Business Planning for the National Capital Area July 2004

1. Business Planning for the National Capital AreaJuly 2004 Office of the Multi-Service Market Manager for the National Capital Area

2. Business Plan Efforts Outline The MSM business planning process: - Reconciliation issues FY-05 Business Plan: Four areas of emphasis Future business planning: How the process will improve

3. Modest increases in enrollment forecasted for WRAMC/MGMC/NNMC (AD/ADFMs) Market level analysis by product line completed Data errors and omissions noted and difficult to draw conclusions Difficulty in completing drill-down analysis by product line complicated effort to assess threats/opportunities at MTF level Enrollee supply/demand (who’s seeing who) not reflected consistently NCA MSM late in receiving queries to execute FY03 data pulls FY03 baseline information to be retrieved and analyzed; MTF trends (by product line) to be examined Inpatient and outpatient direct care productivity FY05-07 FTE projections relatively stable across the board FY05-07 Army/Navy no changes (+/-) identified; AF (MGMC) reductions consistent with projected downsizing

4. Encounter/access satisfaction data not reported for all MTFs Encounter/access satisfaction data not reported for all MTFs

5. FY05 Business Plan:Referral and Authorization Standardized NCA referral process Establishment of joint business process Emphasis on MTF utilization Template integration matched to NCA demand has yet to be tested (Health care delivery begins on 1 September 2004) CLN to CON Conversion Technical preparation (CHCS file & table build) Clinical preparation (MTF staff education & training) Significant variability exists in methods to result consults Administrative preparation (MTF referral center & processes) Referral visibility and analysis Optimize direct care services Effective management of purchased care Compliance with accreditation standards

6. FY05 Business Plan:Appointing NCA Call Center Workgroup established Future State – single NCA 800-Appoint with standardized protocols & roll-over capability, workload leveling, after hours coverage with close ties to integrated referral management Standup expected 01 August 04 NNMC, WRAMC, MGMC and DACH Call Center collaboration to appoint any patient to participating facilities/clinics Standardized Web Based Appointing Business Rules Common Metrics, Ongoing Process Improvement Rotating Saturday Call Center Hours Joint Contingency Plan

7. FY05 Business Plan:NCA Sub-Market Map

8. FY05 Business Plan:Sub-Markets Market Demand Population shift identified and expected to continue; economic affordability Planned decreased services at MGMC in FY 06 23,000+ eligible ADD & NADD beneficiaries south of NMCL Quantico Determine Value of Care in Southern Corridor Examine value of health care we make vice health care we purchase – both primary care and specialty care Explore Optimization Options Leverage DoD partnerships with HealthNet and VA to increase access to primary care in I-95 South, Fredericksburg, and Southeast Core sub-markets Reassign MTF Prime enrollees to new Fredericksburg clinic Backfill vacated primary care space with specialty care providers at Quantico, Woodbridge & DACH Create capacity in “new” DACH to expand medical/surgical services “Old” DACH infrastructure will create additional primary/specialty outpatient care capability

9. FY05 Business Plan:NCA Clinical Services Focusing on two clinical service lines in an effort to build and maintain clinical alignment across the market Dermatology Improve access and efficiency to care throughout NCA Optimize productivity and staff efficiencies Redistribute providers closer to patient demand Cardiovascular Decline in cardiology procedures and surgical case volume Access challenges Increased purchased care service line Transportation issues

10. Future Business Planning Efforts MTF leadership commitment to NCA MHS One Health Plan supported by one integrated health care delivery system and one integrated academic medical system Quantifying unique service readiness requirements and impact on direct care resources and sustained clinical operations Single strategic plan with emphasis on sub-market business planning MTF Service budget formulation, resource allocation and accounting Challenge for joint health care planning and delivery in a dynamic market environment NCA vice MTF-centric PPS capitation resourcing methodology