Section 5: Performance Dashboards for Health-System Leadership

23.5.1 The “Why”: Beyond Anecdotes – The Imperative of Data-Driven Value Demonstration

Throughout this module, we have established the HSSP as a powerful engine for integration, compliance, collaboration, and seamless patient transitions. You, as an advanced specialty pharmacist, understand the profound clinical impact your team makes every day. You see the patient whose transplant was saved because you secured their immunosuppressants before discharge. You hear the relief in a provider’s voice when you resolve a complex PA in hours instead of weeks. You know, intuitively, that your HSSP is adding immense value.

Unfortunately, intuition and anecdotes do not secure budgets, justify staffing requests, or earn a seat at the strategic table. Health system leadership—the C-Suite (CEO, CFO, COO, CNO, CMO)—operates in a world of finite resources, competing priorities, and relentless financial pressure. They speak the language of data, metrics, and return on investment (ROI). To champion your HSSP, ensure its sustainability, and advocate for its growth, you must learn to speak their language. You need to translate your team’s daily clinical victories into the cold, hard numbers that demonstrate unambiguous value to the organization’s bottom line and strategic goals.

This section is your masterclass in that translation process. We will dissect how to identify the Key Performance Indicators (KPIs) that truly matter to leadership, how to collect and validate the data, how to visualize it effectively in performance dashboards, and, most importantly, how to craft a compelling narrative that uses this data to showcase the HSSP not as a cost center, but as a strategic asset essential to achieving the health system’s Triple Aim. Your community pharmacy experience likely involved tracking metrics like script count and wait times. Here, we elevate that skill to track metrics like 30-day readmission avoidance, therapy cure rates, and multi-million dollar revenue capture. Mastering this is the final step in becoming not just a clinical expert, but a true leader within the health system.

23.5.2 Know Your Audience: What Keeps the C-Suite Up at Night?

Before you can build an effective dashboard, you must understand the primary concerns and strategic priorities of your audience. While specific goals vary by institution, most health system leadership teams are focused on a core set of challenges:

Masterclass Table: Aligning HSSP Value with C-Suite Priorities

Your dashboard and presentations must be tailored. While the CEO needs the high-level summary of Triple Aim impact, the CFO will want to drill down into the margin analysis, and the COO will focus on turnaround times. Understanding these differing perspectives is key to effective communication.

23.5.3 The KPI Master List: Selecting the Metrics That Matter

A dashboard filled with dozens of obscure metrics is useless. The goal is to select a focused set of Key Performance Indicators (KPIs) that are SMART (Specific, Measurable, Achievable, Relevant, Time-bound) and directly reflect the HSSP’s contribution to the C-Suite’s priorities. These generally fall into several key domains:

I. Financial Performance KPIs

These answer the CFO’s primary question: “Is the HSSP financially sustainable and contributing positively to the system’s margin?”

• Total Revenue: Gross revenue generated from HSSP dispenses. Shows the overall size and growth of the business.
• Net Revenue: Gross revenue minus payer contractual adjustments (based on payer remittances). Reflects what the HSSP actually expects to collect.
• Drug Cost / Cost of Goods Sold (COGS): The acquisition cost of the drugs dispensed.
• Gross Margin ($ and %): Net Revenue – COGS. The core measure of profitability before operating expenses. Tracking GM % by payer or drug category is crucial.
• 340B Savings Impact ($): Calculated savings generated by purchasing drugs at 340B price vs. WAC/GPO. This demonstrates the direct financial benefit of the 340B program attributed to the HSSP’s activity.
• Operating Expenses ($): Salaries, benefits, supplies, licenses, software, overhead allocation.
• Net Margin / Contribution Margin ($ and %): Gross Margin – Operating Expenses. The HSSP’s “bottom line” contribution to the health system.
• Payer Mix (%): Breakdown of revenue/prescriptions by payer type (Commercial, Medicare Part D, Medicaid MCO, Medicaid FFS). Essential for understanding profitability drivers and risks.
• Cost Avoidance ($ – Estimated): Calculated savings from prevented ER visits, hospital readmissions, or other adverse events attributed to HSSP interventions. (Requires sophisticated modeling but is highly impactful).

II. Operational Efficiency KPIs

These answer the COO’s primary question: “Is the HSSP running smoothly and efficiently?”

• Total Prescriptions Dispensed: Overall volume metric.
• New Patients Started: Measures growth and ability to onboard new therapies.
• Turnaround Time (TAT) – Overall Referral-to-Dispense: Average time (in days) from HSSP receiving a referral to the first fill being dispensed. A core measure of speed and efficiency.
• TAT – Sub-metrics:
  • Referral Triage Time: Time from Rx received to BI initiated.
  • PA Approval Time: Time from PA submission to approval.
  • Dispense Time: Time from financial clearance to drug dispensed/delivered.
• Call Center Metrics (if applicable):
  • Average Speed to Answer (ASA): How quickly calls are answered.
  • Abandon Rate: % of callers who hang up before being answered.
  • First Call Resolution: % of issues resolved on the first call.
• Dispensing Accuracy Rate: % of dispenses with no errors (wrong drug, dose, patient, directions). Should be >99.9%.
• Inventory Turns: How quickly inventory is sold (COGS / Average Inventory). Measures inventory management efficiency. Higher turns = less capital tied up.

III. Clinical Quality & Outcomes KPIs

These answer the CMO’s and CNO’s primary question: “Is the HSSP improving patient care and safety?”

• Adherence Rate (Proportion of Days Covered – PDC): % of days the patient had the medication available, calculated over a defined period (e.g., 90 or 365 days). Target >90% for most specialty meds. Compare HSSP vs. external SP data if possible.
• Therapy Completion / Cure Rate: For curative therapies like Hepatitis C (SVR-12 rate) or certain oncology regimens.
• Clinical Monitoring Interventions: Number of pharmacist interventions documented in the EMR related to safety (e.g., dose adjustments for renal/hepatic function, DDI management, holding therapy for infection) or efficacy (e.g., recommending dose increase for sub-therapeutic levels).
• Side Effect Management Interventions: Number of interventions related to managing medication side effects (e.g., recommending antiemetics, dose reductions, patient counseling).
• Admission / ER Visit Avoidance Rate (Disease-Specific): For target populations (e.g., MS, RA, Transplant), track the rate of disease-related hospitalizations/ER visits among HSSP-managed patients compared to a baseline or external SP cohort. (Requires EMR data linkage).
• REMS Compliance Rate: % of patients meeting all requirements for specific REMS programs.

IV. Patient & Provider Satisfaction KPIs

These answer the CEO’s, CNO’s, and CMO’s question: “Are our patients and providers happy with this service?”

• Patient Satisfaction Score: Overall satisfaction rating from patient surveys (e.g., scale of 1-5, or Net Promoter Score – NPS).
• Qualitative Patient Feedback / Testimonials: Collect direct quotes highlighting positive experiences.
• Provider Satisfaction Score: Overall satisfaction rating from provider surveys (focus on ease of use, communication, clinical support).
• Qualitative Provider Feedback: Direct quotes or feedback from clinic meetings.
• Referral Leakage Rate: % of eligible specialty prescriptions originating within the health system that are sent to external specialty pharmacies instead of the HSSP. A high leakage rate often indicates provider dissatisfaction or workflow barriers.

V. Growth & Capture KPIs

These answer the CEO’s and CFO’s question: “Is the HSSP growing and maximizing its potential within our system?”

• New Patient Growth (%): Month-over-month or year-over-year growth in new patients served.
• Prescription Volume Growth (%): Growth in total prescriptions dispensed.
• Capture Rate (%): The % of all eligible specialty prescriptions written within the health system that are filled by the HSSP. This requires comparing HSSP dispense data against system-wide prescribing data (often from EMR). This is a crucial measure of market penetration *within* the IDN.
• Patient Retention Rate (%): % of existing HSSP patients who remain with the HSSP over a defined period (e.g., 1 year). Measures patient loyalty and effectiveness of clinical programs.

23.5.4 Data Sources & Integrity: Garbage In, Garbage Out

Identifying the right KPIs is step one. Step two is figuring out how to collect accurate, reliable data for each metric. This often requires pulling information from multiple, disparate systems and ensuring the data is clean and consistent. A dashboard built on flawed data is worse than no dashboard at all—it leads to incorrect conclusions and poor strategic decisions.

Masterclass Table: Mapping KPIs to Data Sources

23.5.5 Building the Dashboard: Visualization & Tools

Once you have clean data, the next step is presenting it in a way that is clear, concise, and immediately understandable. A wall of numbers in a spreadsheet is not effective communication. A well-designed dashboard uses visual elements to tell a story at a glance.

Dashboard Design Principles

• Audience First: Design for the C-Suite. High-level summaries first, with the ability to drill down if needed. Focus on trends and key takeaways, not raw data dumps.
• Keep It Simple (KISS): Avoid clutter. Use clear labels, consistent colors, and ample white space. Each chart or graph should convey one key message.
• Use the Right Visual for the Data:
  • Line Charts: Best for showing trends over time (e.g., monthly revenue, adherence rate).
  • Bar Charts: Best for comparing categories (e.g., revenue by payer, capture rate by clinic).
  • Pie Charts: Use sparingly, only for showing parts of a whole (e.g., payer mix percentage). Avoid if more than 5-6 categories.
  • KPI Cards/Gauges: Excellent for highlighting single, critical metrics with status indicators (e.g., current TAT vs. goal).
  • Tables: Good for displaying precise values or detailed breakdowns, but use formatting (like heatmaps) to make them scannable.
• Provide Context: Numbers are meaningless without context. Always include:
  • Targets/Goals: Is performance good or bad relative to expectations?
  • Benchmarks: How does performance compare to previous periods (e.g., vs. last month, vs. last year) or external standards?
  • Trends: Use arrows (up/down/neutral) and color-coding (Green=Good, Red=Bad, Yellow=Warning) to indicate performance direction.
• Tell a Story: Organize the dashboard logically. Start with a high-level summary (Financials, Key Outcomes), then allow drill-downs into operational or clinical details. Use headings and brief annotations to guide the viewer.

Example Dashboard Layout (Conceptual Mockup using Tailwind)

Imagine a web-based dashboard viewed by the CFO:

Common Dashboarding Tools

• Business Intelligence (BI) Platforms (Most Powerful): Tableau, Microsoft Power BI, Qlik Sense. These tools connect directly to multiple data sources (EMR, dispensing system, finance), allow complex data modeling, and create interactive, web-based dashboards. They require specialized analyst support but offer the most robust capabilities.
• Microsoft Excel (Most Common): Can be used for basic dashboards, especially for smaller HSSPs. Requires manual data export/import and is less interactive, but is widely available and understood. Power Query and Pivot Charts enhance its capabilities.
• EMR-Integrated Dashboards (e.g., Epic Reporting Workbench/Radar): If using a Level 3 system like Epic Willow, you can often build dashboards directly within the EMR using its native reporting tools. This leverages real-time data but may be less visually flexible than dedicated BI platforms.

23.5.6 Analyzing & Interpreting KPIs: Beyond the Numbers

Collecting and displaying data is only the beginning. The real value comes from analysis and interpretation. What does the data actually *mean*? What story is it telling? What actions should be taken based on these insights? As an HSSP leader, you need to be the chief interpreter.

The Analyst’s Toolkit: Techniques for Interpretation

• Trend Analysis: Don’t just look at a single data point. How has the KPI changed over time (month-over-month, quarter-over-quarter, year-over-year)? Is performance improving, declining, or stable? What internal or external factors might be driving the trend?
  • Example: “Our Turnaround Time increased by 1 day this quarter. Why? Let’s drill down. Ah, the PA approval time sub-metric spiked. Was there a major payer policy change or staffing issue in the BI team?”
• Benchmarking: How does your performance compare?
  • Internal Benchmarking: Compare performance across different HSSP teams, clinics, or disease states within your own system.
  • External Benchmarking: Compare your KPIs to industry standards (e.g., from URAC/ACHC data, published literature, or benchmarking collaboratives like Vizient). Be cautious, as definitions must align.
  • Goal-Based Benchmarking: Compare performance against pre-defined internal targets or Service Level Agreements (SLAs).
  • Example: “Our overall PDC for inflammatory conditions is 92%, which exceeds the industry benchmark of 88% and our internal goal of 90%. However, our PDC for the downtown clinic is only 85%. Let’s investigate workflow or patient population differences at that site.”
• Segmentation / Drill-Down Analysis: Break down high-level KPIs into more granular segments to pinpoint root causes.
  • Example: “Our overall Gross Margin % dropped by 2%. Let’s segment by payer. Ah, the margin for Payer X dropped significantly, while others remained stable. Did Payer X change their reimbursement rates, or did our mix of drugs shift for that payer?”
• Correlation Analysis (Use with Caution): Explore potential relationships between different KPIs. Does higher adherence correlate with lower hospital admissions? Does faster TAT correlate with higher provider satisfaction? (Correlation does not equal causation, but can suggest areas for investigation).
• Qualitative Overlay: Numbers don’t tell the whole story. Overlay quantitative KPI data with qualitative insights from patient surveys, provider feedback, and staff huddles to get a complete picture.
  • Example: “Our Patient Satisfaction score dipped slightly this month, even though our TAT improved. Reviewing the comments, several patients mentioned confusion about delivery scheduling. Let’s revisit our communication script for delivery confirmation.”

23.5.7 Presenting to the C-Suite: Crafting Your Value Narrative

You have the data. You’ve analyzed it. Now comes the crucial final step: presenting it effectively to health system leadership. This is your opportunity to secure resources, gain strategic alignment, and solidify the HSSP’s position as a vital asset. Remember the investor pitch deck analogy – you need a clear, concise, compelling story backed by data.

Masterclass Tutorial: The C-Suite Presentation Playbook

Structure your presentation (e.g., quarterly business review) logically:

1. Executive Summary (1 Slide – The “Elevator Pitch”): Start with the punchline. Highlight 2-3 key achievements and 1-2 key challenges/opportunities. Use impactful visuals (KPI cards). Answer the question: “How did the HSSP perform this quarter, and why should I care?”
   • Example: “HSSP delivered strong Q3 results, exceeding revenue targets by 5% and contributing $1.1M in 340B savings. Our SMTB program reduced therapy-related readmissions by an estimated $250k. Key focus for Q4 is improving TAT, currently impacted by Payer X PA delays.”
2. Financial Performance (1-2 Slides – The CFO Focus): Show key financial trends (Revenue, Gross Margin, 340B Impact). Use line/bar charts. Clearly explain any significant variances (positive or negative) and the drivers behind them.
   • Focus: Demonstrate financial contribution and sustainability.
3. Operational Performance (1 Slide – The COO Focus): Highlight key efficiency metrics (TAT, Call Center, Capture Rate). Use KPI cards with trends/targets. Briefly explain any initiatives underway to address operational challenges (e.g., “Implementing new PA software to reduce approval times”).
   • Focus: Demonstrate efficiency, scalability, and continuous improvement.
4. Clinical Quality & Outcomes (1-2 Slides – The CMO/CNO Focus): Showcase your impact on patient care (Adherence, Cure Rates, Readmission Avoidance, Safety Interventions). Use clear visuals and link outcomes back to cost savings where possible. Include a compelling patient testimonial (anonymized).
   • Focus: Demonstrate contribution to quality, safety, and the “Better Health” aim.
5. Patient & Provider Satisfaction (1 Slide – The CEO/CMO/CNO Focus): Present key satisfaction scores and trends. Highlight initiatives based on feedback. Address referral leakage data and strategies to improve internal capture.
   • Focus: Demonstrate contribution to the “Better Care” aim and provider alignment.
6. Strategic Initiatives & Future Focus (1 Slide – The CEO Focus): Briefly update on key projects (e.g., new clinic integrations, technology implementations, expansion plans). Outline key priorities and expected impact for the next quarter/year.
   • Focus: Demonstrate strategic alignment and future vision.
7. The “Ask” (If Applicable): If you need resources (staff, budget, technology), clearly state the request, the justification (linked back to specific KPIs/goals), and the expected ROI.
   • Example: “To improve TAT and provider satisfaction, we request one additional FTE for the BI/PA team. This $80k investment is projected to reduce PA delays by 1 day and increase capture rate by 5%, generating an estimated $300k in additional annual margin.”
8. Summary & Questions (1 Slide): Briefly reiterate key takeaways.

23.5.8 Challenges, Pitfalls, and Troubleshooting in HSSP Reporting

Building and maintaining a robust HSSP reporting program is not without its challenges. Anticipating these hurdles is key to creating a sustainable and credible system.

Common Reporting Challenges & Solutions

23.5.9 Section Summary & Key Takeaways

Demonstrating value through data is not a task for the HSSP; it is a core function and a strategic imperative. By mastering the selection, collection, analysis, and presentation of key performance indicators, HSSP pharmacists and leaders can effectively communicate their impact in the language of the C-Suite, securing the resources and strategic alignment necessary for long-term success.

• Speak C-Suite: Translate clinical activities into data focused on financial performance, operational efficiency, quality outcomes, and strategic alignment (Triple Aim).
• Select SMART KPIs: Choose a focused set of metrics covering Financial, Operational, Clinical, Satisfaction, and Growth domains. Identify your 3-5 “North Star” KPIs.
• Data Integrity is Crucial: Map KPIs to reliable data sources and implement rigorous validation processes. Garbage in, garbage out.
• Visualize Effectively: Use clear, simple dashboards with appropriate charts (lines for trends, bars for comparison) and context (targets, benchmarks, trends).
• Analyze, Don’t Just Report: Interpret the data, understand the drivers behind trends, and identify actionable insights.
• Craft a Compelling Narrative: Structure presentations logically, lead with conclusions, focus on impact, and be prepared to defend your numbers.
• Overcome Challenges: Proactively address data silos, inconsistent definitions, attribution issues, and resource limitations.

By becoming fluent in the language of data and performance reporting, the advanced specialty pharmacist transforms from a clinical expert into a strategic leader, capable of articulating and proving the HSSP’s indispensable role within the modern health system.