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Please see attachments for scenairo and previous milestones.
You will draft a letter of proposal outlining a recommended course of action, directed to executive management. Revise your previous milestones based on instructor feedback, compile these components, and add your fully developed introduction and conclusion to submit your final proposal in the form of a letter. It should be a complete, polished artifact containing all of the critical elements of the final product. It should reflect the incorporation of feedback gained throughout the course. After you capture all feedback, write your conclusion first and your introduction last. When you write your conclusion, capture the essence of the issue and your recommendation. Focus on actionable next steps so that the executive knows the path forward. After you finish your conclusion, look back over your entire Part I submission. Your introduction should provide an overview of the entire proposal letter, without going into great detail.
Your proposal must address the following critical elements:
I. Introduction/Executive Summary: Although this is the first section of your proposal, it should be written last. Be sure that your tone and recommendations are appropriate for the intended audience.
A. Clearly identify the scenario and issue you selected.
B. Briefly summarize your analysis.
C. Identify your conclusion and your recommendations.
II. Factual Overview and Identification
A. Clearly state the questions from the scenario that need to be resolved.
B. Identify applicable principles of management theory and population health improvement, and explain why they are applicable to the situation.
C. Identify applicable methods for financing, evaluating, and improving healthcare delivery, operations, and facilities that are reasonably or legitimately raised by the scenario.
D. Discuss healthcare delivery principles and technology relevant to the scenario.
III. Analysis
A. Describe the policy-making processes, if any, implicated by the scenario and issue, and explain why they are implicated. If you feel no processes are fairly implicated, please justify your reasoning.
B. Analyze existing health policy and population-health programs related to the issue in the scenario, and explain why they are related to the issue.
C. Explain how the scenario and issue implicate principles of budgeting, governance, and strategic planning. If you feel it does not implicate any such principles, justify your reasoning.
D. Apply principles of management theory and population health improvement to the scenario, explaining why the principles are applicable to the specific scenario.
IV. Recommended Solution
A. Recommend an appropriate solution to respond to the issue in the scenario.
B. Explain how your recommended solution can be deployed using the policy-making processes you identified above.
C. Discuss how your recommended solution will improve population health and how you will communicate this information to the general populace. Be sure to substantiate your claims.
D. Describe how your recommended solution utilizes healthcare delivery principles and technology.
E. Discuss how your recommended solution utilizes budgeting, governance, and strategic-planning principles to promote quality and organizational improvement.
F. Explain how the methods for financing, evaluating, and improving healthcare delivery, operations, and facilities support your proposed solution to manage behavior and healthcare delivery.
V. Next Steps and Conclusion
A. Summarize your analysis and recommendations in a brief concluding paragraph.
B. Identify immediate next steps for the healthcare organization and executive management.
Guidelines for Submission: Your proposal should be 7–8 pages long, formatted in 12-point Times New Roman font, with one-inch margins. With at least 8 citations and references that were cited in previous milestones should be formatted according to current APA guidelines.
PHE 610 Final Project: Milestone Three 4
Proposed Recommendations for Electronic Medical Records
Since their introduction, Electronic medical records (EMRs) have been perceived to possess the potential to advance the general health of the society. However, the major setbacks with the utilization of EMRs are the costs and challenges associated with the implementation of the systems. According to Hayes (2015), the cost of implementing an EMR system is quite high and could cost about $163, 765 for a single physician. Hayes (2015) research highlights that by 2015, the Center for Medicare and Medicaid Services had spent over $30 billion funding the implementation and utilization of EMR systems in about 468,000 care providers. Although the implementation and maintenance of EMR systems are high, there are several benefits associated with such systems. For instance, they result in minimal medical errors, improved patient care management, reduced costs, and increased productivity (Fottler, Khatri, and Savage, 2010).
For the past ten years, the Wall County Health Department has been using the EMR system offered and maintained by the States Department of Health and Human Services (DHHS). Wall County Health Department has been paying a nominal fee for using the DHHS EMR system. However, following a severe budget cut, DHHS has signaled that it will terminate the maintenance of the EMR system within the next 120 days. After the scheduled termination, the users will manage to access the EMR system for only 12 months. In light of this, the main challenge facing the Wall County Health Department is on whether to install and maintain its EMR system or go back to the conventional medical records storage. For this reason, this proposal aims to offers a recommendation for the installation of an EMR system by the care facility.
The goal of any healthcare facility is to provide improved care to the patients sustainably. EMRs were implemented to increase the quality of healthcare delivery and patients outcomes. Since the introduction of EMRs, many healthcare facilities across the US have shown their interest in their adoption and use (Suresh and Stanton, 2016). For the past ten years, Wall County Health Department has entirely relied on EMR system to create and store medical records. Moreover, the care facility has depended on the system to generate pharmacy utilization, immunization, and treatment reports. For these reasons, Wall County Health Department should install, implement, and maintain its EMR system following the termination of the EMR system provided and maintained by DHHS to align with its mission. Although implementation of EMR is expensive, its long-term benefits are worth the upfront costs incurred. Such benefits include effective cure option at low costs, health expenditure reduction at the national level, provision of effective primary health care measures, and predictive medicine. Ideally, the combination of this benefits results in a healthier society. It is worth realizing that these benefits cannot be realized without the patient, the federal governments, and providers sustaining substantial initial costs for both implementation and maintenance (Hayes (2015).
The main reason why the care facility has not implemented and maintained its EMR system is that of cost-saving purposes. Notably, apart from the nominal fee, it pays for the EMR system provided by DHHS, the care facility major spending are on operation overheads, and care providers’ salaries in its four locations where it offers care services in the County. The healthcare facility receives most of its revenue from the money it collects from providing direct behavioral and physical health services to patients. Other funding is from the County general fund and grant programs. According to Hayes (2015), the cost of implementing and maintaining an EMR system is approximately $65,000 after factoring in federal subsidies.
Although this is still a considerable cost, the facility can manage to sustain it given that most of the care providers who require an EMR system are those involved in physical intervention care delivery with the facility locations. Moreover, the policymakers at the federal level are responsible for providing subsidies to a facility of Wall County Health Department nature, which implies that upfront costs incurred can equally be minimized (Joshi, 2017). The rationality for implementing the EMR system is equally supported by the facility’s desire to join the network of Medicaid Management Care and Medicare Advantage Insurer. Although the Insurer offers the highest rates, it tends to reduce them when facilities fail to improve their population health outcomes. Ideally, implementing an EMR system would result in sustained improved healthcare outcomes.
References
Fottler, M. D., Khatri, N., & Savage, G. T. (2010). Strategic human resource management in health care. Bingley: Emerald.
Hayes, T. (2015). Are Electronic Medical Records Worth the Costs of Implementation? Retrieved 11 January 2018, from https://www.americanactionforum.org/research/are-electronic-medical-records-worth-the-costs-of-implementation/
Joshi, A. (2017). POPULATION HEALTH INFORMATICS: Driving evidence-based solutions into practice. Sudbury: Jones & Bartlett Learning.
Suresh, S. & Stanton, B. (2016). Quality of care and information technology. Philadelphia,
Pennsylvania: Elsevier
PHE 610 Final Project: Milestone Two 2
The first policy-making process implicated by the issue is identification or setting of the problem. The process is implicated in the case scenario because the health facility is required to identify what problem it faces due to the state withdrawing its assistance. The problem identification policy is one that arises from the need to provide quality services or to comply with certain laws (Birkland 2014). For example, identifying that the hospital is faced with the challenge of maintaining medical recorded is a policy-making process which comes from the need to provide quality healthcare. The other policy-making process influenced by the issue is the formulation of the policy process. Since the situation facing the hospital is challenging, then there is need to formulate policies that can help solve the situation.
The policy formulation process implicated by the case requires that policies be made that directly solve the problem. In the given situation, policy formulation would, for instance, entail making strategies that assist the healthcare facility in raising revenue for to cater for its services which the state will be no longer be giving for free.
Another policy-making process that is implicated is adopting the formulated policy (Drummond et al. 2015). The hospital is challenged in many ways ranging from increasing revenue, improving population healthcare, training of personnel and record maintenance. Therefore, the situation implicates that the health care must adopt the formulated policies so that it can solve its problems. Additionally, the case scenario implies that the formulated policies to be implemented. The situation implicates this policy-making process since it the process is not implemented then the problems facing the health facility will not be solved. The implementation process is very critical since it contains specific parameters addressing how the challenges will categorically be resolved (Wallace et al. 2015).
Health institutions continuously develop health programs that are aimed at improving the population health. The focus of these programs may vary from one hospital to the other depending on the objectives set. Some of the goals that an institution would like to achieve in population health programs are improving the life quality and healthcare for the community, reducing differences in health outcomes within and among different health groups, and reducing costs. One of the population health programs related to the case scenario is health education. Policies and educational programs are crucial public health programs. There is a close relationship between health and education.
Furthermore, population health education is a critical determinant of the public health outcomes. Here is need to promote health education programs which bridge the education gap between low and high-income earners, and minority and majority populations (Nash et al. 2015). Population health education policies are implemented through the collaboration of health practitioners and public health policymakers. Health education can be directed towards health conditions that require prioritizing and includes a large population. Health education is best achieved if delivered to specific setting-based designs. The setting for such programs can be done in schools, residential areas, markets, and workplaces while taking into account the complicated health issues, practices and beliefs in the settings being addressed.
Population health is related to the case scenario since the health department serves members of the public on different levels, the health facility serves children the aged adults, and even offers behavioral health services. It is found that health education is fundamental to improving health outcomes and patients health. It, therefore, means that health education could help the hospital cut down its health care bills spent in treating patients since they improve personal health care.
Another population health program related to the case scenario is the integration of clinical networks. The integration of healthcare services is a growing health strategy aimed at promoting the adoption of evidence-based practice that improves delivery of healthcare. The program is a pool of healthcare providers who form a network that observes set protocols to improve healthcare quality and reduce costs (Bachireddy et al. 2014). These strategies offer a shift from the traditional hierarchical healthcare organization structure to a better model which incorporated the engagement of physicians in the development of improved healthcare models. The situation presented in the case scenario relates to the program since Wall county health department is seeking to cut down costs while improving its healthcare provision. Joining a network of other health providers will boost the quality of services offered.
The financial health of an organization is affected by its budgeting principles. A health organization will fail in service delivery if sound budgeting principles are not applied. Being conservative as opposed to being optimistic is the first principle of budgeting (Dunham-Taylor & Pinczuk 2014). The scenario facing the health department requires that the institution underestimate its income and overestimate its expenses. The situation implicates the principle in this manner so that there will be room for contingency expenses.
Additionally, another way to look at how the scenario has implicated this principle for budgeting is through finding out whether the hospital had set aside some revenue for unprecedented events such as being cut out from free services by the state. Another principle of budgeting implicated by the scenario is teamwork and consultation. In budgeting, working as a team is a fundamental concept. As much as one individual may bear the duties of compiling the whole budget, they should not be responsible for doing all the budget work. The presented issues demand that the Wall county health department utilizes this principle in planning its budget since it is faced with a difficult task of managing limited funds and thus consultations will be immensely needed. Managing budgets requires that tasks are split to persons with great expertise in the field. Following this principle will make the budgeting process slow, but the outcome will be more accurate.
In strategic planning the first principle implicated by the situation is accountability. The scenario requires that the involved department leaders become more accountable in handling funds and distributing the institution’s resources since they have become scarce. Accountability principle is not an optional duty and thus cannot be delegated to any other person but only the managers. Another implicated principle is corporate strategic planning principle. The corporate principle is incorporated because it deals with the overall performance of the organization. Given the challenges facing the health department, this principle must be in play when looking at how to improve the quality of healthcare.
There is a wide range of factors which affect the health of a population. They may be from within or outside the health system. Such factors include personal behaviors environmental, social and economic factors. There are healthcare strategies which are developed to improve the population health, and they include; understanding and setting specific objectives on the desired population health improvements. The strategy involves including the public in understanding health issues as well as studying the health needs of various population groups. The strategy is applicable in the case scenario since the health department deals with providing healthcare for the whole population and thus understanding the needs and setting specific objectives is vital to improving the health outcomes.
References
Bachireddy, C., Soule, M. C., Izenberg, J. M., Dvoryak, S., Dumchev, K., & Altice, F. L. (2014). Integration of health services improves multiple healthcare outcomes among HIV- infected people who inject drugs in Ukraine. Drug and alcohol dependence, 134, 106- 114.
Birkland, T. A. (2014). An introduction to the policy process: Theories, concepts and models of public policy making. Routledge.
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford University
Press.
Dunham-Taylor, J., & Pinczuk, J. Z. (2014). Financial Management for Nurse Managers- Merging the Heart with the Dollar. Jones & Bartlett Publishers.
Goetzel, R. Z., Henke, R. M., Tabrizi, M., Pelletier, K. R., Loeppke, R., Ballard, D. W., & Serxner, S. (2014). Do workplace health promotion (wellness) programs work? Journal of Occupational and Environmental Medicine, 56(9), 927-934.
Nash, D. B., Fabius, R. J., Clarke, J. L., & Skoufalos, A. (Eds.). (2015). Population Health. Jones & Bartlett Publishers.
Wallace, H., Pollack, M. A., & Young, A. R. (Eds.). (2015). Policy-making in the European Union. Oxford University Press, USA.
PHE 610 Final Project: Milestone One 2
ELECTRONIC MEDICAL RECORDS
The public health department is faced with the challenge of record keeping since the state’s health department will soon cease to maintain the electronic medical record system (EMR). The department is, therefore, having a hindrance in its workflow and supporting quality healthcare. The department will soon be unable to generate medical records about treatment gaps, immunization status reports and pharmacy utilization reports when the state cuts out its service. The department’s revenue may not be enough to cater for the services, given that most of its revenue is generated from patients within the community where a majority are uninsured while the others are re in Medicaid or mediocre programs.
From the given situation some questions need to be resolved. One is how to continue maintaining an electronic medical record without the state’s services. The other is on how to raise revenue to cater for information technology services and training that the will no longer be given for free. Another question would be as for whether to join the insurer’s network. Other than the uninsured, the department seems to serve patients who are in the insurer’s Medicaid or Medicare program, hence joining the network would probably provide quality healthcare delivery.
To improve the population health, one of the principles to be utilized is identifying priorities through looking at the health trends and the burden of illness by use of the population data. The action will allow the implementation of evidence-based actions to which will facilitate positive health outcomes. The current situation requires that proper management is observed to ensure that the limited available resources cater for the prioritized needs. Additionally, there should be created sustainable funding method which rewards improvement in population healthcare and prevention (Woolf et al. 2015). Funds directed towards population healthcare should be explicitly described for prioritized healthcare intervention.
The department can increase its revenue by joining the insurer’s network where there will be more insured patients and stop relying on direct patients. It can also improve financing through cost transparency which will reduce pharmaceutical costs by allowing drug costs negotiations by Medicare. It can also improve its quality healthcare through maintaining healthy healthcare systems; this means that evidence-based management must support the delivery of evidence-based care. The primary factor will, therefore, be information. Thus patients’ real-time data must be obtained for purposes of maintaining a smooth workflow. Information will lead to making better decisions which will have a direct impact on better health outcomes. An integrated healthcare system will also be vital in improving healthcare delivery and various facilities within the department. When all the healthcare providers work in a coordinated manner in sharing relevant information and focusing on the same goal, then better treatment outcomes will be achieved.
In the given case, one of the relevant healthcare delivery principles is offering preventative and accessible quality healthcare via insurance coverage for the whole population. The coverage should include even those are more vulnerable to inequalities in the healthcare. A technology relevant to the given situation is the adoption of an Electronic Health Record (EHR) which reduces the administrative time spent by physicians. The saved time should be spent engaging with patients. An evaluation of patient-centered care should be improved and other innovative alternative care methods should be adopted (Oleske, 2014). Lastly, healthcare delivery principles require that the health facility integrates with the community in other aspects as it will enhance the delivery system.
References
Dougherty, L., & Lister, S. (Eds.). (2015). The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.
Oleske, D. (2014). Epidemiology and the delivery of health care services (3rd ed.). Michigan: Springer.
Woolf, S. H., Purnell, J. Q., Simon, S. M., Zimmerman, E. B., Camberos, G. J., Haley, A., & Fields, R. P. (2015). Translating evidence into population health improvement: strategies and barriers. Annual review of public health, 36, 463-482.
PHE 610 Electronic Medical Records and Quality Improvement
Wall County is in the State of Drake. Wall County (the “County”) has a local public health department, Wall County Health Department (the “Department”) that
offers a variety of services, including primary care and outpatient behavioral health services for children and adults. The County serves predominantly uninsured,
Medicaid, and Medicare patients in multiple locations around the County. Wall County is a mix of urban and rural areas. In many communities within the County,
the Department is sole provider of physical and behavioral health services.
The Department receives the bulk of its revenue from providing direct physical and behavioral health services. Some additional revenue flows to the Department
from the County’s general fund and by way of small grant programs to support environmental health and nurse home visiting activities. The Department’s budget
year aligns with the County’s budget year and runs July 1 through June 30. The Department’s largest expenses are provider salaries and operating overhead in
each of the four locations where the Department offers services throughout the County.
Drake’s largest Medicaid managed care and Medicare Advantage insurer (the “Insurer”) has approached the Department about joining the Insurer’s network. The
Department has learned from other entities in the Insurer’s network across the State of Drake that network payment rates typically exceed those rates offered by
other payers. However, the Insurer has a history of decreasing payment rates over time for those network providers that do not manage their populations to
improve health outcomes and decrease emergency department utilization. At this time, the Department has not made a decision about whether to join the
Insurer’s network.
For the past 10 years, the Department has paid a nominal fee to use the statewide electronic medical record (“EMR”) system provided and maintained by the
State Department of Health and Human Services (“DHHS”). The EMR system allows the Department to generate limited reports for its providers, including:
Treatment gap lists and risk
Pharmacy utilization reports
Immunization status reports
The EMR system is the only system used by the Department to create and store medical records. Utilization of the system varies widely by provider and by
location, but in general, utilization of the EMR system is lower among behavioral health providers than among physical health providers. Some Department
locations in the County have trained providers on workflows to navigate the EMR system and other locations have not.
Five days ago, on January 2, DHHS notified the Department that it will cease maintaining the EMR system in the next 120 days. DHHS explained that EMR system
users will be allowed to access the EMR system for up to 12 months after maintenance termination, but no user support or security patches will be available
during that time period. Unfortunately, DHHS has experienced a round of severe budget cuts that have limited its ability to respond to questions about the EMR
system or related service requests; DHHS will not offer any information technology support or technology training for the Department.
You are the director of quality for the department. Your supervisor, the director of public health for the department (with the backing of the Board of County
Commissioners), has directed you to brief her on the issue and recommend a course of action. Specifically, the director of public health has asked you to create a
policy proposal for her review.
