Moneyball Playbook for Acute and Post-Acute Care – Part I

The book and movie of the same name, Moneyball, documents how Billy Beane, former baseball player turned general manager of the Oakland A’s, revolutionized baseball. Beane used statistics and data to transform the A’s from a financially struggling organization to champions. While baseball economics and running a Major League Baseball team might seem distant from running a hospital or specialty hospital, the fundamentals of utilizing data still apply.

Using the right data at the right time can help a hospital improve efficiency, effectiveness, care, Press Gainey survey scores, HEDIS ratings, team morale, the stability of its talent, as well as the predictability and sustainability of its business. The list goes on.

Which kinds of data really matter? What you really need – like Billy Beane – is actionable data.

Turning your data into information and then action is the most important aspect of using the “Moneyball” concept to drive your future success. According to Beane, “Every business has metrics that correlate to success – it’s just about finding them.” That’s what our newest acute white paper is about – helping you determine the metrics you need to not just compete, but to thrive and deliver unrivaled care.

Where to start
One of the biggest challenges people face on the use of data is where to start. With today’s technology, we can measure virtually anything and everything.

As the keepers of the financial health and stability of your organization, you need data points that give you actionable information to help you:

• Reduce denials and improve denials management
• Strengthen payor performance and profitability
• Grow revenue and profitability
• Reduce financial errors
• Understand the total length of your Revenue Cycle
• Know the repeatable core of your business and the outliers

While all healthcare organizations might have unique business challenges, there are some leading key performance indicators (KPIs) that can assuredly help you take the action you need to strengthen your organization. These KPIs are where you need to start.

Prospects
For today’s hospital or specialty hospital, understanding your prospects before they ever enter the building can be the difference between just getting by and building a sustainable operation. It’s critical for both specialty hospitals and general acute facilities to understand the populations they serve.

There are data points all around that can help you get the right prospects into your facility. This data can help you estimate how long the patient might be there, how much money you would make off their stay, and most importantly, the projected quality of their care outcomes.

Too often, organizations are not integrated enough, or at all, with referring partners – nor are they using the data available. Therefore, they are seeing poor outcomes and lost revenue before the new patient even arrives.

Make sure you have ready access to these key data points during the admissions process:

A. Payer: Validating the payer prior to admission and the type of services covered.
B. Diagnosis and any comorbidities.
C. Referring hospital/facility/community, plus your outcomes and history with them: Is your outcome success rate better with patients from one facility as compared to others? Is the information they share more accurate and detailed? This applies to employers as well for occupational health services. What are the most common population health issues in the community you serve?
D. The expected number of days the patient will be in your facility and the full and complete list of medications, treatment, and therapy required. For general acute, understanding the needs of your outpatient service population requires you pull this information from patients’ primary care home.
E. High-cost medications/High cost imaging: We recommend you double check to ensure the medications are not on the exclusion lists and confirm IV versus oral or subcutaneous and that any scheduled imaging is covered and subject to plan exclusions.

Stay tuned for parts 2 and 3 of this blog series and download the full white paper here!