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JonathanChapmanDirector,CHCAdvisoryServicesNHCHCFallTrainingSymposium
October4,2017
HealthCenterStrong:DemonstratingHealthCarefortheHomelessValueThroughHealthCenterPerformanceandGrowthTrends
ã 2017CapitalLink 2www.caplink.org
CapitalLink- Overview• Launchedin1995,nonprofit,HRSAnationalcooperativeagreementpartner
• OfficesinCA,CO,MA,ME,MO,SCandWV
• Over$1.1billioninfinancingforover225capitalprojects- Directassistance tohealthcentersandcomplementarynonprofitorganizationsinplanningforandfinancingoperationalgrowthandcapitalneeds
- Industryvisionandleadership inthedevelopmentofstrategiesfororganizational,facilities,operationalandfinancialimprovements
- Metricsandanalyticalservices formeasuringhealthcenterimpact,evaluatingfinancialandoperatingtrendsandpromotingperformanceimprovement
ã 2017CapitalLink 3www.caplink.org
WhatDoesSuccessLookLike?
TimeandResourcestoPlan
ProductiveTeams
ImprovedandStableOperations
StaffandPatientSatisfaction
ImprovedPatientOutcomes
FinancialSustainability
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WhatDoesSuccessLookLike?
Youcan’tmanagewhatyoudon’tknowand…Youcan’tknowwhatyoudon’tmeasure
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KeyPerformanceMetricsMetric WhyThisIsImportant
1 OperatingMargin Measuringstickofyourbusinessmodel;marginstypicallysmallbutneedtobepositive
2 BottomLineMargin Isperformancedependentuponlargecapitalgrantsand/orothersourcesofnon-operatingrevenue?
3 Personnel-RelatedExpense Consumes70-75%ofbudget;keydriveroffinancialperformance
4 DaysNetPatientA/R Financialmanagementstartswithcollectingyourmoneyefficiently
5 DaysCashonHand Isthereenoughliquiditytokeepoperationsrunningsmoothly?
6 PhysicianProductivity(visits) Productivityisthebasisforrevenuegeneration
7 Mid-LevelProductivity(visits) Productivityisthebasisforrevenuegeneration
8 DentalProviderProductivity(visits) Productivityisthebasisforrevenuegeneration
*CapitalLinkPerformanceBenchmarkingToolkit
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TTBEAM!
AssessingPerformance
• TRACK
• TREND
• BENCHMARK
• EVALUATE
• ACT
• MONITOR
Revise
Reward
Review
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HRSA– SponsoredHighPerformersStudy
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HRSA-SupportedHighPerformanceStudy:Purpose
Seektoshedlighton2keyquestions:
1. Dohealthcentersthatexcelinprovidinghighqualitypatientcaredobetterorworsethanotherhealthcentersfinancially?
2. Whatdohealthcentersthatachievehighqualityandthestrongestfinancialresultslooklike?Whatdotheydodifferently/betterthantheirpeers?
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HRSA-SupportedHighPerformanceStudy:AnalyticApproach
• WestudiedacohortofHRSA2014QualityLeaderAwardees- 180healthcentersforwhichwehave4yearsofaudits
• ControlGroup:HealthcentersthatdidnotreceiveaQualityLeaderaward- 360healthcentersforwhichwehave4yearsofaudits
• Studytimeperiod:2010- 2013
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Similarities/DifferencesintheDataSet
• Patients• Urban/rurallocation• Medicaidexpansionstate(ornot)• Budgetsizeandregionallocation
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Similarities/DifferencesintheDataSet
• SizeandLocation
$0
$5
$10
$15
$20
$25
$30
$35
2010 2011 2012 2013
Millions
TotalOperatingRevenue
QualityAwardees(75th)
QualityAwardees(Median)
QualityAwardees(25th)
Control(75th)
Control(Median)
QualityAwardeesmorelikelytobefromNortheast(HRSARegions1&2)andlesslikelytobefromtheSoutheast(Region4)orSouthwest(Region6)
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TotalOperatingRevenue
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
$35,000,000
$40,000,000
2012 2013 2014
HighPerformers75th
HighPerformersMedian
HighPerformers25th
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Data
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OverallFinding
Clinicalqualityandstrongfinancialperformancegohandinhand!
QualityAwardeesperformbetteronkeyfinancialratios!!
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OperatingMargin
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0%
2012 2013 2014 2015 2016
HCHGrantees- Median
NationalMedian
HighPerformersMedian
BenchmarkMedian
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DaysCashonHand
0
25
50
75
100
125
150
2012 2013 2014 2015 2016
HCHGrantees- Median
NationalMedian
HighPerformersMedian
BenchmarkMin
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Personnel-RelatedExpensesAsPercentofOperatingRevenue
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
2012 2013 2014 2015 2016
HCHGrantees- Median
NationalMedian
HighPerformersMedian
BenchmarkMax
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DaysinNetPatientReceivables
0
10
20
30
40
50
60
70
2012 2013 2014 2015 2016
HCHGrantees- Median
NationalMedian
HighPerformersMedian
BenchmarkMax
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HCHGrantees-OperatingRevenue&ExpensePerPatient
2016NationalMedians:Revenue$904;Expense$842
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2016NationalMedians:Revenue$230;Expense$214
HCHGrantees-OperatingRevenue&ExpensePerVisit
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330GrantDollarsperUninsuredPatient
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
2013 2014 2015
HCHGrantee75%
National75%
HCHGranteeMedian
NationalMedian
HCHGrantee25%
National25%
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Information
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QualityAwardeesAchieveStrongerOverallResults,Despite…
• Proportionallylessgrantfunding
• Slightlylessfavorablepayermix
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HowDoQualityAwardeesAchieveStrongerOverallResults?
• Slightlydifferentserviceandstaffingmix• Bettercollections• Higherutilization• Higherproductivity
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PayerMix:PatientsperPayerasaPercentageofTotalPatients
0%
10%
20%
30%
40%
50%
60%
2013 2014 2015 2016
HCHGranteeMedianMedicare
HCHGranteeMedianMedicaid
HCHGranteeMedianPrivate
HCHGranteeMedianSelf-Pay
NationalMedianMedicare
NationalMedianMedicaid
NationalMedianPrivate
NationalMedianSelf-Pay
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PayerMix:CollectionsperPayerasaPercentofTotalCollections
0% 10% 20% 30% 40% 50% 60% 70% 80%
2013 2014 2015 2016
HCHGranteeMedianMedicare
HCHGranteeMedianMedicaid
HCHGranteeMedianPrivate
HCHGranteeMedianSelf-Pay
NationalMedianMedicare
NationalMedianMedicaid
NationalMedianPrivate
NationalMedianSelf-Pay
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HCHGrantees- MedianGrowth
2016NationalMedian:Patients5.0%;Visits6.9%
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PhysicianVisitsperPhysicianFTE
2,500
2,750
3,000
3,250
3,500
3,750
2012 2013 2014 2015 2016
HCHGranteeMedian
NationalMedian
HighPerformersMedian
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Mid-LevelVisitsperMid-LevelFTE
2,000
2,250
2,500
2,750
3,000
3,250
3,500
2012 2013 2014 2015 2016
HCHGranteeMedian
NationalMedian
HighPerformersMedian
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Knowledge
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OtherDistinguishingCharacteristics-HighPerformers
• Evenhigherutilization
• Higherproportionofenablingservicesandstaff
• Newerfacilities
• Lowermid-leveltophysicianratio
• Heavierpediatricfocus
• Longeraveragetenureofmanagementstaff
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Conclusions
• QualityAwardeesappeartobestrongerfinanciallyprimarilydueto:- Revenuemaximization- Positiveengagementwithpatients,whichdriveshigherutilization
- Productiveteams
• HighPerformersaregoodatalltheaboveANDarestrongoncostcontrol(particularlystaffingcosts)
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DistinguishingCharacteristics–HCHGrantees
• HCHGranteeMedianisprimarilyfollowingNationalmediantrendsalthoughdoingbetterinDaysinA/R
• Havereversed2013outcomesandnowrevenuesexceedexpensesonbothpatientsandvisits
• MediansrelyonMedicaidmorethanNational
• SimilardownwardtrendasNationalinproviderproductivity
• Positivegrowthtrendswithvisitshavingagreaterincreasethanpatients
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PerformanceEvaluationProfiles(PEP)
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Value&ImpactofHealthCenters
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WhatDoesSuccessLookLike?
TimeandResourcestoPlan
ProductiveTeams
ImprovedandStableOperations
StaffandPatientSatisfaction
ImprovedPatientOutcomes
FinancialSustainability
ã 2017CapitalLink 37www.caplink.org
Wisdom
