Each team will carefully read the case scenario presented below, and then prepare for formal proposal and recommendations on how the organization can more effectively manage its clients with chronic diseases. This proposal will be for a new tracking system that will meet the needs of the key stakeholders. The team should carefully weigh all acquisition options, which would include building in-house, contracting with an application service provider, or lease versus buy. The proposal will need to incorporate the following components:

Executive summary
Background
Financial analyses, which will include, at a minimum, the revenue impact, cost reductions, capital budgeting (NPV and IRR, assuming a cost of capital of 10%)*
Patient or customer satisfaction*
Quality of work life; quality of care*
Regulatory compliance; potential learning value *
Formal recommendations (logically presented and well supported)
The asterisked components will be the criteria used by the integrated delivery systems senior leadership team to make a decision on whether or not to adopt the teams recommendations.

Case Scenario

Your team will work with the manager of the medical management department of a small integrated healthcare system, which includes several hospitals, a network of physicians and specialists, and outpatient clinics that have a high volume of Medicaid patients. The Chief Medical Officer (CMO) has asked the team to work with the manager to improve the organizations medical management programs, such as disease management and case management intervention strategies, and track the outcomes and costs of care to help manage patients with chronic diseases, such as asthma and diabetes. Recent reports for the organization showed that avoidable emergency room and hospitalization costs for these patients have increased steadily over the last few years and that appropriate primary care and specialty care is underutilized for many of these patients.

The organization currently has case managers and a disease management program for some patients with chronic diseases. The case management and disease management program intervention strategies currently include patient assessment, care planning, patient and provider education, as well as monitoring utilization of health services, such as primary care and specialty office visits, lab tests and results, and prescriptions.  Other interventions that have been useful in patient management are appointment and scheduling reminders, mailings of educational materials, and regular telephone conferences with patients and providers. Patient compliance with care plans and active participation of patients in case management and disease management programs are often challenging, because of lack of incentives, transportation, and other socioeconomic issues with many Medicaid patients. Many of these patients do not regularly see a primary care physician, and some patients on Medicaid do not have consistent and valid home addresses, email addresses, or home telephone numbers.

Information on medical management interventions and outcomes for patients are tracked manually, and opportunities to identify patients at-risk are missed due to lack of access to complete and timely information.  Currently the case managers and disease managers have access to a basic disease registry in a database created by the Information Systems department. An electronic medical record system is currently only available in the hospitals, but not in the physician offices. The Information Systems department also provides a monthly report that lists those patients with chronic diseases who have been seen in the emergency room and who have been hospitalized. Also the finance department has some claims data from various providers, such as physician offices, hospitals, lab and pharmacies within the integrated healthcare system.

The manager has expressed a desire to develop or acquire a new system to track and manage the information and data that are available and identify any other useful sources of data to help manage patients with chronic diseases. The manager is also interested on how physician offices, hospitals, health plans, and pharmacies can also participate in this tracking system, in order to improve medical management strategies, communication, continuity of care, and reduce costs for these patients. The CMO agrees that the system needs to develop or purchase a new tracking system complete with performance indicators to help track progress toward goals and monitor the outcomes of patients with chronic diseases. The team will need to submit a proposal with recommendations for a new tracking system through the CMO to the rest of the integrated delivery systems senior leadership team.  These efforts will also help the organization comply with Pay-for-Performance programs between the health system and several health plans.

Important Notice: It is at the sole discretion of the instructor to change team members with or without advance notice for cause or for no reason at all. In addition, the instructor has the right to change the parameters of the team projects, including, but not limited to: moving up or pushing back due dates, changing deliverable expectations, or request progress reports. 

Permission to Use

Explicit permission to adapt this case scenario for use in HA509 was granted by the copyright holder, Dr. Maria Kronenburg, on March 9, 2016, at 9:36 p.m.

Team Project Deliverable (Formal Proposal) Description (0 points)

There are NO page limits associated with this deliverable; however, it is expected the quality of the product will be consistent with that expected of an industry professional.  Special attention should be given to the quality and accuracy of the content; the layout of the content; and ensuring the topics flow logically throughout the document. The proposal must adhere to the APA writing style (6th edition) ONLY in terms of properly in-text citing and the listing of sources on a references pages. The remaining form and style guidelines covered in the APA are suspended for purposes of completing this project. The proposal will be due Friday, by 11:59 p.m. (CT), and uploaded in the appropriate Unit 8 assignment page. 

My portion is to be written on these two subjects: Patient or customer satisfaction, and
Quality of work life; quality of care.