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! 

Rest assured. LTPAC Clinical executives can know rather easily.

What keeps you up at night? When I ran SNFs, many things would intrusively leap onto the stage of my dreams, stealing the limelight. Their discordant presence would dash the quiet and restful performance currently playing, causing me to start into a sudden and unwelcome wakefulness. It was one thing to steal the limelight, it was another to completely take over the show and lock the stage door to my more sedate and slumber-inducing dreams. Stifling a cry, I would sit bolt upright in bed, beads of sweat on my furrowed brow. One of those frequent limelight-stealing imps was a nagging doubt about my facility’s compliance.

Compliant to what? Federal and State regulations? Fire and safety? The Fair Labor Standards Act? Safe Harbor? HIPAA? Corporate standards and objectives? The list goes on and on, each list member competing animatedly for my attention. “No sleep tonight,” I’d groan. But times have changed and so has technology potentially barring the stage doors to unsolicited dream disturbers.

In the days before automated data mining and business intelligence (BI)-generated dashboards and reporting, I would have to make a mental note to investigate if and how compliant we were, recognizing that the research alone would take quite a lot of time, assuming no interruptions (silly me), sorting through charts, files, and printouts. But today WITH BI at a manager’s fingertips, those with compliance concerns, including clinical managers, have ready access to critical Key Performance Indicators (KPIs). With Business Intelligence, clinical managers can conveniently view a variety of KPIs which they can make their own. (I’ll get to that shortly.)

Let’s take a look at some of the KPIs clinicians can view to discover in measurable terms if their areas of concern are compliant. With regular input either directly from the data which resides within their clinical application automatically “pumped” into the data warehouse or keyed in directly, clinicians have access to frequently refreshed information. This information can include such KPIs as in-house-acquired or community-acquired pressure ulcers with the number of residents with pressure ulcers at what stages and at what percent of the average daily census over a month’s period of time or trended over a 12-month period.

Restraints? Weight loss? Anti-psychotic use? Infections? Readmissions? Falls/Accidents? Sentinel events, such as dehydration or fecal impaction? Indwelling catheters? Pain management? Hour per patient/resident day compared to state standards and to budget? Overtime usage? And more. If the data exists, the information can be viewed in the BI dashboard.

Now, I referred earlier to managers making KPIs their own. How about comparing the KPIs against benchmarks the clinical team has created based on regulations and company/facility-established standards, usually set to exceed the regulatory requirements? It’s all in one dashboard. No longer do clinicians have to wait for reports to be researched, compiled, published, and distributed. Log in and find out. No more uncertainty. Just discover. Take action. Get results.

With BI, this potentially sleep-disruptive concern can be put to rest. It’s called peace of mind. Take a dose of BI every day and sleep well.

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.

“I believe people are like boats.” With that I’ve started many a seminar and webcast. After a brief pause, I relieve the tension by saying, “They toot the loudest when they’re in a fog.” Ambiguity, tardy information, and just plain situational ignorance can keep many a decision-maker in a fog. However, because of the critical need to know how much and when cash will be flowing into and out of the bank, CFOs need crystal clear visibility. And business Intelligence dispels the haze and sharpens the perception of what is happening. From cash collections and revenue projections to labor and non-labor spend management, operations and finance executives alike can know almost up to the minute how much cash is flowing in and how much is flowing out.

Business Intelligence makes it happen

As we have discussed in previous blogs, Business Intelligence (BI) has become the go-to tool to help managers keep their fingers on their business’s multiple pulses all in one convenient easy-to-view location. For LTPAC providers, this amounts to such Key Performance Indicators (KPIs) as census, cash, accounts receivable, labor and non-labor spend, clinical, and other information. Roll up. Drill down. It doesn’t matter. CFOs can glimpse a consolidated view of KPIs important to them and then drill down as deep as they need to track, trend, and act. It’s real time and it’s highly effective. How? BI makes information visible at all levels within the organization simultaneously. And visibility drives accountability

But let’s limit this conversation to cash flow

Turning revenue into cash in the bank

Let’s explore a day-in-the-life-of one of a CFO who uses BI to monitor and hold accountable those responsible for keeping the cash flow steady and predictable. It’s mid-month and after logging into the BI tool (in our customers’ case, primeVIEW), the CFO, we’ll call him, “Craig”, reviews the tiles he’s configured for his home page displaying what to him are the critical KPIs. From there he clicks on the Cash/AR tab to view such information as:

• The current month collections-to-goals performance with 12-month trending
• What’s been collected and deposited each day by payer type for the current month, recent quarter, and year-to-date (Remember. He can view a corporate summary or drill down to a region or facility level.)
• How each facility or region ranks compared to their company peers by payer type
• The status of each facilities aging with payer type drilldown capabilities
• The Days Sales Outstanding (DSO) over a specified period of time
• How revenue is trending by payer typ

Craig notices that the South region is falling short of its MTD collections through the 15^th of the month. He calls Melissa, one of his veteran regional managers, and invites her to open up primeVIEW to discuss these outliers and what her staff can do today to right the regional ship and get it back on course by the next collection benchmark which is the 20^th. Melissa reports that she and her staff have been working with Facilities A and D since noticing the slowdown in collections on the 10^th. She assures Craig that her team is confident that these facilities will reach the month-end harbor very close to their goals

Financial performance

After concluding the call, Craig clicks on the financial tab to check on current revenues generated compared to budgeted projections by region as well as by facility by payer type. He further reviews revenue by occupancy by day, by payer, and by service. Convinced that the company is on track to meet goals and, in a couple of facilities, to exceed goals, Craig then turns his attention to the bad debt allowance status by facility as well as month-to-month trending. He makes a note to himself to address this issue in the next meeting with his corporate AR manager

Conclusion – Visibility is more than just clarity of sight

Because of BI, cash flow visibility is current, communication is specific, and required action is timely. Visibility encourages accountability and fosters real results.