How business intelligence can improve value.

Case studies of three healthcare organizations reinforce the premise that business intelligence--the ability to convert data into actionable information for decision making--is critical to demonstrating improved value.

Measuring and monitoring IT using a balanced scorecard approach.

Ensuring that the information technology department is aligned with the overall health system strategy and is performing at a consistently high level is a priority at Saint Luke's Health System in Kansas City, Mo. The information technology department of Saint Luke's Health System has been using the balanced scorecard approach described in this article to measure and monitor its performance for four years. This article will review the structure of the IT department's scorecard; the categories and measures used; how benchmarks are determined; how linkage to the organizational scorecard is made; how results are reported; how changes are made to the scorecard; and tips for using a scorecard in other IT departments.

Strategies for multi-hospital networks: a framework.

The last two decades have seen the significant emergence of multi-hospital networks (MHNs) in the health sectors of all industrialized countries. Such networks seem to represent an organizational choice, which provides interesting opportunities to cope with cost and quality issues stressing the health field. This work proposes and discusses a framework for strategies that can be implemented by MHNs to achieve projected benefits. The estimated advantages are then weighed against unexpected or underrated drawbacks and empirical evidence. The conclusions point out MHNs as viable future alternatives for freestanding hospitals looking to improve their efficiency and financial stability, on condition that a 'proper management' of their consolidation processes is carried out. This requires extensive pre-deal analysis to critically assess what benefits could be achieved through the network's formation, as well as post-deal perseverance in implementing consolidation strategies to their full. In this perspective, specific advices apt to minimize the risk of creating MHNs in the wake of a management fashion instead of through sound rational assessments are also discussed.

Strategic service-line planning. Building competitive advantage.

Service-line planning requires a healthcare organization to develop a business plan for each of its service lines. Successful service-line planning requires top leadership support, a willingness to allocate resources, the development of support mechanisms, the active support and involvement of physicians, and management commitment and accountability during implementation.

Governance in a period of strategic change in U.S. healthcare.

The increased enrollment in managed care plans, merger mania and the development of politically and financially powerful integrated delivery systems have significantly complicated the governance of U.S. healthcare organizations. These modifications in fiscal incentives and the corporate restructuring undertaken by American health organizations has resulted in limited fiscal savings or improvements in access to care. As a result, trustees are now faced with divesting their losers, and shuttering facilities and services to reduce fixed costs. Decision-making by trustees will be further thwarted in the future by: their institutions being forced to deliver more care without a proportional increase in revenues; physicians seeking to obtain more ambulatory revenues at a hospital's expense; the inability to adequately finance mental health and long-term care services except among the wealthy; the number of divestitures increasing so that eventually the organizational focus for most IDSs will once again be on regionally oriented hospital systems; and much more difficulty being experienced in attracting sufficiently qualified personnel to deliver high quality health services. Finally, many of these findings relevant to the United States also are being shared by governing boards in Canada, Germany, The Netherlands and the United Kingdom.

Structuring a central business office to succeed in a managed care dominated environment.

Integrated delivery systems have begun to consolidate the business office functions of their member facilities in response to a decline in managed care revenues and an increase in health care expenses. Many who have pursued this strategy have experienced cost reductions through staff restructuring, but have not experienced the revenue retention, cash acceleration, and other performance gains originally envisioned. This often occurs when the role of the central business office (CBO) has been limited to serving only the "back-office" functions of claims processing. In today's health care environment, the viability of a CBO depends on its responsiveness to the administrative complexities of managed care. Successful CBOs accommodate extensive cross-functional coordination, achieve operational efficiencies through the use of automation, and adopt best practices for implementing managed care contractual obligations.

The coming millennium: enduring issues confronting Catholic health care.

Professor Singer and Ms. Johnson Lantz provide a cogent overview of Catholic health care in the United States and address the key issues affecting Catholic health care in the coming years. In particular, (1) clarity in canonical and ethical interpretation; (2) industry consolidation; and (3) "next generation" sponsorship and the impact of these issues are discussed in detail. The authors conclude that successful Catholic health care organizations must maintain strong mission and business fundamentals in an increasingly competitive reimbursement and regulatory environment.

How we moved our doctors back to market fitness.

How does an integrated health system facing market turndown and tremendous losses on its acquired physician practices get back to market sanity? That question is one that many hundreds of hospitals and health systems are trying to answer, as they attempt to disentangle themselves from physician practice purchases of the past decade that have not worked out as planned. The example of one Midwestern health system provides a classic case study in how to turn around the very common "we-bought-all-these-docs'-practices-too-high-now-what-do-we-do" scenario plaguing health systems across the country. A senior executive in charge of the physician-practices turnaround at one system spoke at length recently with Physician Performance & Payment Report about his organization's experiences and ongoing turnaround. He has asked that the name and location of the organization and his own name be obscured. Here is his organization's story.