Growth Planning: Tools and Strategies to Win the Growth Race

2. January 22, 2014 Growth Planning: Tools and Strategies to Win the Growth Race Health Choice Network Of Florida June 2014 Presented by: Terry Glasscock Senior Project Consultant

3. Growth? Why? • Congress’ own Commission on Entitlement Reform reported that SS, Medicare, Medicaid and interest on the national debt will exceed all federal income by 2030! • Annual budget fights will not resolved as long as congress is so polarized. • The longer we wait to enforce changes the more painful the results will become…in the mean time more people will fall through the cracks and into CHCs • Affordable Care Act

4. Number of Workers Per Retiree

5. Federal Receipts vs. Entitlements (As percent of GDP)

6. Federal Government Spending Medicaid Medicare S.S. 20% Medicaid Medicare S.S. 43%

7. International Monetary Fund • The United States must either decrease benefits for Medicare and Medicaid by 50% or increase taxes by 60% to maintain solvency of those programs.

8. A Race? Why? • Limited government resources (productivity becomes more important – increasing income and controlling expenses) • New payment system based on number of patients not number of visits. (Goal: more patients with fewer visits) • Accountable Care Organizations will create more powerful competition. • Affordable Care Act will change the “payer” playing field. • Demographics will slowly change both your patient mix and the type of services demanded (who will capture them – chronic v. acute) • A race against the system and against becoming irrelavent

9. We Need To Get Started

10. Who will succeed? • Successful centers will be the ones who are willing to take risk in an uncertain environment and who have a well-founded plan to manage the downside risk (ACTIVE) •  The need for rapid growth will likely advantage health centers that have already achieved a certain level of scale. •  Active smaller centers that are less sophisticated will also be trying to get in the game •  Passive centers will not succeed

11. New Management Skills Will Be Needed • The growing sophistication of the active centers will create need for learning “cutting edge” management techniques • The pressure for speed and a high level of technical knowledge will continue to grow. • Learning to manage strategically will become essential • Acquiring reliable management information for making decisions will also be essential

12. Strategic Influences (Landscape) Action Plan Demographics, Government Policy Impact Analysis What might happen What to do when it does happen Managing Strategically Self-Assessment Who you are Strengths/ Weaknesses

13. 1. Self Assessment

14. Self-Assessment • What you do • Why you do it • How you do it • What you do well • What you could do better • Operational capacity • Financial capacity • Physical capacity Who you are Strengths/ Weaknesses

15. Self-Assessment –Looking at Yourself • Mission fulfillment • Efficiency – measuring outputs • Effectiveness – measuring outcomes • Capacity – measuring capability

16. Vision • What is your collective vision of who you should be? • What could change that? • Is this a shared vision? • What are the outlier visions?

17. Mission • Is your mission consistent with your vision? • Is it focused on need, not just symptoms? • In other words, does it empower not just treat? • Does it support and derive support from like-minded organizations in your community?

18. Services • Are they focused on need? • Have needs changed? • Are they effective in filling needs? • Do they fulfill the mission? • Where are they on a mission/margin evaluation?

19. Systems • Do they work? • Do you really know how they work? • How did they evolve? • What has changed since they were first created? • Do you measure outputs or outcomes? • What happens at the “water cooler”. • Mattress Tags • Transformative systems

20. Structure • A circular organization • How close to the edges do you manage? • Organi-zation – Organism – Biological paradigm not mechanical • Creating Adjacent Possibilities through structure. • Should your structure be changed? Can it be changed?

21. Some Tools for Self-Assessment

23. Tool: Listing and Diagramming a SWOT Assessment Strengths, Weaknesses, Opportunities Threats • List your organization’s primary (program and administrative) strengths and weaknesses—internal forces working for and against your organization achieving its mission. • List your organization’s key opportunities and threats — political, economic, social, technological, demographic, or policy trends that are or may impact our organization’s ability to achieve its mission. • Draw lines connecting any opportunity or threat that may be either positively or negatively impacted by any of the organization’s strengths or weaknesses

24. Tool: Analysis of Competitive Position

25. Tool: Create a “Who’s Who” List Do you use a consultant? Who? Who makes what decisions for the organization Whether to use an existing committee or a strategic planning committee for such activities as coordinating the work and assisting with some of the planning activities (such as external stakeholder interviews, research, etc.) If using a strategic planning committee, deciding who should be on that committee. If using ad hoc task forces, deciding membership of those committees (including the decision as to whether non-board members might be on those committees) Who will be the primary writer of the plan (with guidance from a consultant if necessary) The sequencing of discussions (i.e., “do data collection first and then have a retreat” or “kick off the planning process with a board/staff retreat and then create issue-focused board/staff task forces to collect and analyze data and make recommendations to the board of directors”)

26. Tool: The Readiness Checklist

27. Tool: The Readiness Checklist

28. Tool: The Readiness Checklist

29. 2. Landscape

30. Landscaping • You can’t manage what you don’t know • What lies ahead (environmental scan) • Demographic shift (overwhelming) • Government healthcare policy • Government fiscal policy • National and global economy • Local economy • Invite stakeholders to provide input • Community • Patients, Providers, staff • Government: local, state, federal • Other social services • There is no “future” there are possible “futures” Demographics, Government Policy Result: Possibilities Inventory

31. Tool: Environmental Scan

32. Tool: Issue Identification Guide

33. Tool:Internal Stakeholder Input Guide

34. Tool: External Stakeholder Input Guide

35. 3. Impact Analysis

36. Impact Analysis Possibilities and implications • What possibilities did we find in landscaping • What are the operating and financial implications of each of those possibilities. • Listing the possibilities and the impacts on the CHC of each one • Prioritizing the probabilities • Analyzing the impact on each possibility • Capital Needs, human resources Result: Impact Catalogue

37. Tool: Impact Analysis

38. Tool: Implication Catalogue

39. 4. Action Planning

41. Action Plan • Contingencies • “What if” planning • Match the impacts with action items • Solving future problems • How to mobilize resources • “Back-to-the-Future” planning • Maximizing positive possibilities • Minimizing negative possibilities • Timeline estimates for intervention • Community Activation What to do When to do it Result: Action Immediacy Plan Action Contingency Plan

42. Tool: Back To The Future Planning • What was a problem 10 years ago? What was the strategy to resolve the problem? What resources were necessary to solve the problem? • What is the problem you face today? Based on your experience what should your strategy be to resolve the problem? What resources will be needed?

43. Tool: Program Decision Matrix

44. Tool: Skills Assessment

45. Tool: Program Adjustment

46. Tool: Managing Change

47. Tool: Action Strategy Worksheet

48. Tool: Action Step Worksheet

49. Strategic Influences (Landscape) Action Plan Demographics, Government Policy Impact Analysis What might happen What to do when it does Must Be An Annually Renewing Plan Self-Assessment Who you are Strengths/ Weaknesses

50. To Help You • Strategic Growth Assessment for your center will be paid for by HRSA: Terry Glasscock tglasscock@caplink.org • Complimentary Financial Trend Analysis for your health center if you send 5 years of Audits to: Steve Rubman srubman@caplink.org