2010 UBO/UBU Conference

Title: MEPRS Strategic Plan Update

Session: W-4-0800

Objectives

Gain an understanding of the MEPRS Strategic Plan Become familiar with the purpose, process and

components of the MEPRS Annual Operational Plan Gain an understanding of how the MEPRS Strategic

Plan supports the MHS Strategic Plan

2

Overview

What Is a Strategic Plan? About the MEPRS Strategic Plan

– Conceptual Framework– Goals– Annual Operational Plan

MEPRS Strategic Plan Supports Quadruple Aim

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What Is a Strategic Plan?

A Strategic Plan is … A process Used to focus / guide an organization A map leading to a desired state

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5

MEPRS Policy & Business Rules Oversight

MEPRS Management Improvement Group (MMIG)– Established in 1999– Provides Functional Oversight– Tri-Service Integration, Standardization and

Compliance—now includes JTF CAPMED representatives

– Automated Information System Oversight– Coordinates Policy / Action with Resource

Management Steering Committee (RMSC)– Meeting Minutes and Information on

www.meprs.info

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TMA P

rogr

am

Offi

ces

(DH

IMS

/ DH

SS) Chartered W

orkgroups

(UBU / UBO)

HA / TMA Directorates

MMIG

MEPRS Policy & Business Rules Oversight

MEPRS Strategic Plan

7

MHS-MEPRS Execution Model

MEPRS Strategic Plan

8

Conceptual Framework for An Integrated Cost System

Experience and research show the Military Health System (MHS) has struggled to effectively use its only managerial cost accounting system to support a variety of external reporting and managerial requirements. This conceptual framework for evolving the Expense Assignment System (EAS) to better support a comprehensive integrated cost accounting system for the MHS is predicated on improving the current system to meet the three fundamental information requirements of any cost accounting system. This model is an adaptation of Kaplan’s Four Stage Cost Model1 which begins with data quality and ends with a fully integratedcost system. Instead of employing the linear construct used by Kaplan, our model emphasizes that evolution can be non-linear meaning one stage does not have to be completed prior to progressing to the next and that modifications affecting one stage can have profound effects on the other three stages. The greatest benefit of this model is its flexibility in supporting enhancements as small as updating an algorithm or as large as implementing multiple costing systems if needed to meet diverse user needs.

1Finkler, Steven A., Ward, David, and Baker, Judith J. Essentials of Cost Accounting for Health Care Organizations. 3rd Ed. Sudbury, MA: Jones and Bartlett Publishers, Inc., 2007.

EASInformation for Financial Statements

Information for Management

Decisions

Information to Motivate and Evaluate

Managers

Exte

rnal

Report

ing

Data Quality

Innovatio

n an

dM

anage

rial Rele

vance

Integrated Cost System

MEPRS Strategic Plan

“LEARNING AS WE GROW”

Process

Why a Strategic Plan?– MHS Strategic Plan, MMIG Charter, Last Plan 2006

Who was involved?– MMIG, Senior MHS Stakeholders (PPS, MERHCF…)

How was the plan developed?– Identified goals, objectives and initiatives– Categorized each objective based on priority– Selected initiatives for the FY11 Operational Plan

What is the expected outcome?– Our work will support Efficiencies, Compliance, and Cost

Measurements – Our progress will be Measurable, Accountable and Transparent

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MEPRS Strategic Plan

Goals Goal 1: Enhance data quality by systematically

eliminating data compilation errors. Goal 2: Sustain and enhance Tri-Service data uniformity,

integrity, consistency and compliance with DoD MEPRS policy.

Goal 3: Transform MEPRS to produce managerially relevant data to support the MHS Strategic Goals and Senior MHS Stakeholders' operational objectives.

Goal 4: Support financial reporting and product cost management through linked databases.

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MEPRS Strategic Plan

FY11 Operational Plan – Score Card

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MEPRS Strategic Plan

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MHS Strategic Plan

The Quadruple Aim

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ReadinessEnsuring that the total military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions.

Experience of CareProviding a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always of the highest quality.

Population HealthReducing the generators of ill health by encouraging healthy behaviors and decreasing the likelihood of illness through focused prevention and the development of increased resilience.

Per Capita CostCreating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity.

MEPRS Supporting Quadruple Aim

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MEPRS Supporting Quadruple Aim

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MHS Quadruple Aim

• Readiness: Ensuring that the total military force is medically ready…• Experience of Care: Providing a care experience that is patient and family centered…• Population Health: Reducing the generators of ill health by encouraging healthy

behaviors…• Per Capita Cost: Creating value …quality, eliminating waste, and reducing unwanted

variation…

Patient Centered Medical Home Policy

Memo, Sep 2009

• Supersedes Individual Assignments to PCM By Name Policy Memo• Implements PCMH model of primary care delivery for the MHS• Improves Continuity of Care/enhances access through patient-centered care• Improves outcomes, reduced mortality, fewer admissions, and lower utilization• Cornerstone of PCMH implementation

Use of 4th-Level MEPRS Code per PCMH TEAM, Feb

2011

• Unique 4th Level Per PCMH Team…Key pillar to analyzing team performance• Enables MHS to measure all aspects of PCMH• Consistent manner and allow for studying variation within each MTF and the MHS• Requires more granular dataset based on MEPRS “Chart of Accounts”

• 4th Level codes will populate Team data across MHS Automated Info Systems (AIS): EAS, DMHRSi, DMLSS, CHCS/AHLTA

• Data will be viewed in multiple MHS data repositories for performance benchmarking and analyses

PCMH-MEPRS Interactive Way Forward

“LEARNING AS WE GROW ”

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Fiscal Month

Skill Type Code

Skill Type Suffix Description

Service Occupation Description BGZA - Green BGZB - Blue BGZC - Gold

02 1 Intern-Medical FAMILY PRACTICE, GENERAL 0.1

GENERAL MEDICINE 0.4 0.3 0.4

Physician FAMILY PRACTICE, GENERAL 0.6 0.6 0.8

MEDICAL OFFICER 0.5 0.5 1.1

Resident-Medical FAMILY PRACTICE, GENERAL 0.5 0.7 0.5

GENERAL MEDICINE 0.1 0.0

2 All Others in Skill Type 2 CLINICAL PSYCHOLOGY 0.3 0.2 0.2

PHARMACIST-CIVILIAN 0.3 0.3 0.3

Clinical Nurse Specialist RN CLINICAL SPECIALIST-CIV 1.3 0.1 0.1

Nurse Practitioner FAMILY NURSE PRACTITIONER 0.1 1.2 0.9

NURSE PRACTITIONER-CIV 1.8 0.6

Occ Health Nurse (Cred) OCCUPATIONAL HEALTH RN-CIV 0.9

Total Providers 6.6 4.5 4.3

PCMH ClinicProvider Detail

EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02

EASIV PCMH PROVIDER DETAIL – FY11/FM02

4th-Level FCC

4th Level FCC Description

Performance Metric Oct Nov Dec

BGZA MED HOME GREEN CLINIC Total Expenses $203,558 $316,384 $297,837 Total Visits 7 1,742 1,712 Personnel Direct Expense $43,601 $40,564 $38,255 Providers 6.0 6.6 5.4 Cost per Visit $29,079.73 $181.62 $173.97 Support per Provider 1.7 1.4 1.7 Admin per Provider 0.2 0.2 0.2

BGZB MED HOME BLUE CLINIC Total Expenses $177,868 $315,558 $295,463 Total Visits 3 1,689 1,589 Personnel Direct Expense $63,048 $60,567 $59,228 Providers 4.6 4.5 3.7 Cost per Visit $59,289.27 $186.83 $185.94 Support per Provider 2.3 2.4 3.5 Admin per Provider 0.1 0.1 0.1

BGZC MED HOME GOLD CLINIC Total Expenses $161,599 $314,590 $347,146 Total Visits 1 1,552 1,833 Personnel Direct Expense $63,228 $55,041 $57,598 Providers 4.6 4.3 3.6 Cost per Visit $161,598.50 $202.70 $189.39 Support per Provider 2.0 2.4 4.0 Admin per Provider 0.0 0.1 0.3

EASIV PCMH MTF SUMMARY – FY11

PCMH NAVY“Learning as We Grow”

DA DB DC DH EA EB ED EE EF EG EK EL

P HARMACY SERVICE

P ATHOLOGY RADIOLOGYREHAB

SERVICESDEP RECIATION

COMMAND, MANAGEMENT,

AND ADMINISTRATION

SUP P ORT SERVICES

MATERIEL SERVICES

HOUSE-KEEP ING

BIOMEDICAL EQUIP MENT

REP AIR

AMBULATORY CARE P ATIENT

ADMIN.

MANAGED CARE

BGZA - GREEN 1,742 $37.68 $69.28 $12.55 $9.45 $0.76 $3.94 $25.57 $4.31 $0.90 $1.58 $0.34 $10.61 $4.66 $181.62

BGZB - BLUE 1,689 $47.86 $71.07 $10.83 $6.34 $0.61 $3.94 $25.00 $4.01 $0.22 $1.44 $0.35 $10.61 $4.54 $186.83

BGZC - GOLD 1,552 $47.15 $71.01 $14.96 $15.95 $1.66 $3.94 $25.85 $4.70 $0.07 $1.74 $0.38 $10.61 $4.69 $202.70

PURIFIED DIRECT

COST PER VISIT

TOTAL VISITS

4th Level Functional Cost Code

STEPDOWN EXPENSES - COST PER VISIT

TOTAL COST PER

VISIT

EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02

EASIV PCMH PROVIDER DETAIL – FY11/FM02

EASIV PCMH MTF SUMMARY – FY11

Fiscal Month

Skill Type Code

Skill Type Suffix Description

Service Occupation Description

BGAD - FAMILY

PRACTICE BLUE TEAM

BGAE - FAMILY

PRACTICE YELLOW

TEAM

BGAZ - FAMILY

PRACTICE BEHAVIORAL

HEALTH

02 1 Physician FAMILY PHYSICIAN 1.0 2.3

GENERAL PRACTICE PHYSICIAN 1.1

RESIDENCY TRAINED FLIGHT SURGEON 0.0 0.0

2 All Others in Skill Type 2 CLINICAL PSYCHOLOGIST 0.9

Nurse Practitioner CLINICAL NURSE, ADULT NURSE PRACTITIONER 0.0 0.9

CLINICAL NURSE, FAMILY NURSE PRACTITIONER 0.8

Physician Assistant PHYSICIAN ASSISTANT 1.0 2.0

Grand Total 3.9 5.1 0.9

Provider Detail PCMH Clinic

4th-Level FCC

4th Level FCC Description Performance Metric Oct Nov Dec

BGAD FAMILY PRACTICE BLUE TEAM Total Expenses $652,604 $732,245 $971,193 Total Visits 2,019 1,680 1,396 Personnel Direct Expense $140,548 $163,294 $182,997 Providers 4.8 3.9 2.6 Cost per Visit $323.23 $435.86 $695.70 Support per Provider 3.5 4.8 7.5 Admin per Provider 0.2 0.2 0.3

BGAE FAMILY PRACTICE YELLOW TEAM Total Expenses $494,571 $587,349 $630,309 Total Visits 2,644 2,433 2,323 Personnel Direct Expense $105,178 $91,328 $91,450 Providers 6.2 5.1 5.3 Cost per Visit $187.05 $241.41 $271.33 Support per Provider 2.9 3.2 3.1 Admin per Provider 0.2 0.3 0.3

BGAZ FAMILY PRACTICE BEHAVIORAL HEALTH Total Expenses $4,450 $3,939 $5,022 Total Visits 164 118 169 Personnel Direct Expense $33 $31 $31 Providers 0.9 0.9 0.9 Cost per Visit $27.13 $33.38 $29.72 Support per Provider 0.0 0.0 0.0 Admin per Provider 0.0 0.0 0.0

DA DB DC EA EB ED EE EF EG EH EK EL

P HARMACY SERVICE

P ATHOLOGY RADIOLOGY DEP RECIATION

COMMAND, MANAGEMENT,

AND ADMINISTRATION

SUP P ORT SERVICES

MATERIEL SERVICES

HOUSE-KEEP ING

BIOMEDICAL EQUIP MENT

REP AIR

LAUNDRY SERVICE

AMBULATORY CARE P ATIENT

ADMIN.

MANAGED CARE

BGAD - FAMILY PRACTICE BLUE TEAM

1,680 $236.56 $101.75 $19.37 $21.98 $5.26 $19.38 $3.90 $0.05 $3.42 $0.00 $0.03 $9.42 $14.73 $435.86

BGAE - FAMILY PRACTICE YELLOW

TEAM2,433 $58.81 $93.83 $22.35 $21.86 $5.26 $13.13 $2.63 $1.71 $2.30 $0.10 $0.03 $9.42 $9.98 $241.41

BGAZ - FAMILY PRACTICE

BEHAVIORAL HEALTH 118 $0.26 $0.00 $0.54 $0.00 $5.26 $10.08 $0.15 $0.00 $0.00 $0.00 $0.00 $9.42 $7.66 $33.38

TOTAL VISITS

PURIFIED DIRECT

COST PER VISIT

STEPDOWN EXPENSES - COST PER VISIT

4th Level Functional Cost Code

TOTAL COST PER

VISIT

PCMH AIR FORCE“Learning as We Grow”

EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02

4th Level Functional Cost

CodeDoD SEEC DoD SEEC Description Total

11.10 CIVILIAN PERSONNEL COMP $51,334

11.72 MILITARY PERSONNEL COMPENSATION $111,960

21.00 TRAVEL & TRANSPORT OF PERSONS $1,423

25.50 CONTRACT HEALTH CARE $232,494

26.15 MED/DENT SUPPLIES $209

11.10 CIVILIAN PERSONNEL COMP $26,922

11.72 MILITARY PERSONNEL COMPENSATION $64,406

25.50 CONTRACT HEALTH CARE $42,278

26.15 MED/DENT SUPPLIES $9,469

BGAZ - FAMILY PRACTICE

BEHAVIORAL HEALTH

11.10 CIVILIAN PERSONNEL COMP $31

BGAD - FAMILY PRACTICE BLUE

TEAM

BGAE - FAMILY PRACTICE YELLOW

TEAM

Closer examination of Direct Expenses suggest that Labor Expense and FTEs may not be aligned properly – affecting team-level cost per visit.

DA DB DC EA EB ED EE EF EG EH EK EL

P HARMACY SERVICE

P ATHOLOGY RADIOLOGY DEP RECIATION

COMMAND, MANAGEMENT,

AND ADMINISTRATION

SUP P ORT SERVICES

MATERIEL SERVICES

HOUSE-KEEP ING

BIOMEDICAL EQUIP MENT

REP AIR

LAUNDRY SERVICE

AMBULATORY CARE P ATIENT

ADMIN.

MANAGED CARE

BGAD - FAMILY PRACTICE BLUE TEAM

1,680 $236.56 $101.75 $19.37 $21.98 $5.26 $19.38 $3.90 $0.05 $3.42 $0.00 $0.03 $9.42 $14.73 $435.86

BGAE - FAMILY PRACTICE YELLOW

TEAM2,433 $58.81 $93.83 $22.35 $21.86 $5.26 $13.13 $2.63 $1.71 $2.30 $0.10 $0.03 $9.42 $9.98 $241.41

BGAZ - FAMILY PRACTICE

BEHAVIORAL HEALTH 118 $0.26 $0.00 $0.54 $0.00 $5.26 $10.08 $0.15 $0.00 $0.00 $0.00 $0.00 $9.42 $7.66 $33.38

TOTAL VISITS

PURIFIED DIRECT

COST PER VISIT

STEPDOWN EXPENSES - COST PER VISIT

4th Level Functional Cost Code

TOTAL COST PER

VISIT

PCMH AIR FORCE (CONT.)“Learning as We Grow”

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EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02

CHCS Workload – TOC Report – FY11/FM02EASIV PCMH MTF SUMMARY – FY11

PCMH ARMY“Learning as We Grow”

4th-Level FCC

4th Level FCC Description

Performance Metric Oct Nov Dec

BGZB AMH **** FAMILY MED Total Expenses $1,659,023 $2,215,181 Total Visits 6,062 8,128 Personnel Direct Expense $485,913 $733,673 Providers 16.5 25.8 Cost per Visit $273.68 $272.54 Support per Provider 1.8 1.6 Admin per Provider 0.5 0.5

MEPRS4 Clinic Name (Place of Care) VisitsBGZB PCMH COURAGE 1,024

PCMH OCS 46PCMH HONOR 636AMH RACH INTEGRITY 625PCMH LOYALTY 884PCMH RESPECT 742PCMH SERVICE 635

BGZB Total 4,702

Task NameTask Fcc

ProvidersSupport to Providers

Ratio

Admin to Providers

Ratio

Total FTEs

PCMH COURAGE BGZB 2.5 1.5 0.0 6.2

PCMH FM OCS BGZB 2.0 2.2 3.6 13.4

PCMH HONOR BGZB 2.0 1.8 0.0 5.4

PCMH INTEGRITY BGZB 1.5 2.5 0.0 5.4

PCMH LOYALTY BGZB 3.2 2.4 0.0 10.9

PCMH RESPECT BGZB 2.6 1.2 0.0 5.5

PCMH SERVICE BGZB 2.7 1.5 0.0 6.9

Grand Total 16.4 1.8 0.4 53.8

DMHRSi Task-Level Labor – FY11/FM02

DA DB DC DD DE DH DI EA EB ED EE EF EG EH EK EL

P HARMACY SERVICE

P ATHOLOGY RADIOLOGYSP ECIAL

P ROCEDURE SERVICES

CENT STERILE SUP P LY/MATERIEL

SERV

REHAB SERVICES

NUCLEAR MEDICINE

DEP RECIATION

COMMAND, MANAGEMENT,

AND ADMINISTRATION

SUP P ORT SERVICES

MATERIEL SERVICES

HOUSE-KEEP ING

BIOMEDICAL EQUIP MENT

REP AIR

LAUNDRY SERVICE

AMBULATORY CARE P ATIENT ADMIN.

MANAGED CARE

BGZB -- PCMH 6,062 $94.34 $85.85 $13.89 $23.75 $1.43 $0.60 $3.66 $3.12 $1.22 $19.33 $14.23 $1.72 $5.53 $0.13 $0.01 $3.64 $9.51 $281.96

TOTAL COST PER

VISIT

4th Level Functional Cost Code

TOTAL VISITS

PURIFIED DIRECT

COST PER VISIT

STEPDOWN EXPENSES - COST PER VISIT

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Summary

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What Is a Strategic Plan? About the MEPRS Strategic Plan

– Conceptual Framework– Goals– Annual Operational Plan

MEPRS Strategic Plan Supports Quadruple Aim

22

Questions?

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JTF-CAPMED-Joint Task Force National Capital Region Medical

GFEBS-General Fund Enterprise Business System

SFIS-ERPs-Standard Financial Information Structure, Enterprise Resource Planning System

DEAMS-Defense Enterprise Accounting & Management System

CHCS/AHLTA-Composite Health Care System/Armed Forces Health Longitudinal Technology Application

EAS IV Repository – Expense Assignment System IV Repository

MEWACS - MEPRS Early Warning and Control System

Six Sigma - MEPRS Management Metrics (S2M3)

EHR-WA – Electronic Health Record - Way Ahead BOXi-Business Objects XI

MERHCF - Medicare Eligible Retiree Health Care Fund

CCR-Consolidated Cost Report

PPS - Prospective Payment System PCMH – Patient Centered Medical Home

DMHRSi-Defense Medical Human Resource System-internet

DMLSS-Defense Medical Logistics Standard Support

Acronym List

Bibliography

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