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Other Healthcare Organizations |
Creating a New Approach to
Financial and Operational
Projections for a Home Health Agency
Client Profile: One of the nation’s largest non-profit home health agencies
Project Type: Strategic and business planning
Challenge: To create a new approach for the agency to project visit volumes and staffing needs in an environment of changing payment approaches that affect utilization. The agency had a complex and inflexible projection model that was causing significant problems in their budgeting process.
DGA Solutions and Results: DGA assessed the variables that affect volume for the various services provided by the agency including changes in payer type and referral source, as well as the rate and frequency of patient transfer between the agency’s programs.
We then designed a prospective volume simulation model for all of the client’s programs, based on a detailed understanding of the market environment. The model uses sophisticated data analysis techniques based on the relationship between market and program factors and historical utilization.
DGA’s simulation model provides the volume detail necessary for the agency to test new ideas and make sound long term financial and operational decisions. It provides four years of detailed projections with data on all patient characteristics that were available in the historical data.
Using the model, the client now has a common platform for budgeting across all of its varied divisions, and can now explore the patient and visit volume impact of a range of market and operational scenarios.
Optimizing Performance for
A PACE Organization
Client profile: A leading PACE organization experiencing rapid growth.
Project type: Care management and operations
Challenge: Optimize financial and clinical performance for a PACE organization.*
DGA Solution and Results: DGA assessed every major aspect of the organization’s management and operations:
- Clinical care and protocols
- Service pre-authorization
- Claims payment operations
- Information systems, and financial and medical cost reporting
- Staffing, policies and policy adherence
- Performance monitoring approaches
- Contracting and credentialing
- Marketing strategy
We confirmed the appropriateness of much of the operation, and developed a focus set of recommendations for improvement that provided the management staff with a clear roadmap and specific tasks.
*PACE organizations provide comprehensive managed care services as an alternative to nursing home care for a frail population. Because they receive a capitated payment to meet all of a participant’s needs, PACE organizations must apply managed care principles to a small population needing intense and complex medical and social support.
Helping a PACE Organization
Define IT Requirements
Client Profile: A well-established PACE (Program of All-Inclusive Care for the Elderly) that is part of a larger health system.
Project Type: Determine functional information technology (IT) requirements
Challenge: To assess the client’s IT needs before significant investments were made. This was a particularly complex task due to the wide range of health plan, health provider and social service agency functions provided by PACE organizations, and the relative lack of specialized software for these organizations. In addition, as part of a larger health system, the PACE organization was expected to accept certain system IT services that did not meet the unique needs of PACE organizations.
DGA Solution and Results: We interviewed staff and management, defining the organization’s functional IT needs, including workflow, reporting and data analysis. We determined which data was now captured in systems (including an electronic medical record and a claims system) and which was paper-based.We identified risks and inefficiencies associated with duplication of effort and opportunities to provide better management information.
DGA recommended an overall strategy for information technology, refining a strategy recommended by the PACE organization’s health system parent. Our recommendations reduced complexity with only minimal reductions in functionality, an approach readily embraced by the PACE organization and the parent organization’s IT staff.
The strategy included use of an SQL database to improve data integrity for home-grown Access and Excel applications. In addition, the existing specialized stand-alone software systems feed a business intelligence data warehouse to support reporting and analysis.
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