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

Questions & Answers