May 30, | nursing, med, NURS, Paper
CLC – Health Promotion and Community Resource Teaching Project
CLC – Health Promotion and Community Resource Teaching Project
My Group
Group Forum
This is a Collaborative Learning Community (CLC) assignment.
An important role of nursing is to provide health promotion and disease prevention. Review the topics and related objectives provided on the Healthy People 2030 website. Choose a topic of interest that you would like to address, in conjunction with a population at-risk for the associated topic. Submit the topic and associated group to your instructor for approval CLC – Health Promotion and Community Resource Teaching Project.
Create a 15-20 slide PowerPoint presentation for your topic and focus group. Include speaker notes and citations for each slide, and create a slide at the end for References.
Address the following:
Describe the approved topic and associated population your group has selected. Discuss how this topic adversely affects the population. How does health disparity affect this population?
Explain evidence-based approaches that can optimize health for this population. How do these approaches minimize health disparity among affected populations?
Outline a proposal for health education that can be used in a family-centered health promotion to address the issue for the target population. Ensure your proposal is based on evidence-based practice CLC – Health Promotion and Community Resource Teaching Project.
Present a general profile of at least one health-related organization for the selected focus topic. Present two resources, national or local, for the proposed education plan that can be utilized by the provider or the patient.
Identify interdisciplinary health professionals important to include in the health promotion. What is their role? Why is their involvement significant?
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.
Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style CLC – Health Promotion and Community Resource Teaching Project.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Materials if you need assistance.
Course Code
Class Code
Assignment Title
Total Points
NRS-429VN
NRS-429VN-O502
CLC – Health Promotion and Community Resource Teaching Project
160.0
Criteria
Percentage
Unsatisfactory (0.00%)
Less than Satisfactory (75.00%)
Satisfactory (79.00%)
Good (89.00%)
Excellent (100.00%)
Content
100.0%
Approved Topic, Associated Population and Health Disparity
10.0%
Topic and associated population selected is not approved; topic and associated population are not relevant to the scope of the assignment. Topic and associated population are omitted.
Approved topic and associated population are partially presented. It is unclear how the topic adversely affects the selected population. Health disparities are partially described, or are not relevant to selected population. There are significant inaccuracies.
Approved topic and associated population are summarized. A general correlation of how the topic adversely affects the selected population is presented. Relevant health disparities are summarized. There are some inaccuracies. More evidence or rationale is needed for support.
Approved topic and associated population are described. A correlation of how the topic adversely affects the selected population is established and discussed. Relevant health disparities are discussed. There are minor inaccuracies. Some evidence or rationale is needed for support.
Approved topic and associated population are thoroughly described. A strong correlation of how the topic adversely affects the selected population is established and discussed in detail. Relevant health disparities are clearly presented and discussed. Strong evidence and compelling rationale is offered for support.
Evidence-Based Approaches to Optimize Health for Population
10.0%
Evidence-based approaches to optimize health for this population are not presented.
Evidence-based approaches to optimize health for this population are partially presented; some approaches presented are not evidence-based, or are not relevant for this population. Explanation of how these approaches minimize health disparity is incomplete, or are not relevant for the affected population. There are significant inaccuracies.
Evidence-based approaches to optimize health for this population are summarized; it is unclear how some approaches presented are relevant for this population. A general explanation of how these approaches minimize health disparity is presented. There are some inaccuracies. More evidence or rationale is needed for support.
Evidence-based approaches to optimize health for this population are discussed. Explanation of how these approaches minimize health disparity is presented. Some evidence or rationale is needed for support.
Evidence-based approaches to optimize health for this population are discussed, and approaches are accurately represented and highly relevant to the population. Explanation of how these approaches minimize health disparity is well-developed. Strong evidence and rationale are provided throughout. An understanding of the importance of evidence-based approaches in the optimization of health for an at-risk population is demonstrated.
Proposal for Health Education for Family-Centered Health Promotion CLC – Health Promotion and Community Resource Teaching Project
10.0%
A proposal for health education for a family-centered health promotion to address the issue for the target population is omitted. The proposal is not supported by evidence-based practice.
A proposal for health education for a family-centered health promotion to address the issue for the target population is partially presented. The proposal is not entirely relevant to the target population. The proposal requires more support relevant to evidence-based practice. There are significant inaccuracies.
A proposal for health education for a family-centered health promotion to address the issue for the target population is presented. It is generally supported by evidence-based practice; there are some inaccuracies, or some areas need more support using evidence-based practice. Overall, the proposal is relevant to the target population.
A proposal for health education for a family-centered health promotion to address the issue for the target population is presented. It is supported by evidence-based practice and relevant to the target population. There are minor inaccuracies.
A well-developed proposal for health education for a family-centered health promotion to address the issue for the target population is presented. It is strongly supported by evidence-based practice and highly relevant to the target population. The ability to apply evidence-based practice to health education for a target population is clearly demonstrated.
Resources and Organizations for Proposed Education Plan
5.0%
Resources and organizations to support the proposed education plan are omitted.
One health-related organization for the selected topic is presented. The profile is incomplete, or it is unclear how the organization is relevant to the focus topic. Two resources (national or local) are presented. It is unclear how the resources are supposed to be used, or how the resources are relevant to the focus topic.
A general profile for a health-related organization relevant to the selected topic is summarized. Two relevant resources (national or local) are presented, and there is a general explanation for how the resources are supposed to be used by the patient or provider.
A general profile for a health-related organization relevant to the selected topic is presented. Two relevant resources (national or local) are presented, and there is an explanation for how the resources are supposed to be used by the patient or provider.
A general profile for a health-related organization relevant to the selected topic is well presented. Two relevant resources (national or local) are presented, and there is a clear explanation for how the resources are supposed to be used by the patient or provider.
Interdisciplinary Health Professional Involvement
5.0%
Interdisciplinary health professionals important to the health promotion are not included.
At least one significant interdisciplinary health professional is presented. It is unclear how the professional important to the health promotion, and what the role of the professional would be. Support for the suggested member is needed.
Some significant interdisciplinary health professionals are presented. A summary of their role and importance to the health promotion is provided. Some support for the suggested members is needed.
Key interdisciplinary health professionals are presented A discussion of their role and importance to the health promotion is provided.
All significant interdisciplinary health professionals are presented. A clear discussion of their role and importance to the health promotion is provided.
Presentation of Content
40.0%
The content lacks a clear point of view and logical sequence of information. Includes little persuasive information. Sequencing of ideas is unclear.
The content is vague in conveying a point of view and does not create a strong sense of purpose. Includes some persuasive information.
The presentation slides are generally competent, but ideas may show some inconsistency in organization or in their relationships to each other.
The content is written with a logical progression of ideas and supporting information exhibiting a unity, coherence, and cohesiveness. Includes persuasive information from reliable sources.
The content is written clearly and concisely. Ideas universally progress and relate to each other. The project includes motivating questions and advanced organizers. The project gives the audience a clear sense of the main idea.
Layout
5.0%
The layout is cluttered, confusing, and does not use spacing, headings, and subheadings to enhance the readability. The text is extremely difficult to read with long blocks of text, small point size for fonts, and inappropriate contrasting colors. Poor use of headings, subheadings, indentations, or bold formatting is evident.
The layout shows some structure, but appears cluttered and busy or distracting with large gaps of white space or a distracting background. Overall readability is difficult due to lengthy paragraphs, too many different fonts, dark or busy background, overuse of bold, or lack of appropriate indentations of text.
The layout uses horizontal and vertical white space appropriately. Sometimes the fonts are easy to read, but in a few places the use of fonts, italics, bold, long paragraphs, color, or busy background detracts and does not enhance readability.
The layout background and text complement each other and enable the content to be easily read. The fonts are easy to read and point size varies appropriately for headings and text.
The layout is visually pleasing and contributes to the overall message with appropriate use of headings, subheadings, and white space. Text is appropriate in length for the target audience and to the point. The background and colors enhance the readability of the text.
Language Use and Audience Awareness (includes sentence construction, word choice, etc.)
5.0%
Inappropriate word choice and lack of variety in language use are evident. Writer appears to be unaware of audience. Use of primer prose indicates writer either does not apply figures of speech or uses them inappropriately.
Some distracting inconsistencies in language choice (register) or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.
Language is appropriate to the targeted audience for the most part.
The writer is clearly aware of audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.
The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5.0%
Slide errors are pervasive enough that they impede communication of meaning.
Frequent and repetitive mechanical errors distract the reader.
Some mechanical errors or typos are present, but they are not overly distracting to the reader.
Slides are largely free of mechanical errors, although a few may be present.
Writer is clearly in control of standard, written, academic English.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5.0%
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Total Weightage
100%
CLC – Health Promotion and Community Resource Teaching Project
May 30, | nursing, med, NURS, Paper
Tulsa Memorial Hospital Case Study
Tulsa Memorial Hospital Case Study
Assignment for Unit 2 – Tulsa Memorial Hospital (SoonerCare)
You are a member of the consulting firm advising Dr Wilson. The following case study contains the instructions and requirements for the deliverable.
Tulsa Memorial Hospital is a community hospital in Tulsa, Oklahoma. Recently, the hospital and its affiliated physicians formed Tulsa Memorial Healthcare (TMH), a physician-hospital organization (PHO). TMH is close to signing its first contract to provide exclusive local healthcare services to enrollees in SoonerCare (the Plan), the local Blue Cross Blue Shield of Oklahoma HMO TMH as an alternative. In the proposed contract, TMH will assume full risk for patient utilization. In fact, the proposal calls for TMH to receive a fixed premium of $200 per member per month from the Plan, which it then can allocate to each provider component in any way it deems best using any reimbursement method it chooses. TMH’s executive director, Dr. Randy Wilson, a cardiologist and recent graduate of the University of Oklahoma Nonresident Program in Administrative Medicine, is evaluating the Plan’s proposal. To help do this, Dr. Wilson hired a consulting firm that specializes in PHO contracting. The first task of the consulting firm was to review TMH’s current medical panel and estimate the number of physicians, by specialty, required to support the Plan’s patient population of 50,000, assuming aggressive utilization management. The results in exhibit 3.1 show that TMH’s medical panel currently consists of 249 physicians, whereas the number of physicians required to support the Plan’s patient population is only 61. Note, however, that TMH physicians serve patients other than those in the Plan. Thus, the total number of physicians required to treat all of TMH’s patients far exceeds the 61 shown in the right column of exhibit 3.1. Tulsa Memorial Hospital Case Study
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The second task of the consulting firm was to analyze TMH’s physicians’ current practice patterns. Clearly, utilization, and hence, cost is driven by·TMH’s physicians and that variation in practice patterns. Results of the analysis show significant variation in practice patterns, both in the physicians’ offices and in the hospital. For example, exhibit 3.2 contains summary data on hospital costs by physician for three common diagnosis related groups (DRGs). Consider DRG 470 (major joint replacement). The physician with the lowest hospital costs averaged $12,872 in costs per patient, the highest-cost physician averaged $24,638, and the average cost for all physicians was $14,999. The consulting firm commented that reducing this variation is important because TMH is at full risk for patient utilization.
The third task of the consulting firm was to recommend an appropriate allocation of the premium dollars to each category of provider. Specifically, the contract calls for TMH to receive $200 per member per month, for a total annual revenue of$200 x 50,000 members x 12 months = 120 million. To reduce potential conflicts about how to divide the 120 million among providers, the consulting firm proposed a “status quo” allocation that would maintain the current revenue distribution percentages shown in exhibit 3.3.
The final task of the consulting firm was to recommend provider reimbursement methodologies that create appropriate incentives. In the contract, TMH assumes full risk for patient utilization, so the consulting firm recommended that all component providers be capitated to align cost minimization incentives throughout TMH. Furthermore, capitation of all providers would eliminate the need for risk pools, a risk-sharing arrangement that TMH has never used. In addition to the consulting firm’s report, Dr. Wilson decided to ask TMH’s new operations committee for a short report on th;e current line of thinking among TMH’s major providers. The committee provided the following information.
Tulsa Memorial Hospital
Historically, the profitability of Tulsa Memorial Hospital has been roughly in line with the industry. Last year, when the hospital received about 75 percent of charges, on average, the hospital achieved an operating margin of about 3 percent. However, hospital managers are concerned about its profitability if the Plan’s proposal is accepted. The managers believe that controlling costs under the full-risk contract would require extraordinary efforts and that the most effective way to control costs is to create a subpanel of physicians to participate in the capitation contract. When asked how the subpanel should be chosen, the operations committee recommended choosing the physicians who would do the best job of containing hospital costs.
Primary Care Physicians
Many of the primary care physicians are dissatisfied. On average, primary care physicians receive only about 60 percent of charges and are concerned about being penalized by accepting utilization risk for the Plan’s enrollees. Primary care physicians know that they are paid less and believe that they have to work much harder than do the specialists. Furthermore, primary care physicians believe that the specialists supplement their own incomes by overusing in-office tests and procedures. Some primary care physicians are even talking about dropping out of TMH to form their own contracting group, taking away the entire capitation payment from the Plan and contracting themselves for specialist and hospital services.
Specialist Care Physicians
The specialists believe that the primary care physicians refer too many patients to them. The specialists do not mind the referrals as long as their reimbursement is based on charges because, on average, they receive 90 percent of charges. However, if they are capitated, the specialists want the primary care physicians to handle more of the minor patient problems themselves. Also, whenever the subject of subpanels is raised, many of the specialists become incensed. ”After all,” they say, “the whole idea behind the PHO is to protect the specialists.” Both sets of physicians-primary care and specialist-agree that the hospital is hopelessly inefficient. Said one specialist, “No matter how much revenue the hospital receives, it still seems to barely make a profit.”
Question 1
What reimbursement method would you recommend for each of the following providers? Be sure to justify your answers.
Primary Care Physicians
Primary care physicians should be paid by capitation, which, however, encourages these physicians to shift patients to other service providers, but the sharing of risk will generate incentives to lower utilization levels of hospitals as well as specialists aligned to patient traffic. Aleternatively these physicians can also be paid service fee on discounted basis which will work as an incentive offer comprehensive preventive care thereby restricting cost escalation in the long run.
Specialists
Specialists can also be paid by capitation, but then there exist peculiar issue with respect to this mode of payment. Based on estimated patient population of 50,000, the number of physicians required for certain specialities will be relativley smaller. Given as per exhibit 3.1, the number of cardiology, neurosurgery, thoraic, and urology surgeons required is just 1.0 in each case. Around 25 specialists would be optimal, however with lower utilization levels resulting in accretion of lower capitation payments from PHO. As a result of this a small increase in high-cost patients will put physician on the losing side with lower capitation fees. Thus it is wise to pay specialists on a discounted-fee basis, however may be lower than their current reimbursement percentage of 90%.
Hospital
It is a common practice with managed care plans to pay hospitals on a per day basis and hence make it attractive for physicians to limit admissions and length of stay. This is because hospital utilization can be controlled more effectively by managed care plans than the hospital itself. As a result, payment on per day basis will keep a check on the costs over the long run for the PHO.
Other Services
The utilization levels are lower and unpredictable in this case and such services are often managed by out-of-area providers. Thus they should be reimbursed on fee-for-service basis. Services given by frequent providers can be engaged at discounted contract rates and rest should be paid at actuals.
Question 2
What allocation of premium dollars do you recommend for each provider? Be sure to justify your recommendations.
Though the case provide allocation as guided by the consultant, we have made certain changes to include consideration for risk pool, which was ignored by the consultant. According to us, PHO administration overhead and in-system physicians should be given the greater allocation than what was advised by the consultant. This is because if fixed payments needs to be made to PHO and are made accountable for healthcare needs of the covered population, it needs to be equipped with talent pool of managerial staff and adequate information system which will enable them to exercise control over its components. Further, PHO should be in a position to create reserves (surplus overheads) to cover any such payments to providers on non-capitated basis over and above those allocated.
Primary care should be given higher allocation and specialists and in-system hospital should be given lower allocation than recommended by the consultants in order to set up a risk sharing arrangements within the PHO so as to reduce the amount of specialty and inpatient services provided going ahead. While the primary care physicians’ charges can be increased above traditional rates, the total compensation of specialists and hospital must be reduced in order to run successful PHO. Under the new contract, if utilization levels of these services are reduced, the profitability of specialists and hospital can be increased but with increased pressure on the hospital and specialists under the new proposed revenue distribution. Professional and in-patient services risk pools should be encouraged to get established which will provide financial incentives for promoting more cost effective and efficient practice patterns. Given that rest of categories falls outside the purview of PHO, the recommendations given by consultant seem reasonable.
The new allocation should be phased over next two to three years, instead of pushing from year 1, in order to make hospital and specialists familiar with reduced allocation of reimbursements and understand and respond to newly introduced incentives of risk pools so as to become more productive and efficient. Tulsa Memorial Hospital Case Study
Question 3
What proportion of the premium dollar would you allocate to the professional services risk pool?
Generally, risk-sharing arrangements allocate 10% to 20% of each reimbursement amount to one or more risk pools. Since PHO has never used risk pools in the past, it is prudent to start with 10% with gradual increase in later periods one they become familiar with the risk sharing experience. Since typical allocation of premium dollar for specialists is given as 16%, the allocation to professional services risk is given as 10% x 16% = 1.6% of premium amount and rest 14.4% is allocated to specialists.
How would you split the professional services risk pool between primary care physicians and specialists?
We have taken 50% for each category in order to maintain simplicity.
What proportion of the premium dollar would you allocate to the inpatient services risk pool?
Typical allocation of premium amount for hospital is 33%. Similar to professional services risk pool, 10% x 33% or 3.3% of premium amount is allocated to inpatient services risk pool and balance 29.7% or premium amount is allocated to hospitals.
How would you split the inpatient services risk pool among primary care physicians, specialists, and the hospital?
For simplicity purpose, we have divided this equally among the three parties. Tulsa Memorial Hospital Case Study
Question 4
Conduct a sensitivity analysis. More specifically, using your allocation of the premium dollars, how does the total budgeted reimbursement compare with the total actual reimbursement to primary care physicians, specialists, and the within-system hospital.
If actual payments equal the premium allocation?
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If both specialist and hospital payments are 10 percent greater than the premium allocation?
If both specialist and hospital payments are 10 percent lower than the premium allocation?
Do the risk pools provide appropriate incentives to the primary care physicians and the specialists?
If actual payments of hospital and specialists are above 10% over the budgetary allocation, the primary care physicians failed to exercise proper control over referrals to specialists, and specialists failed to exercise proper control over hospital utilization. As a result, the actual reimbursement of both groups is less than the budget.
In case of primary care physicians, the actual payment equals the budgetary allocation given that we chose to capitate them. However, their poor specialist referral program reduces the amount they receive from professional services risk pool from $960,000 to $96,000 and hence indicates that they have incentive to reduce specialist referrals.
In case of specialists, the actual premium payment at $19,008,000 is more than the budgetary allocation given that the physicians are paid on discounted-fee service basis. However, such increase in premium payment is offset by decline in professional service risk pool (reduced from $960,000 to $96,000) amount influenced by poor specialist referral performance of primary care physicians. The amount further gets reduced by inpatient service risk pool (reduced from$1,320,000 to $132,000) due to poor performance of specialists with respect to utilization of hospital. This shows that specialists have clear incentive to reduce hospital utilization. This has also reduced primary care of physicians share of inpatient risk services pool from $1,320,000 to $132,000. v
Above analysis reveal that, the risk pools provide clear incentive for control of specialist referral and hospital utilization.
Question 5
What are some reasons in favor of forming subpanels of the PHO’s primary care physicians to handle only Plan patients?
It makes financial sense to create subpanels to handle only Plan patients.
Primary Care Physicians will have only capitated payments and thus will not have to worry about varying incentive structure based on different reimbursement methodologies.
Overheads would be reduced in absence of need to maintain staff for billing third party vendors.
Risk of each provider on the panel would be reduced given that they would have large number of capitated patients from the Plan.
Of the total 57 primary care physicians, 25 can work on Plan patients and rest on non-Plan patients.
What are some reasons against forming subpanels of the PHO’s primary care physicians to handle only Plan patients?
In reality subpanel may be difficult to create given that only those primary care physicians may be willing to join who do not have full workload of patients and hence may not give requisite numbers.
While some physicians may have lower number patients because of low traffic, others may have because of poor quality of physicians or poor bedside manners.
Voluntary formation of subpanel may create pool of less efficient and effective Team.
Because of full workload by these members, Plan patients, currently seeing other primary care physicians, may be forced to change physicians as would non-Plan patients who are seeing the physicians for the Plan. It will create problems both for the physicians, by losing patients, and for the patients, who would have to change physicians. Tulsa Memorial Hospital Case Study
As a result, keeping competitive forces in mind, restricting Plan patients to lower number of primary care physicians will impact PHO’s revenues.
Should subpanels of the PHO’s specialists be created to handle only Plan patients?
It is easy to create subpanels for specialists. Given that future reimbursements might be less than the current reimbursements, specialists could be polled to find out their interest to join subpanel to serve Plan patients. So long as sufficient numbers are recruited, subpanel may be created for each category. Since they would continue to reimbursed based on discounted-fee for service basis, billing and efforts would remain unaffected.
Question 6
Consider some other actions that the PHO could take to ensure that its contract with the Plan is successful. Specifically, comment on the advisability and feasibility of taking actions in the following areas:
Utilization Review
PHO must be in possession of adequate information system in order to ascertain individual physician referral costs and the costs and effectiveness of alternative treatment methods. Further PHO should convince providers that lower-cost treatment is equally effective compared to higher cost treatment and hence encourage providers to use lower cost methods. Further such review can be used to limit referrals and inpatients utilization to those that are clinically warranted. Tulsa Memorial Hospital Case Study
Quality Management
Better the quality lower will the costs in the long run. Hence use of correct procedure and use it in the first attempt will be crucial. Stressing on quality throughout PHO will lead to higher patient satisfaction thereby ensuring contract renewal with the Plan and a potential driver to negotiate higher payments.
Information Systems
All above actions and performance will become possible only with availability of accurate, timely and structured clinical and financial information. Lack of availability of information will lead to collapse of entire PHO. Hence creation of proper information system infrastructure will be critical for the success of PHO which will help to manage patient population and financial drivers under check. Tulsa Memorial Hospital Case Study
Question 7
What are three key learning points from this case
It helps to build an understanding on premium payment allocation and risk-sharing with an integrated set up – PHO.
It helps to build an understanding on impact of referrals and hospital utilization on premium payments.
It improves analytical skillset with respect to using the case information into a financial model and interpret results basis change in assumptions. Tulsa Memorial Hospital Case Study
