health center strongcouncilbackup.flywheelsites.com/wp...hch...trends.pdf · through health center...

ã 2017CapitalLink 1www.caplink.org

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?

ã 2017CapitalLink 9www.caplink.org

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)

ã 2017CapitalLink 12www.caplink.org

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

ã 2017CapitalLink 16www.caplink.org

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

ã 2017CapitalLink 32www.caplink.org

Conclusions

• QualityAwardeesappeartobestrongerfinanciallyprimarilydueto:- Revenuemaximization- Positiveengagementwithpatients,whichdriveshigherutilization

- Productiveteams

• HighPerformersaregoodatalltheaboveANDarestrongoncostcontrol(particularlystaffingcosts)

ã 2017CapitalLink 33www.caplink.org

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

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JonathanChapmanCapitalLink970.833.8513

jchapman@caplink.org