Business Planning to

Inform Next Steps

Shannon T. Harvey, LCSW, ACSWMacon, Georgia Communities in Charge

478-994-1914 sharvey@chwg.org

Convening Intent:Systemic Change in the Financing and

Delivery of Healthcare for the Uninsured

Initial Planned Financing Strategy:•2 partner hospitals contribute:

$4,419,150 through increased DSH payments from the indigent care trust fund

•1 partner hospital contribute: $4,080,850 through increased Medicaid payments

Contingent on Department of Community Health and HCFA approval

Initial Planned Sustainability Strategies:

Sale of safety net enhanced care management services to state benefit programs

ICTF prospective payment demonstration project with partner hospitals sharing resulting cost savings with HCCG

Business Plan Iteration #1:

$8,499,600 to $0 overnight

Leadership at DCH gone

Now what?

Business Plan Iteration #1 Decision:

• Begin with donated hospital/MD care model

• Local partner contribution to cover pharmacy, DME, lab

• Based on actuarial studies: $1,137,000• Secondary gain: Leverage with other

grantors

Business Plan Iteration #1 Further Exploration re: Sustainability:

Can the sale of care management services to public payors generate

enough revenue to support the administrative and case

management functions of the uninsured program?

2002 Medimetrix TA Bottom Line: • At $10 PMPM with enrollment of 5000 first year, 7500 increase each

year thereafter and 800 enrollees per care manager: losses from $681,201 to $2,167,087 annually for first five years.

• At $20 PMMPM with enrollment of 5000 first year, 7500 increase each year thereafter and 800 enrollees per care manager: losses from $381,201 to $473,947 annually for first three years, minimal revenues thereafter.

• At $10 PMPM with enrollment of 5000 first year, 7500 increase each year thereafter and 1600 enrollees per care manager: losses from $681,201 to $790,340 annually for first five years.

Conclusion: Not feasible, difficult process, draw resources away from services to uninsured

Business Plan Iteration #2 – 2C:

1 – Prove value to local investors - Recoup of caid/care/insurance – direct out of system - Evaluation

2 - Legislative action – huge changes this session

3 - Maximize leveragable assets - Partnership and Leadership - Local investments - Information technology and other infrastructures

So what’s the point?

Business planning, even when it yields answers you “don’t want”, is useful in informing next steps.

Finally…

Making the Business Plan Practical in the Day to Day…

1.Take Care of Patients2.Add Value to Partners3.Maximize Every Investment