals. Let’s say your team has identified that certain private-pay collection benchmarks are achieved by the 10^th. On that day, you receive an alert that specific facilities are falling short of their collection goals for private-pay with resident-specific contact and balance information. Because of this alert, your team can address the issues now.

Business Intelligence generated alerts not only deliver timely information, they also reinforce accountability. I don’t think it’s so much of matter of “Big Daddy” is watching. Rather, it’s an opportunity. When facilities are falling short of their goals, they may be distracted by other matters. Receiving an alert-generated call from your team can be helpful and supportive.

If you have a Business Intelligence tool like primeVIEW, that generates alerts, use them! It’s one more benefit available to help your team to effectively manage that which really matters.

Recognizing the value of Business Intelligence to monitor and manage your business is one thing. Doing something about it is another? What is the next step? Do you build it or buy it? Admitting we are biased towards “Buy it,” we will identify what appears to be “best practice” for most SMBs.

Build it?

While several larger provider organizations have elected to invest the time, resources, and money to build their own data warehouse and reporting systems, such an investment is far out of the financial reach and expertise for most SMBs. Here are some of the key reasons why not to build is the better decision:

Those who have their own IT departments think they can do it themselves – It’s just a matter of directing the IT manager to create reports, isn’t it? Actually, it’s not that simple. Because they think they know how, we have discovered that some well-intentioned companies will start by hiring a programmer to write reports. However, business intelligence is interactive and displays critical Key Performance Indicators (KPIs) not only as tables, but as graphs and charts as well, involving higher levels of reporting. The distinction is that BI dashboards provide greater versatility than a report generator. It uses a warehouse to aggregate data, no matter the source, and normalizes the data so that the data is interoperable – where data comes from disparate sources, yet must work together. In this way, trending information becomes easier. Business intelligence also enables the users to roll up and or drill down to critical information depending on their needs and permissions. What we have observed is that the one programmer becomes multiple programmers as the project falls further behind and the requirements expand.

Beyond the danger of scope creep and its unforeseen impact on the budget, there is the development time to consider. Programmers have to learn the various databases that serve as the data generators and repositories. This requires expertise in data warehouse technologies and best practices. Without going too deep, another complication is retrieving the data on a scheduled basis and combining it into useful information. And, in our observations, all of this can take up to eight months on average and, in some cases, years. Then there is the situation where the nature of an application’s database may change, requiring understanding and a working knowledge of the new database.

Assuming the developers have BI up and running, it doesn’t stop there. As competitive, regulatory, reimbursement, and new legislative pressures evolve, so must Business Intelligence. That means that the BI project never ends. Building and maintaining it requires retaining in-house specialists or engaging outside resources – an expensive proposition.

There are other non-development issues to consider, such as the actual go-live, the initial user training, and on-going support. Since LTC does experience high turnover even among members of the management and executive teams, training is a recurring issue and, more importantly, so is support.

Then there is the power of the aggregation of understanding what providers across the country need and want to view, what information is important to them, and how to turn their data into actionable information. That uniquely is found with those who have developed and maintained dashboards for years for providers across the country at affordable economies of scale.

Buy it

Let’s assume that if you were tempted to create your BI tool or you have started it and found it to be a big black hole that seems to suck in more time and funds that your worst fears anticipated, pause. It’s never too late to cut your losses and investigate what is already available. But, though we consider this to be the right direction, we recommend you do your homework before you buy. Beyond the usual promotional materials and even the demonstration, consider the following:

• Outsourcing BI can be less expensive in the short and long term. Investigate the monthly subscription fees and any one-off fees. Know what you are getting yourself into financially.
• Get an estimate of the time it takes to get the system up and running. In our experience, assuming we have the necessary information needed to create connections to the various data sources, we have been able to get customers fully up and running in a matter of weeks.
• How long has the vendor been developing and satisfactorily meeting the needs of its customers? Our primeVIEW has been evolving with long term care providers for years which brings up another issue. Is the BI vendor responsive to customer requests for new features in a timely manner? Responsiveness is critical to providers who must be prepared to deal with changing challenges and opportunities quickly.

Summary

We highly recommend that you seriously consider looking into procuring a BI system developed by specialists who understand LTPAC and BI technologies. It’s cost-effective, scalable, and they can offer suggestions, based on what other providers have done. LTPAC specialists, like primeVIEW, also listen to customer suggestions to further enhance business intelligence’s capabilities and anticipate providers’ information needs. Our customers acknowledge that such a strategy is affordable and highly effective in controlling costs, ensuring compliance, improving service quality, and improving cash flow without the distractions inherent in “do-it-yourself” BI development.

Yesterday’s tactics will not work in today’s LTPAC marketing game

When I was operating SNFs in the late 70’s through the early 90’s, the traditional way to forge and foster a solid referral pipeline was to schmooze the hospital discharge planners by visiting them, occasionally taking them to lunch, sending periodic greeting cards, and doing a good job. That “good job” meant that the discharge planners didn’t receive any complaints about the care given to those they referred to us. That was about the extent of it. Like most sales, it was all about personal relationships supported by the absence of complaints. But times have changed.

Today, we’d lose with just schmooze. In this data-driven world of ours and closer scrutiny of functioning relationships between acute care and post-acute care providers (read, hospital readmission rates, for example), we have to demonstrate that our goals and performance align with each hospital’s expectations. Those providers which are able to share statistics vital to acute care providers have a significant advantage over those who can’t. But to be able to do that can be a daunting task, but it doesn’t have to be.

Data – the LTPAC marketer’s (not-so) secret weapon

Data mining and business intelligence technologies simplify the collection, storage, retrieval, and conversion of data into readily retrievable and actionable information practically in real time. The information BI offers comes in the form of Key Performance Indicators (KPIs) which can include census, labor, wages, admissions/discharges/readmissions, cash and collections, clinical, 5 Star, and RAC audits, customer satisfaction, QAPI, actual-to-budget spend, job postings, and more. You get the idea. If the data exists, it can be mined and reported. As you read through this list, you can also see that a tremendous opportunity exists for providers not only to establish a substantial and mutually-beneficial relationship, but one that is easy to maintain. The key here is transparency. It’s no longer, “Just take my word for it.”

But where do you start? First and foremost, find out what matters most to the hospitals in your area. What services do they need post-acute care providers to offer? Do your services offerings align with what they need? Assuming they do, what data points/KPIs would indicate that you are in alignment with their goals? Readmission information? Customer satisfaction survey results? Staffing levels? Lengths of stay? Discharges destination? Clinical trending? Quality measures specific to the services important to the hospital? BI becomes your scorecard in the game of 21^st century census building.

Visualize your marketing team walking into the hospital’s conference room where you are introduced to its team of discharge planning stakeholders. Following introductions and the usual “getting-to-know-you” banter, you start your presentation. Now, here’s the fun part. At the right moment in your presentation, you pull out a report generated by your BI tool and distribute a copy to each person. You discern some “Aha!” facial expressions as they easily interpret the charts, graphs, and tables illustrating the KPIs germane to their specific needs. Further, you sense the building excitement as you report that you can provide updates as frequently as they require. You’ve added credibility to your claims that your facility can be the go-to facility for their post-acute discharges. This is the stuff of solid partnerships.

Let’s take rehospitalization KPIs, for example. With hospitals and SNFs under close scrutiny regarding rehospitalization rates, being able to quickly report up-to-the-moment current and trending readmissions-related KPIs by payer, by diagnosis, and by risk levels can be a positive game changer for you.

Bottom line

Using BI can help providers confidently say to their acute care referral sources, “We’re in this together.”

Steer wrestling and data chasing (Yes, there is a point to this.)

I admit it. I am a born city slicker who likes to wear jeans, cowboy-style shirts from CAL Ranch, a cowboy hat (although it’s been a while since I donned one of them), and a good comfortable pair of cowboy boots. I’ve ridden a horse a handful of times, almost got thrown once, and chased more cows on foot than I care to count when I worked on a farm one summer when I was 17. Now if that don’t qualify me as a rootin’, tootin’, shootin’ wrangler, well…it just doesn’t. But I do like a good rodeo once in a while. And the event that gets my attention happens to be steer wrestling. (Probably because it’s

the quickest event and I have a short attention span – where was I?) I mean, think about it. The steer and the cowboy are rocketing along side-by-side at about 30 miles per hour. The cowboy then slides off his horse on to a 600 lb. steer, catches it behind the horns, stops its forward momentum, and then has to wrestle it to the ground. The world record currently sits at 2.4 seconds. (It took me longer that 2.4 seconds to write that last sentence.)

So, what in the pea-pickin’ world does data chasin’ have to with steer wrestlin’ or bull doggin’, as it is otherwise called?

Actually a lot. I mean think about it. It’s the end of the week, the month, the quarter, the year, you name it. Whether you’re a corporate or regional VP of Operations, a facility administrator or executive director, or a department head, you have to file reports and be accountable for the stories they tell. I recall years ago, when operating a 120-bed SNF that I had to meet with the RVP each month and, at times, the divisional VP of Operations as well, to review my facility’s performance. I had a rack on wheels on which I kept all the A/R, A/P, payroll, and P&L printouts and my own manually-generated reports.  I would roll that sucker into the facility conference room ready to present and defend my case. In retrospect it is quite comical to think about. The best way to hide a so-so performance was to bury the RVP and AVP in well-organized outdated and irrelevant summaries based on arcane and rearview-focused information. Yee-haw! It weren’t quick, Ma’am, but it sure got the job done. Sadly, it was also meaningless and unnecessarily time consuming.

Succeedin’ in data wrestlin’

What is the secret to successful steer wrestling? Speed, leverage, and strength. In previously posted blogs, we have repeatedly beat the drum of data mining and business intelligence (BI). Succinctly stated, data mining is “technology-driven processes and practices used to convert raw and sometimes disparate data into easy-to-interpret and actionable information.” Business intelligence gives you the speed and leverage to retrieve the data needed to make sound decisions quickly. And like a good “hazer” (the cowboy riding on the right side of the steer to keep it running straight), BI helps decision-makers focus on what really matters without distractions. Here’s how:

• Speed – business intelligence can retrieve data in real time or at least process the data into useful information in real time as soon as the data is available. (Most of our customers want their data retrieved several times a day.) The BI dashboard displays the data in useful graphs, charts, and tables which are readily accessible and easy to interpret and act on.
• Leverage – Such timely and actionable information gives decision-makers the leverage to make the right decisions to seize opportunities and problems and wrestle them to the ground in record time.
• Strength – Because the dashboard is viewable at multiple levels in the organization with roll-up and drill-down capabilities, organizations can concentrate their leaders at multiple levels to make things happen quickly and powerfully.

Providers today have so many issues, challenges, and opportunities before them and so many regulatory, investment, and regional and corporate stakeholders to answer to. It’s insane to try to wrestle that 600 lb. steer of data to retrieve, compile, make sense of, and report without BI. If you have BI, good job. If you don’t or are not fully taking advantage of it, you don’t need a “steer”-ing committee to create one. There are BI tools available right out of the chute, like PCT’s primeVIEW, designed for the LTPAC steer wrestlers, like you, cowboy.

Now, git off’n your high horse and take a gander.