Strategic Options for a PHO
Client profile: PHO associated with a major New England tertiary care teaching hospital
Project type: Strategic and business planning
Challenge: Help the PHO reach a new market by bringing its varied constituents (employed faculty, community physicians, hospital management) together around offerings that would be attractive to the community’s several large self-insured employers.
DGA Solution and Results: DGA facilitated a strategic planning process culminating in facilitation of a retreat. We presented options and analysis to support decision-making. The PHO’s multiple constituents were emboldened to contract directly with self-insured employers using pay-for-performance contracts. This innovative strategy offers these employers value through a coordinated healthcare delivery system. The PHO, by becoming a preferred option for large employers, established a strong market position.
Capturing Information from Non-Structured Interviews
via a Case Management Tracking System
Client Profile: Physician-hospital organization affiliated with a major health system
Project Type: Healthcare business intelligence
Challenge: Create a tool to structure and track the recording of information gathered during unstructured telephone conversations between “coaches” and patients in a disease management program. Data from these phone interviews was used in quantifying the effectiveness of the programs, so it had to be maintained in an organized form.
The coaches needed a system that would allow rapid navigation to different pages on which they could record health status data during the conversation with the participants. They also needed to track whether critical questions had been answered during the call, and to navigate easily to unanswered questions.
DGA Solution and Results: Through interviews with the coaching managers and staff we identified required features for the tracking and recording system.
We developed a series of non-functional prototypes to present our interpretation of the design concepts to the client’s staff. Through several iterations of rapid prototyping, we developed a clear definition of the system requirements and categorized features by phasing priority.
We developed the system, writing the user interface in Visual Basic .NET, with the database maintained in SQL Server 2005. As components were developed, we previewed them with the client’s disease management staff, and worked with the client’s IT staff to integrate the database with others maintained by the IT staff.
Implementation of the system resulted in a 40% increase in department productivity compared with the previous paper-based system, according to the department’s manager. The system has been extended to accommodate additional diseases, and is currently being used to generate the first set of annual reports on the effectiveness of the clinical programs.
Building Business Intelligence Capabilities at a Physician-Hospital Association
Client Profile: Physician-hospital association affiliated with a major health system
Project Type: Healthcare business intelligence
Challenge: Implement an analytical data warehouse with On-Line Analytical Processing (OLAP) capabilities, following another vendor’s failure caused by intricacies in the data. The organization had a very fragmented data system, with important data stored in “desktop databases” throughout the organization. Due to HIPAA requirements, different levels of data security needed to be implemented throughout the organization.
DGA Solution and Results: DGA restructured the previous consultant’s processes, eliminating unnecessary steps that caused inaccurate results. We designed processes to extract data from the desktop databases and developed crosswalks to integrate it into the rest of the data, using more modern and efficient Extraction/Transfer/Load tools to transfer the data from its sources into the redesigned data warehouse. A new set of OLAP cubes was created using SQL Server 2005, which allows significantly better customization than previous versions.
We developed and conducted a series of training sessions to familiarize various departments with the use of OLAP cubes. Internal “SharePoint” websites were established with links to training and reference materials, discussion groups on various topics, and announcements of new releases and upgrades to the cubes. This greatly facilitates communication with and among the users.
As users work with OLAP cubes, they increase their analytical skills and consequently can identify new features that will make cubes even more useful. We continue to work with the client on creating these features as their analytical capabilities evolve.
Increasing PHO Revenues
with Clinical Integration and Expanded
Pay-for-Performance
Client Profile: PHO associated with a tertiary teaching hospital
Project Type: Strategic and business planning
Challenge: To help a successful PHO adjust to changes in regulations and market conditions by adopting clinical integration and expanding pay-for- performance.
DGA Solutions and Results: DGA led strategic planning processes developing new strategies to replace the original contracting focus of the organization. The new strategies included an extensive clinical integration effort and significantly expanded pay-for-performance based on evidence-based clinical protocols and other quality initiatives. DGA also assisted the PHO to enhance its disease management program and develop an electronic medical record strategy.
The new strategies provide value to large payers in addition to the smaller payers that had previously been served by the PHO. This new client base significantly increased PHO revenue based on the true value of the services it was in a unique position to provide.
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