FY STRATEGIC BUSINESS PLAN

Transcription

1 FY , North Carolina

2 OUR To save a life, hold a hand, and be prepared to respond in our community when and where our patients need us. OUR Medic will be an adaptable patient-centered system of care by: Continuously improving the patient experience of care Involving patients in decision making regarding their healthcare Better aligning resources with patient needs Becoming more integrated into community and healthcare resources Medic will be an excellent place for people to work by: Demonstrating appreciation and value Seeking to understand and meet employee needs Providing opportunities to develop and use skills and talents Involving employees in improvement and decision making Medic will be fiscally sustainable by: Reducing per capita costs Exploring or pursuing alternative funding sources or models Adapting to future healthcare policies PATIENT QUOTES I would like to thank John M. Gibson and Donnell Wilson for the outstanding treatment my mother received while in their care. Their professional attitude, courtesy, compassion, and kindness was greatly appreciated. - Geralyn S. Your Paramedics showed great patience and resolve in administering care to my daughter. My family and I are deeply grateful for her professionalism and compassion, and commend your employees for exceeding our expectations. Thank you! - Michael B. They were superb. They were sympathetic, knowledgeable, capable and quick in their response. I felt confident in their care & expertise. Please commend them for their medical excellence & compassionate care. They epitomize your motto. - Jude L.

3 OUR ENVIRONMENT Mecklenburg EMS Agency (Medic) is responsible for all Emergency Medical Service activity in the county. Medic is the largest and busiest 911 EMS Agency in the Carolinas. With over 500 employees and a fleet of 70 ambulances, the Agency will respond to more than 128,000 calls for service and transport upwards of 108,000 patients in FY 16. High Deductible Health Plans The rising cost of healthcare coupled with the impact of the Affordable Care Act (ACA) has had a tangible impact on the patient s Medic serves. The number of insured in our population has increased by more than 36,000 in 2015, and a large number of these people have chosen high deductible health plans. According to data recently released by The Kaiser Family Foundation, 65% of all newly insured people who purchased a plan through the Healthcare Marketplace chose a silver plan, which has an average deductible of $2,900. The same report also stated that 46% of all insured people in the US currently have a deductible greater than $1,000, and that figure is rising rapidly as more and more employers migrate to high deductible plans. The impact of this shift to a Medic patient is an increased likelihood that they will need to pay their bill for service out of their own pocket. The impact to Medic is longer collection cycles and a lower reimbursement rate per transport. To this point, since FY 10 Medic has seen a 6% decrease in reimbursement on a per call basis, due in large part to changes in insurance coverage, increasing deductibles and Medicare/Medicaid rates. Burgeoning Demand Demand for Medic s services continues to grow at a rate that significantly outpaces population growth. Between 2010 and 2014, s population increased by 10%. Medic s call volume grew over this same timeframe by 19%. This level of growth is difficult and costly to sustain, especially since the majority of these patients weren t experiencing an emergent health condition. 67% of Medic s patients in FY 15 did not have a life threatening situation, and a large number of these patients did not require Paramedic care or transport via an ambulance. Impact of Frequent Users It is imperative to Medic s future sustainability that measures are taken to align people with the supportive care they actually need, taking undue pressure off of the 911 system and enabling Medic to focus on delivering emergency medical services to those who actually require such attention. Medic has already taken the first steps necessary to address this issue by partnering with other service providers in the community to identify and better serve frequent users of the 911 system. These partners include Community Support Service of Mecklenburg County, the Charlotte Housing Authority and the Department of Social Services. Together, we aim to better serve the needs of this population while reducing unnecessary reliance on more costly, emergency oriented services. Impact to Reimbursement Medicaid reform in North Carolina remains an unknown variable that will likely impact future reimbursement; whether it is positive or negative depends on what path state legislation takes. Medic continues to benefit from the short term agreement reached between the county and Blue Cross/Blue Shield of NC. Any changes to this agreement or legislation that would impact the way BC/BS reimburses EMS Agencies for care provided could significantly impact Medic s future revenue stream. Sustaining System Medic continues to focus on continuous process improvement to better meet the needs of Mecklenburg County and the people we serve. Agency performance relative to response time compliance, trauma scene time, time to intervention for heart attack victims and the resuscitation of sudden cardiac arrest victims all continue to perform at levels that are among the very best in the country. Making this even more remarkable is the fact that Medic s county funding per transport for FY 16 is forecasted to be an all-time low of $116 per, and the Agency s overall cost per transport is on track to finish at $498 per, the lowest it has been since FY 07. 3

4 OUR GOALS Whether facing the impact of healthcare reform, dwindling reimbursement or increased demand for services, Medic must continue to adapt or risk backing into an unsustainable service model. Medic s goals for the next three years squarely address the changing landscape facing this Agency and will help ensure its ability to continue serving this community in a cost effective, high performing manner. 1. Reduce reliance on the 911 system by frequent users by 38% a. This ties back to the significant increases in demand for service that are not emergent in nature. i. Medic intends to continue working with community partners to identify frequent users of the 911 system and align them with supports that best meet their needs. ii. Medic also intends to launch an educational campaign to inform prospective patients of the cost of treatment and transport by EMS along with alternative options for non-emergent care. 2. Further improve fiscal sustainability a. This relates to the high cost of healthcare delivery and the need to leverage efficiencies without negatively impacting service. b. Next to labor, capital expenditures represent the largest portion of Medic s annual budget. i. Medic is exploring new vehicle chassis to better meet the needs of patients and employees while reducing total cost of ownership, improving safety and overall employee satisfaction with their work environment. ii. With cost justification, Medic intends to replace its existing fleet of ambulances over the course of the next three fiscal years 3. Optimize service and operations at Medic s new facility a. This relates to Medic s ability to maintain long term sustainability while improving processes and efficiencies. i. Medic is working to redesign workflow and processes to better meet Agency needs; these revised plans will be incorporated into the new building design. ii. Employee inclusion in planning and their overall satisfaction with the work environment are key drivers of the Agency s success, making their participation in all aspects of this work critical. The provision of healthcare continues to evolve in dramatic ways. The diverse needs of our patients, the impact of healthcare reform, the prevalence of high deductible healthcare plans and the need to do more with less are all impacting how Medic plans for the future. Medic s goals for the next three years squarely address the changing landscape facing this Agency and will help ensure its ability to continue serving this community in a cost effective, high performing manner. 4

5 GOAL 1: Reduce Demand for Service on Medic Objective 1: Reduce reliance on the 911 system by frequent users by 38% Action FY 17 Partner with Community Support Services (CSS) to identify frequent users of the 911 system and align them with more appropriate healthcare resources to best meet the needs of these patients Medic will provide monthly EMS System utilization data relative to frequent users of the 911 system to CSS and engage in ongoing program development Total associated costs: No known new costs to Medic at the time; the program is still developing Medic will work to expand the partner Agencies with which the Agency works and identify resources that could improve the effectiveness and scope of the program Total associated costs: No known new costs to Medic at the time Medic will coordinate with the Public Health Department to review the program for overall effectiveness Total associated costs: No known new costs to Medic at the time Measure Comment Quantity of service requests by frequent users of 911 will be reduced by 38% by the end of FY 19 Between 1/1/15 and 11/30/15 Medic transported 308 high frequency patients 10,129 times. 5

6 Objective 2: Identify tactics to safely reduce unnecessary use of the 911 system by 10% Action FY 17 Develop processes to safely identify users of the 911 system who do not have an emergent condition and leverage more appropriate resources to better meet their needs Analyze existing data and Identify patient conditions that could be safely tested for inclusion; Develop strategies for safely identifying such patients prior to initiating a response or transport; Analyze the impact to patients (outcomes) and Medic (financial) as a result of reducing transports & make recommendations of next steps Total associated costs: No known new costs to Medic at the time; the program is just beginning. Continue to test strategies; Review results and refine plans; Make recommendations based on results. Total associated costs: No known new costs to Medic at the time Implementation of strategies developed in FY 18; Continued monitoring of results to ensure continued patient safety and positive impact to Medic. Total associated costs: No known new costs to Medic at the time Measure Comment The number of unnecessary ambulance transports will be reduced by 10% by the end of FY 19 68% of patients treated by Medic are dealing with a non-life threatening situation; Medic currently treats/transports 100% of those who request help; Many don t know there is a fee for service. 6

7 GOAL 2: Further Improve Fiscal Sustainability Objective 1: Decrease total cost of ownership for Medic s ambulance fleet Action FY 17 Replace Medic s current ambulance chassis/module with one with a lower total cost of ownership Evaluate chassis and module options against Medic s need and projected total cost of ownership Total associated costs: A portion of Medic s existing capital expenditure budget for small scale testing Develop a fleet replacement strategy based on new design to optimize total cost of ownership Total associated costs: TBD based on purchase price and replacement strategy selected Continued implementation of replacement strategy and analysis of total cost of ownership to date Total associated costs: TBD based on purchase price and replacement strategy selected Measure Comment Cost per mile to own/operate new vehicle vs. cost per mile to own/operate current vehicle Medic has selected a new ambulance chassis that is $20,000 each less expensive to purchase than the current chassis. The cost per mile to operate the new ambulance is predicted to be.03 cheaper than the current model. The lifetime savings per ambulance are predicted to be $71,147. 7

8 GOAL 3: Optimize Service and Operations at Medic s New Headquarters Objective 1: Improve efficiency of key core processes within Medic Operations Action FY 17 Improve processes related to ambulance turnover post shift & pre deployment Design and test new logistics processes at existing Medic headquarters Implement new logistics processes at Medic s new Headquarters; test and modify new processes Monitor and improve new processes as necessary Measures Comment Time required to clean, stock and return an ambulance to service (post shift) Impact of process improvements on the production of effective unit hours The ability to restock vehicles accurately and quickly is essential to minimizing lost unit hours in the system due to defects; the new building offers great opportunities for improvement in this area as the space is being designed around improved processes. 8

9 GOAL 3: Optimize Service and Operations at Medic s New Headquarters (cont d) Objective 2: Improve employee satisfaction related to the work environment Action FY 17 Work with employees to design facets of the new Medic Headquarters Engage employees and gather input into design process Implement design and construct new Medic Headquarters; Solicit feedback post move Total associated costs: Building construction costs still TBD Continue to monitor employee feedback relative to new building and improve as appropriate Measures Employee satisfaction with their level of input into the design process Overall employee satisfaction with Medic s new Headquarters 9