Sample project: The Implementation of a Primary Care Provider for the Poor Shared Services Arrangement Goal of Grant: To reduce organizational costs and increase access to health care for uninsured and lowincome people Grant Objectives: To establish a shared management arrangement between two primary care organizations To implement shared after-hours, on-call medical coverage To implement a shared automated billing system To sustain the shared services after the grant ends The Health Foundation of Greater Cincinnati s Evaluation Packet 1
Define the Problem LOGIC MODEL Inadequate health services for uninsured and lowincome people in our area. Define the Intervention Shared management and clinical services for two primary care providers will reduce overall expenses and improve service capacity. Your Goal To reduce organizational costs and increase access to health care for uninsured and low-income people Objectives To establish a shared management arrangement between two primary care organizations To implement shared after-hours, on-call medical coverage To implement a shared automated billing system To sustain the shared services after the grant ends Outcomes Reduce costs through shared operations 24 hour medical coverage Reduce inappropriate Emergency Room and Urgent Care use Reduce days outstanding in accounts receivable Increase the capture of billable encounters Achieve financial stability to sustain new shared services The Health Foundation of Greater Cincinnati s Evaluation Packet 2
Process Evaluation Plan Project Objective: To establish a shared management arrangement between two primary care organizations A. Performance Target (activity) B. Data source(s) showing that the activity has occurred Hire an Executive Director who will be shared between the two health care sites Appointment letter and letter of acceptance C. Method by which the data will be collected, including person responsible D. Target date to accomplish the activity CEO to have letters on file January 1, 2004 Develop policies regarding authority and responsibilities for shared Executive Director for both agencies Policy and Procedures manuals Each agency s Board President to have copies on file February 1, 2004 Orient agency staff to Executive Director role in each primary care agency Meeting agenda and minutes Each agency s Board President to have copies on file March 1, 2004 The Health Foundation of Greater Cincinnati s Evaluation Packet 3
Process Evaluation Plan Project Objective: To implement shared after-hours, on-call medical coverage A. Performance Target (activity) B. Data source(s) showing that the activity has occurred 1) Implement 24/7 after-hours, on-call medical coverage within 3 months 2) Develop and distribute appropriate patient education materials (specify materials such as brochures, posters, etc.) about the new after-hours service After-hours medical coverage schedule Educational materials C. Method by which the data will be collected, including person responsible Project Director will keep file on after-hours medical coverage records Project Director will keep copies of materials on file D. Target date to accomplish the activity April 1, 2004 March 1, 2004 The Health Foundation of Greater Cincinnati s Evaluation Packet 4
Process Evaluation Plan Project Objective: To implement a shared automated billing system. A. Performance Target (activity) B. Data source(s) showing that the activity has occurred Align sites for consistent billing practices (completed before implementation of billing system) Billing guidelines or policies from each agency C. Method by which the data will be collected, including person responsible Project Director to keep billing practices documentation on file D. Target date to accomplish the activity March 1, 2004 Choose, implement, and test new billing system Software literature, log of installation, test results Project Director will keep materials on file Train staffs to use new billing system Curriculum and attendance sheet Project Director will keep curriculum and training attendance sheets on file Capture billable encounters Transaction documents Project Director will maintain a monthly summary of accounts receivable April 30, 2004 May 15, 2004 June 1, 2001 and monthly afterwards Timely transmission of a clean transaction to payors Claims remittance reports Project Director will maintain a monthly claims remittance log sheet July 1, 2001 and monthly afterwards Third party and payer payment tracking Management reports Project Director will maintain a monthly summary of payment trends by payer source July 15, 2001 and monthly afterwards The Health Foundation of Greater Cincinnati s Evaluation Packet 5
Process Evaluation Plan Project Objective: To sustain the shared services after the grant ends A. Performance Target (activity) B. Data source(s) showing that the activity has occurred Apply cost savings and any increase in revenue to sustaining shared services Monthly revenue and expense reports C. Method by which the data will be collected, including person responsible Project Director will keep reports on file D. Target date to accomplish the activity June 1, 2004 (and monthly afterwards) Apply for FQHC funding based on aligning Center with FQHC requirements Submitted FQHC application Project Director will have copy of submitted application on file Based on FQHC deadline Apply for {specify state or national funders) for funding Submitted funding request(s) or grant proposal(s) Project Director will have copy of submitted proposal on file Based on funder s deadline Apply to (specify local funders) for funding Submitted funding request(s) or grant proposal(s) Project Director will have copy of submitted proposal(s) on file Based on funder s deadline The Health Foundation of Greater Cincinnati s Evaluation Packet 6
Outcome Evaluation Plan Project Objective: To establish a shared management arrangement between two primary care organizations A. Client Outcomes (sometimes cost outcomes) Reduce costs through shared operation (specify savings targets or anticipated changes for shared service) B. Indicator(s) of the outcomes Shared management costs C. Specific instrument and data sources for the indicator(s) Financial records D. Comparison(s) if applicable Comparison to previous management arrangement costs. E. Person responsible for data collection F. Target date to evaluate the outcome 1 Project Director March 1, 2004 1 Dates chosen for outcome evaluation should, if at all possible, be soon enough to provide supporting evidence for seeking funding for continued sustainability of the program to avoid interruptions in service. If you begin collecting and analyzing data early in the project, the preliminary results can strengthen the case you present to potential funders. The Health Foundation of Greater Cincinnati s Evaluation Packet 7
Outcome Evaluation Plan Project Objective: To implement shared after-hours, on-call medical coverage. A. Client Outcomes (sometimes cost outcomes) Reduce after-hours physician coverage costs (specify savings targets or anticipated changes for shared service) B. Indicator(s) of the outcomes Shared afterhours physician coverage costs C. Specific instrument and data sources for the indicator(s) Financial records D. Comparison(s) if applicable Comparison to previous arrangement costs. E. Person responsible for data collection F. Target date to evaluate the outcome 1 Project Director July 1, 2004 Reduced inappropriate after-hours Emergency Room and Urgent Care visits (sample target = 20% reduction) Ambulatory sensitive client encounters (specify CPT codes) Advice of treatment notices sent to agency by cooperating ERs and Urgent Care Centers MCO holdback documentation and notice of payments by MCO to ERs and Urgent Care Centers Aggregate quarterly comparisons to previous year of the number of after-hours client contacts across sites Project Director July 1, 2004 Oct 1, 2004 Jan 1, 2005 Apr 1, 2005 1 Dates chosen for outcome evaluation should, if at all possible, be soon enough to provide supporting evidence for seeking funding for continued sustainability of the program to avoid interruptions in service. If you begin collecting and analyzing data early in the project, the preliminary results can strengthen the case you present to potential funders. The Health Foundation of Greater Cincinnati s Evaluation Packet 8
Outcome Evaluation Plan Project Objective: To implement a shared automated billing system A. Client Outcomes (sometimes cost outcomes) Reduce billing costs through shared automated billing system (sample target =25% reduction) Reduce days outstanding in accounts receivable (AR) (specify target reduction) B. Indicator(s) of the outcomes Shared automated billing costs Accounts receivable report C. Specific instrument and data sources for the indicator(s) Monthly revenue and expense reports Billing system reports D. Comparison(s) if applicable Comparison to previous billing system costs Monthly trend of gross days in accounts receivable (AR) E. Person responsible for data collection F. Target date to evaluate the outcome 1 Project Director July 1, 2004 Project Director June 1, 2004 (and monthly afterwards) Increase capture of billable encounters (specify target increase) Billed number of encounters per provider Billing system reports Billed encounters per provider Project Director June 1, 2004 (and monthly afterwards) 1 Dates chosen for outcome evaluation should, if at all possible, be soon enough to provide supporting evidence for seeking funding for continued sustainability of the program to avoid interruptions in service. If you begin collecting and analyzing data early in the project, the preliminary results can strengthen the case you present to potential funders. The Health Foundation of Greater Cincinnati s Evaluation Packet 9
Outcome Evaluation Plan Project Objective: To sustain the shared services after the grant ends A. Client Outcomes (sometimes cost outcomes) Achieve financial stability after incorporating new costs from this project B. Indicator(s) of the outcomes Breakeven or better for shared services C. Specific instrument and data sources for the indicator(s) Written business plan; three-year budget D. Comparison(s) if applicable E. Person responsible for data collection F. Target date to evaluate the outcome 1 N/A Project Director January 1, 2005 1 Dates chosen for outcome evaluation should, if at all possible, be soon enough to provide supporting evidence for seeking funding for continued sustainability of the program to avoid interruptions in service. If you begin collecting and analyzing data early in the project, the preliminary results can strengthen the case you present to potential funders. The Health Foundation of Greater Cincinnati s Evaluation Packet 10