Transcript Slide 1

MHS Business
Planning
Translating Strategy into Action to
Manage the Business
Medical Expense and Performance Reporting System
Conference
S. Stone DASG-DSC/(703)-681-1871/[email protected]
Objectives
• Objective 1: Discuss purpose, importance and
evolution of business planning
• Objective 2: Present overview of Tri-Service
Business Planning Process
• Objective 3: Demonstrate MEPRS role in MTF
business planning
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Why Business Planning?
• To forecast health care needs and purchased
care requirements
• Coordinate care in multi-market regions
• Place accountability for care at MTF
• Quantify deviations from plan
• Base budgets on outputs, not inputs
• Justify budget
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Policy & Guidance
Business Planning Framework
Management
Initiative
Decision
TRICARE
Governance
Plan
Service
Strategy
Map
Defense
Health
Performance
Plan
Quadrennial
Defense
Review
Service
Guidance
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
Military
Health
System
Strategy
MHS
Guidance
17 July 2015
Where We Started
FY2003
First business planning data call.
TRICARE Governance Plan published.
FY2004 Service-unique approaches to business planning.
Basic Prospective Payment System template.
FY2005 Leadership mandates Tri-Service approach to tool.
Tri-Service Business Planning Tool developed
and used.
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Mission
Develop and apply structured, coherent
processes and information infrastructure to
enable effective decision-making to achieve
MHS organizational strategies, goals and
objectives.
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
MTF Business Planning Model
Unique
Users
Unique
Users
Total Gov’t Paid
Inpatient
Outpatient
Enrollment
Total Cost
Inpatient
Outpatient
MCSC Enrollment
Space Available
Price Per RWP
Price Per RVU
Market Share
Inpatient
Outpatient
Cost Per RWP
Cost Per RVU
Market Share
Inpatient
Outpatient
Performance
Improvement
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Aligning Continuous Performance
Improvement with
MHS Strategic Goals
thru Critical Initiatives
•
•
•
•
•
•
•
•
Access to Care
Referral Management
Provider Productivity
Pharmacy
Management
Evidence-Based
Health Care
Labor Reporting
Documented Value of
Care
Contingency
Planning \ Value of
Readiness
• Logistics Management
• Venture Capital \ BCA
• Facility Management
S. Stone DASG-DSC/(703)-681-1871/[email protected]
UNCLASSIFIED
17 July 2015
MTF Business Plans
Planning Process
SECTION 1
SECTION 2
SECTION 3
SECTION 4
Analyze
Market
Understand
Demand
Evaluate
Performance
Determine
Capacity
Enrollment
DMISID
=
Enrollees
Bencat GenderAge Group History FY03
0
0
15 to 17
17 17
18 to 24 13,377 16,416
M
25 to 34 13,589 15,196
35 to 44
6,816 8,017
45 to 64
772 1,001
Plan
FY04 FY05
17
18
16,506 16,496
15,170 15,115
7,929 7,815
926 874
AD
F
15 to 17
18 to 24
25 to 34
35 to 44
45 to 64
Total
5
1
2
4
2,002 2,393 2,384 2,377
1,869 2,216 2,167 2,111
682 892 843 799
87 121 113 107
0
39,215 46,270 46,057 45,716
Empanelled TRICARE Plus 4,188 4,188 4,188
4,188
All Bencats
89
Plan
Enrollees
Enrollees
Bencat Gender Age Group History FY03 FY04 FY05 Bencat Gender Age Group History
0 to 4
6,484 6,330 6,347 6,348
0 to 4
129
5 to 14
8,799 9,022 8,969 8,996
5 to 14
737
15 to 17
1,348 1,346 1,337 1,317
15 to 17
417
18 to 24
958
983 983
979
18 to 24
520
M
M
25 to 34
407
410 408
401
25 to 34
84
35 to 44
273
242 244
245
35 to 44
787
45 to 64
107
107 104
99
45 to 64
2,870
65+
0
0
0
0
65+
0
ADFM
0 to 4
6,199 6,019 6,023 6,058 Ret/Others
0 to 4
104
5 to 14
8,630 8,759 8,763 8,804
5 to 14
711
15 to 17
1,410 1,428 1,420 1,406
15 to 17
414
18 to 24
5,767 5,507 5,531 5,540
18 to 24
586
F
F
25 to 34
9,675 9,123 9,172 9,135
25 to 34
203
35 to 44
4,843 4,859 4,833 4,815
35 to 44
1,070
45 to 64
935
928 930
918
45 to 64
3,015
65+
0
65+
0
Total
55,835 55,063 55,063 55,063
Total
11,649
Enrollees
Plan
HistoryFY03 ChangeFY04 ChangeFY05 Change
106,700 114,083
7,383 113,870
(212) 113,530
(341)
FY03
122
756
450
630
84
752
3,290
0
108
708
457
659
208
1,057
3,469
0
12,750
Plan
FY04
113
728
448
634
85
694
3,402
0
104
678
446
663
202
1,000
3,551
0
12,750
FY05
109
701
443
633
89
648
3,512
0
101
656
429
663
198
944
3,624
0
12,750
DMISID
History
Primary Care
Emergency
Mental Health/Social Work
Ortho/Phys Ther
Internal Med Sub
Surgery
Surgery Sub
Ophthalmology/Optometry
OB/GYN
RVUs
ENT
Dermatology
Facility
Radiology
Anesthesiology
Pathology
Home Health Care
Other
Total
=
123
Normative
Enrollee
Demand
Demand In-house
Other DC Purchase
156,859 197,765
175,617
17,270
4,878
27,048
28,722
16,565
3,064
9,093
60,390 121,569
88,550
19,794
13,226
47,251
83,559
50,166
28,448
4,945
1,580
70,929
13,497
54,131
3,301
9,852
21,934
5,783
15,355
796
8,574
14,066
2,501
11,208
356
29,549
51,051
31,734
11,961
7,356
28,224
41,881
21,131
20,031
718
8,383
11,971
3,375
8,059
538
6,847
12,199
2,019
6,717
3,463
25,338
10,791
10,791
5,924
1,529
1,529
1,445
159
159
554
296
296
765
205
205
16,115
22,163
3,925
15,869
2,369
434,699 690,790
414,863 211,907
64,020
Care for Other
Enrollees
18,245
7,047
18,859
15,108
2,731
2,091
991
3,197
6,008
1,042
470
1,084
76,875
Space-A
Space-A
AD
Non-AD
7,289
20,943
1,244
5,345
2,803
11,017
3,484
7,728
466
1,571
193
793
112
345
2,589
2,180
520
2,418
73
269
58
136
398
1,136
19,230
53,879
Plus Care
<65
109
9
7
17
14
7
6
19
16
1
204
TFL Care Total
(65+)
In-house
40,031
262,234
3,827
34,038
3,405
124,641
6,099
82,602
3,556
21,834
2,412
11,279
1,667
5,622
5,273
44,991
1,734
31,827
438
5,198
505
3,189
1,459
8,003
70,406
635,457
SECTION 5
SECTION 6
SECTION 7
SECTION 8
Coordinate
Healthcare
Delivery Plan
Develop
Action Plans
Assess
Financial
Impact
Submit Plan/
OSD(HA)
Template
Develop Business Plan
Complete Organizational Summary
Governance Structure
Organizational Chart
Scope of Services
Partnerships and Alliances
MCSC/Network Providers
Contracted Arrangements
Veterans Administration Agreements
Other DOD Facilities and Scope of Services
Conduct Market Analysis
Market demographics by risk adjusters (Age, Sex, Ben Cat) and Zip Code
Enrollment status by risk adjusters and Zip Code
Care Patterns (MTF work by product line, PSC by Spec and Pt zip)
PSC government cost by enrollment status, risk adjuster, zip code, and specialty sorted high to low
SECTION 9
S. Stone DASG-DSC/(703)-681-1871/[email protected]
Monitor
Plan
UNCLASSIFIED
Performance
17 July 2015
Prospective Payment System
Concept of Operations
Business Planning
Business Case Analysis
Reconciliation
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Example Labor Reporting Critical Initiative
Action Plan
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Are you capturing FTEs to MEPRS
FCC GDA*?
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015
Making MEPRS Matter
Information
 Educate Commander
and Clinicians on how
MEPRS data are used
 Explain effects of untimely and inaccurate
data
 Recruit a Provider
Champion to help
spread the message
KNOWLEDGE
 Provide Commander
and Clinicians ongoing feedback
 Compute Performance
Contract, Instrument
Panel, and other Metrics
by Department, Service,
external Peer Groups
 Look for variation and
conduct root cause
analysis
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
DECISION
MAKING
 Work with Commander,
Clinicians, and Provider
Champion to integrate
findings in the decision
making process of the
organization, to include:
 Staffing
 Budgeting
 Resourcing
 Training
 Areas for Improvement
17 July 2015
Making MEPRS Matter
What gets measured matters.
Measures are a strong force in
shaping the culture of an
organization.
Feedback is key to making
change and improving data.
UNCLASSIFIED
S. Stone DASG-DSC/(703)-681-1871/[email protected]
17 July 2015