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Attending to the Business Demands of Maturing
Programs
RWJF/CIC Cluster MeetingChicago, IllinoisJune 5-6, 2003
Project Access Central Plains Regional Health Care Foundation
Wichita/Sedgwick County, Kansas
Objectives
Identify some of the business-related challenges that are likely to arise as a program maturesUnderstand what it takes for a more mature program to continue to evolve
Project Snapshot/Mature Programs
Established and integrated community relationshipsRecognized in the community Unique operations and areas of expertise Have met early program goals Developing and meeting long-term program goals
Established funding and financing strategies A set operating budget Short-term and long-term funders Building on successful funding relationships to
recruit new partnerships
Project AccessFunding Partners
United Way of the Plains-Agency MembershipSedgwick County and City of Wichita-Prescription Medication ProgramKansas Health Foundation-Outreach and Interpreter ServicesRobert Wood Johnson Foundation-Increased Access/InfrastructureHRSA Community Access Program-Hospital Case Management Project and other specialized activitiesWichita Community Foundation-Dental Care
Project AccessIn-Kind Partners
Medical Society of Sedgwick CountyWichita Area SRS OfficePhysiciansHospitalsResidency Programs PharmaciesOther health care providersWichita District Dental Society
Business-related Challenges
Internal and external changes Changing course to alter the path Outside forces requiring flexibility and
adaptability including a changing health care market and changing funding patterns
Remaining entrepreneurial/Future planning Meeting core objectives Designing new program areas Staying out in front of the community needs
Business-related Challenges
Understanding what it takes for a more mature program to continue to evolve Testing new operations and streamlining
standardized operations to keep things simple Measuring outcomes and tracking success and
mistakes Making adjustments Maintaining relationships with current
investors Identifying needs and attracting new investors
Examples of Challenges
1. Prescription Dilemma2. Hospital Contributions Dilemma3. Keeping Investors at the Table
The Prescription DilemmaChallenge: Increasing expenses and decreasing funding
Funding relationships remained strong but money is in shorter supply
Strategies: Reviewed trends (expenses and types) Identified highest prescribers Made alterations in the course
New staff position; Prescription Service Coordinator Educating physicians about prescribing behaviors
(step-therapy approaches for example) Moving to generic-only policy A future non-profit pharmacy
Hospital Contributions Dilemma
Challenge: Hospitals expressing concern about
uncompensated care
Strategies: Review data on charges, diagnoses and
procedures; share information with CEOs Consider capping number of patients served,
or alter approved services Remain committed to working out solutions Reminder about value of project to the table Whatever decisions are made, remain
engaged in the process
Keeping Investors at the Table
Challenges: No longer providing mutual benefits to funders Becoming too expensive Moving away from acute community needs Losing the relationship
Strategies: Build and maintain relationships on multiple levels Communicate the value proposition Provide accurate, timely responses; honor your
commitments Share information Consult funder’s expertise; ask for advice Demonstrate return on investment; Use your data
Communicate the Value Proposition
New links to new contribution base; United WayPhysicians and hospitals taking leadership role in the public domainNew available resources for SRS staffLocal and national recognition for funders; United Way of AmericaRecognition of leaders’ legacies County Commissioner Tim Norton, City
Manager Chris CherchesMeeting highest priority community needs
Share Information
Ask funders what kinds of information they wish to have tracked and reportedDevelop databases early on to facilitate information sharingProvide reports of specified data when requested for funders’ uses elsewhere Health Department’s Vision Group; Kansas
Legislators County’s request for prescription trends
related to a prospective non-profit pharmacy
Share InformationSince September 1, 1999:
4,050 new patients have been enrolled
Value of donated medical care = $22,017,196 Hospitals: $15,225,274 Physicians: $6,791,922 Additional labs, ambulatory surgery centers,
and other ancillary services
Prescription medications purchased with City and County funds: $1,418,760 (61,829 prescription claims processed)
Share Information70% of MSSC physicians participate Primary care physicians=10 patients/year Specialists=20 patients/year 139 primary care physicians 398 specialist physicians 50 physicians donate time in community clinics
All area hospitals participate
69 pharmacies fill prescriptions at 15% below AWP and do not charge filling fees
Provide additional information in an annual evaluation report and specialized report requests; Make reports available on Web site
Demonstrate Return on Investment
Refer to specific outcomes when discussing return on investmentExamples: 6-point improvement of health status measured with
pre and post administered SF-8 survey Cost savings to community of $10 million by
coordinating patients’ care Patient satisfaction surveys:
94% of patients report being “very satisfied” or “satisfied” with Project Access
Highest satisfaction relates to Rx program Physician satisfaction surveys:
85% of physicians report being “very satisfied” or “satisfied” with Project Access
Demonstrate Return on Investment
HRSA/CAP-funded hospital emergency department case management project 608 patients served in intensive case
management project SF-8 results show early success in increasing
health status Early success in improving patients’ perceived
locus of control over health conditions HRSA’s investment has resulted in $1.1 million
savings in charge avoidance, a 69.1% reduction in utilization of area EDs and established medical homes for patient
Demonstrate Return on Investment
County’s 2004 investment for a new .75 FTE staff position will result in a $100,000 returnRWJF’s 2003 financial investment results in new access points including a dental initiative to serve 900 to 1,800 individualsIn 2002, the United Way of the Plains’ $180,000 annual investment in coordinating a system of voluntary medical care yielded $6,656,282 in donated care for patients
Final Points The talents, skills and knowledge base required for implementing new projects are not the same talents as those needed to maintain mature projectsIdentify people within your staff and across the larger community partnership who can start projects and those who can maintain them; these are not the same peopleMix maintenance activities with new growth to balance the full continuum
Final Points
Delegate, assign and entrust roles and responsibilities to people with the appropriate talents, knowledge base and skills to complete the tasks required to be a successful community partnershipSuggested reading: First, Break All the Rules and Now, Discover Your Strengths by Marcus Buckingham and Curt Coffman