Attending to the Business Demands of Maturing Programs RWJF/CIC Cluster Meeting Chicago, Illinois

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Examples of Challenges • Prescription Dilemma • Hospital Contributions Dilemma • Keeping Investors at the Table

9. The Prescription Dilemma • Challenge: • Increasing expenses and decreasing funding • Funding relationships remainedstrong 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

10. 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

11. Keeping Investors at the Table • Challenges: • No longer providing mutual benefits to funders • Becoming too expensive • Moving away from acutecommunity 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

12. 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

13. 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 Department’s Vision Group; Kansas Legislators • County’s request for prescription trends related to a prospective non-profit pharmacy

14. 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)

15. Share Information • 70% 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

16. 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

17. 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

18. Demonstrate Return on Investment • County’s 2004 investment for a new .75 FTE staff position will result in a $100,000 return • RWJF’s 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

19. 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

20. 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

21. Questions & Answers