Appendix C
Performance Measure Framework
and Balanced Scorecard Example
Throughout this report, the committee recognizes the need for the Department of Homeland Security (DHS) to take a strategic approach to planning for and management of workforce health protection. An important part of strategic planning is aligning activities with the department’s vision and strategy and ensuring the ability to monitor progress and adjust accordingly based on predetermined measures and metrics. Although the committee recognizes that there are multiple approaches DHS can take to these ends, this appendix provides as an example the performance measure framework and balanced scorecard currently used by the U.S. Coast Guard1 for tracking progress on strategic goals and objectives and for accountability purposes. Ultimately, the committee believes DHS will be in the best position to determine which approach to take and what metrics to use.
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1USCG (U.S. Coast Guard). 2011. Office of health services strategic plan (2011-2015). Washington, DC: USCG.
Performance Measure Framework
Measurement Focus
In light of these major initiatives the following information is intended to provide a framework to monitor success as this Strategic Plan is carried out, enabling value creation opportunities and building momentum toward organizational excellence. Notes are provided in parenthesis (red text) below to link them with existing measure in the Balanced Scorecard.
| Quad Aim | Strategic Imperative | Performance Measure(s) | Initiatives |
| Medical Readiness | Individual Medical Readiness Family Readiness |
Readiness compliance (S1 measure) EHR Utilization Work-Life Survey |
• Reserve Health Readiness Program (RHRP) for Periodic Health Assessment & Dental Screening for Reservists (S1 measure) • Track/identify deployment limiting conditions (S1 measure) • Patient Centered Medical Home Implementation (SG 3 measure) • Epic Electronic Health Record Implementation (SG 1,3,4,5 measures) • Work-Life Family Readiness programs |
| Healthy workforce (Psychological) | Identify % completed of post deployment health medical needs |
• Conduct/track Pre and post deployment assessments (PDHA, PDHRA) (S2 measure) • Others to be developed • Operational Stress Continuum adoption (SG 1 measure) |
|
| Population Health | Engaging workforce in healthy behaviors | Influenza management Adopt HEDIS measures Percentage of population over fat |
• Maintain influenza prevention program (S1 measure) • Monitor tobacco use • Monitor weight program • Integrate health lifestyle program • HEDIS Women's health measures • Identify and prepare for other emerging health threats • Implement Population Health Portal access (IP 5 measure) • Quad Aim/PCMH - Population Health (SG 1 measure) |
| Experience of Care | Evidence-based care 24/7 access to your team (C2 measure) |
Enrollee Preventive Health metric HEDIS Index Internal/external EPIC/MRRS Number of referrals by clinic provider (F1 measure) External Accreditation (C3 measure) |
• Develop system wide policy for access to Medical Home • Effective Appointment template Management (F1 measure) • Monitor Medical Home initiative • Identify elements of patient behavior, e.g. primary & specialty care visits per member per year • Adopt NCQA Certification of Medical Home (tentative) |
| Case Management Personal relationship with your provider |
Effectiveness of care for complex Med/Social problems Satisfaction with health care (C1 measure) |
• Continue Patient Satisfaction Survey and Peer Review; medical Encounter Review System (MERS) (S3, C1, IP3 measures) • Implement Medical Home • Continue HSWL SC Case Management Program |
| Strategic Imperative | Performance Measure(s) | Initiatives | |
| Per Capita Cost (Responsible Stewardship) | Optimize all product lines by using standard business planning processes | CG-11/HSWL Budget Execution/Performances Enrollment utilization of ER services Reduce PMPM costs for healthcare Identify provider excess capacity for reallocation of responsibilities |
• Approval of clinic business plan submission • Maximize opportunities to identify and implement solutions that gain efficiency • Develop/implement staffing standard (R3 measure) • Ensure AFC-57 FRMM Compliance (R1 measure) • Adhere to AFC-57 Budget Model |
| CFO Act compliance | Achieve Audit Compliance in Financial Processes (F2 measure) |
• Complete Electronic billing MOU with DoD • Achieve MERHCF billing (F1 measure) • Achieve OHI Billing Capability (F1 measure) • Resolve weaknesses identified within DoD MTF claims processing • Identify and counter internal weaknesses in business processes (F2 measure) |
|
| Learning & Growing | Functional EHR | Implementation of CG EHR (IP7 measure) Provider satisfaction with EHR |
• Sustain EHR • Maintain HIPAA Compliace • Conduct MIS Program Review Board • Enhance Coding Accuracy • Conduct periodic Staff Satisfaction surveys |
| Using research to improve performance | Product and Product Services |
• Implement an in-house IRB |
|
| Fully capable CG workforce | Complete EHR Training |
• Monitor training database (IP4 measure) • Track organizational competency development • Complete Health Service Corps Analysis • Identify IT enhancements to support provider effectiveness • Improve deployment capability for contingency response • Add professional training courses |
Balanced Scorecard
Balanced Scorecard
The balanced scorecard is a strategic planning and management tool that is used to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organization performance against strategic goals. The balanced scorecard suggests that we view the organization from four perspectives, and to develop metrics, collect data and analyze it relative to each of these perspectives:
The Learning & Growth Perspective
This perspective includes employee training and corporate cultural attitudes related to both individual and corporate self-improvement. In a knowledge-worker organization, people -- the only repository of knowledge -- are the main resource. In the current climate of rapid technological change, it is becoming necessary for workers to be in a continuous learning mode. Learning and growth constitute the essential foundation for success of any knowledge-worker organization.
The Business Process Perspective
This perspective refers to internal business processes. Metrics based on this perspective allow us to know how well the business activities are running, and whether our products and services conform to customer requirements (the mission).
The Customer Perspective
Recent management philosophy has shown an increasing realization of the importance of customer focus and customer satisfaction in any business. These are leading indicators: if customers are not satisfied, they will eventually find other suppliers that will meet their needs. Our healthcare delivery system must adhere to the same principles to satisfy beneficiaries and to develop processes that are efficient and effective.
The Financial Perspective
Timely and accurate funding data will always be a priority, and we must do whatever is necessary to provide it. With the implementation of the Epic® Electronic Medical Record, standardized business planning and other initiatives, it is hoped that more of the processing can be centralized and where possible automated. There is a major organizational emphasis on financials to maintain the ability to meet operational mission requirements. There is a need to include additional financial-related data, such as risk assessment and cost-benefit data, in this category
The following two sections seek to: (1) provide some clarity on measures being developed and how the intersect with the Balanced Scorecard perspectives, and (2) provide a visual Strategy Map to help illustrate how our activities are influenced within the perspectives.
Measures of Primary Emphasis
| Balanced Scorecard Perspectives | Strategic Goal 1 Provide for a Medically Ready & Protected Coast Guard Active Duty & Reserve Member Workforce | Strategic Goal 2 Maintain & develop an operational response capability & operationally ready Coast Guard Medical Force | Strategic Goal 3 Provide quality, accessible & efficient care | Strategic Goal 4 Create Chief Financial Officer (CFO) compliant Coast Guard Health Care Financial Management System and an overall increased emphasis on business planning for the Coast Guard’s Organic Health Care Delivery System | Strategic Goal 5 Achieve full operational capability & modernization of Coast Guard Mission Support |
| Customer Perspectives | Readiness Compliance Internal/external EPIC/MRRS Percentage of population over fat |
Deploy with CG and DoD assets in training environments | Satisfaction with health care Number of referrals by clinic provider |
Staffing Standard | Patient Centered Medical Home implementation |
| Internal Process Perspective | Post deployment health medical needs Enrollee Preventive Health metric MRRS/CGBI data feeds, monitoring, and communication |
Track and manage CG/DoD deployments to ensure breadth of knowledge across the organization | Work-Life Survey Effectiveness of care for complex Med/Social problems HEDIS Index Adopt HEDIS measures HSWL SC HPAP surveys |
External Accreditation (AAAHC/NCQA) Internal QA process (HPAP) Regional Practice Business Planning Process/Budget Build |
Influenza management PCMH/EHR Maintain achieved gains of HSWL SC implementation Leverage regional practice concept for accountability, communication, standardization |
| Learning and Growth | EHR Utilization PCMH implementation training | Implementation of CG EHR Complete EHR Training Develop Training tracking database and proactively manage training quotas | Provider satisfaction with EHR | Tracking and reconciliation of training quotas Tracking/optimizing utilization of training quotas | HSWL FO Guide/Org Man |
| Financial Perspective | Prioritize funding to Readiness programs for ensured continuity | Dedicate deployment/training quotas targeting operational experiences | Enrollment utilization of ER services | Achieve Audit Compliance in Financial Processes | CG-11/HSWL Budget Execution/Performances |
