Attending to the Business Demands of Maturing Programs

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• Attending to the Business Demands of Maturing
  Programs
• RWJF/CIC Cluster Meeting
• Chicago, Illinois
• June 5-6, 2003
• Project Access Central Plains Regional Health
  Care Foundation Wichita/Sedgwick County, Kansas

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Objectives

• Identify some of the business-related challenges
  that are likely to arise as a program matures
• Understand what it takes for a more mature
  program to continue to evolve

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Project Snapshot/Mature Programs

• Established and integrated community
  relationships
• Recognized 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

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Project Access

• Funding Partners
• United Way of the Plains-Agency Membership
• Sedgwick County and City of Wichita-Prescription
  Medication Program
• Kansas Health Foundation-Outreach and Interpreter
  Services
• Robert Wood Johnson Foundation-Increased
  Access/Infrastructure
• HRSA Community Access Program-Hospital Case
  Management Project and other specialized
  activities
• Wichita Community Foundation-Dental Care

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Project Access

• In-Kind Partners
• Medical Society of Sedgwick County
• Wichita Area SRS Office
• Physicians
• Hospitals
• Residency Programs
• Pharmacies
• Other health care providers
• Wichita District Dental Society

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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

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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

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Examples of Challenges

1. Prescription Dilemma
2. Hospital Contributions Dilemma
3. Keeping Investors at the Table

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The Prescription Dilemma

• Challenge
• 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

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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

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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 funders expertise ask for advice
• Demonstrate return on investment Use your data

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Communicate the Value Proposition

• New links to new contribution base United Way
• Physicians and hospitals taking leadership role
  in the public domain
• New available resources for SRS staff
• Local and national recognition for funders
  United Way of America
• Recognition of leaders legacies
• County Commissioner Tim Norton, City Manager
  Chris Cherches
• Meeting highest priority community needs

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Share Information

• Ask funders what kinds of information they wish
  to have tracked and reported
• Develop databases early on to facilitate
  information sharing
• Provide reports of specified data when requested
  for funders uses elsewhere
• Health Departments Vision Group Kansas
  Legislators
• Countys request for prescription trends related
  to a prospective non-profit pharmacy

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Share Information

• Since 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)

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Share Information

• 70 of MSSC physicians participate
• Primary care physicians10 patients/year
• Specialists20 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

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Demonstrate Return on Investment

• Refer to specific outcomes when discussing return
  on investment
• Examples
• 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

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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
• HRSAs 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

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Demonstrate Return on Investment

• Countys 2004 investment for a new .75 FTE staff
  position will result in a 100,000 return
• RWJFs 2003 financial investment results in new
  access points including a dental initiative to
  serve 900 to 1,800 individuals
• In 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

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Final Points

• The talents, skills and knowledge base required
  for implementing new projects are not the same
  talents as those needed to maintain mature
  projects
• Identify 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 people
• Mix maintenance activities with new growth to
  balance the full continuum

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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
  partnership
• Suggested reading First, Break All the Rules and
  Now, Discover Your Strengths by Marcus Buckingham
  and Curt Coffman

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Questions Answers