Chapter 15 Managing Finance and Budgets1Objectives

Chapter 15: Managing Finance and Budgets
1
Objectives
Know the elements of a business plan
Be able to interpret a set of organizational financial documents
Understand budgets and explain the uses of budgets
Be able to construct incremental and zero-based budgets
Outline
Business Plans
Financial Statements
Budgets and Budgeting
Operating Budget
Capital Budget
Cash Budget
Zero-based Budget
Implementing and Using Budgets
Using Budgets to Evaluate Organizational Performance
Business Plans
Outline used to launch, maintain, or expand the activities of an
organization
9 components

Executive summary
Market analysis
Description of the organization
Ownership and management
Marketing and sales strategy
Description of product, program, or service
Funding needed
Prospective financial data
Appendix
Financial Statements
Convey the financial position of an organization
4 parts:
Income Statement
Balance Sheet
Statement of Cash Flows
Statement of Retained Earnings
Income Statement
Also known as the profit and loss statement
Details the sales, expenses, and net income generated by an
organization
6
Balance Sheet
Also known as the statement of financial position
3 sections

Assets
Liabilities
Equity
Assets = Liabilities + Equity
Cash Flows
Reconciles changes in cash balances of a business
3 sections
Operating activities
Investing activities
Financing activities
See Figure in text for an example
Retained Earnings
Reconciles the equity section of the balance sheet
4 parts
Beginning equity balance
Net income
Dividends paid
Final equity balance

Budgets
Budget is defined as a comprehensive, detailed plan for
achieving an organization’s goals and objectives expressed in
monetary terms
Budgets include data which are:
Objective
Measurable
Obtainable
Preparing a Budget
Budget preparation will likely include many revisions.
Approaches to budgeting:
Incremental: based on previous budget
Zero-based: starts with blank slate
Completing a budget should involve input from various levels
of personnel (executives to front-line staff)
Types of Budgets
Operating – detailed plans for revenues and expenses
Capital – plan for spending on improvements and additions to
property, buildings, or equipment
Cash –detailed estimates of anticipated cash receipts and
disbursements

Operating Budget
Contains detailed plans concerning the anticipated revenues and
expenses for every product, program, or service delivered
Created at the department or unit level but rolled up into a
consolidated operating budget
Operating budgets contain four parts: statistics, revenues,
expenses, and pro forma
Operating Budget: Statistics
Contains information related to the expected extent and scope of
activities.
3 steps/decisions
1) Output expectations – estimates of the activities of a given
department
2) Methodology – the approach used to calculate output
expectations
3) Responsibility – accountability for meeting expectations
placed with appropriately knowledgeable personnel
Operating Budget: Expenses
Converts expected work activities into predicted expenditures
2 main components:
1) statistical information – generally a unit of volume to
measure service output
2) cost data – all costs can be defined as either variable or fixed
The time length of an expense budget can be fixed or rolling
Allocating indirect costs can be contentious

Operating Budget: Revenues
Estimates the payments or other monetary collections used to
offset expenses
Revenue budgets are driven by the statistics and expense
budgets
Rates are designed so that the anticipated expenses break even
at minimum
Remove period in bullet two
Pro forma Budget
Designed to project revenue and expenses for a possible
scenario
Contains information developed in the statistics, expense, and
revenue budgets
Used as a final test to check the validity of the other budgets
and the accuracy of their assumptions
Capital Budget
A plan for spending on improvements and additions to property,
plant, or equipment (generally fixed assets)
Capital budgets are long-term in nature (greater than 1 year)
and require an analysis of the time value of money.
The time value of money is an analysis that determines the
current value of future money

Analyzing a Capital Request
Non-financial Criteria:
Safety and Regulatory
Quality and Customer Service
Mandatory Replacement
Discretionary Replacement
Expansion
Cash Budget
Used to evaluate an organization’s solvency in the immediate
future
Uses information from the operating and capital budgets
Typically compiled for one or more defined periods within a
budget cycle
Zero-based Budget
Arranges an expense budget using the assumption that no
existing program is entitled to renewal
Cost data is obtained and listed as in incremental budget
Importance of each budget item is prioritized and ranked
Rankings are split into two categories, those required by law
and those not required by law

Incremental Budget
A budget developed by modifying an existing budget, usually
the current or previous
Modifications are based on changes in assumptions
Changes tend to be small and applied uniformly to all categories
Remove period in bullet one
Implementing and Using Budgets
Creating an appropriate budget requires informed decision
making and this can be accomplished by:
Budget reviewing and analysis
Enabling employee participation
Anticipation of funding needs over time
Context of quality and customer service
Budget Options
Type of Budget – incremental or zero-based
Level of Detail – determine how thorough data collection
activities should be
Sources of Information – deciding who should participate in
budget creation and what sources of data should be used

Budget Options (continued)
Approach to Information Gathering
Bottom-up budgeting – budget process starts with information
provided by front-line workers
Top-down budgeting – budget process starts with senior
managers influencing and controlling budget inputs
Expense Budgets – Fixed budget vs. flexible expenses
Bottom-Up vs. Top-Down Budgeting
Using Budgets to Evaluate Organizational Performance
Monitoring the Budget
Setting Performance Standards
Using Industry Standards
Comparing Organizational Performance with Industry Standards
Evaluating and Correcting Organizational Processes
Variance Analysis
Variance Analysis
Using monthly variance analysis is an effective way to compare
planned budgets and actual expenditures
4 steps:
1) focus on significant variances
2) identify the cause for each variance
3) concentrate on controllable variances
4) take action to correct variance

BUSI 511
Discussion Board Rubric
(50 Points)
Content 70%
Advanced
Proficient
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Content
20 Points
Points: 18 to 20
All key components of the Discussion Board Forum prompt are
answered in the thread.
Major points are supported by all of the following:
· Reading & Study materials;
· Pertinent, conceptual, or personal examples;
· Thoughtful analysis (considering assumptions, analyzing
implications, and comparing/contrasting concepts); and
· Two peer-reviewed source citations in current APA format, the
text and the integration of 1 biblical principle.
Points: 17
Some key components of the Discussion Board Forum prompt
are answered in the thread.
Major points are supported by some of the following):

Points: 1 to 16
Minimal key components of the Discussion Board Forum
prompt are answered in the thread.
Major points are supported by none of the following:
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Points: 14 to15
Contribution made to discussion with each reply expounding on
the thread.
Major points are supported by all of the following:
Points: 13
Marginal contribution made to discussion with each reply
slightly expounding on the thread.

Major points are supported by some of the following):
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Structure 30%
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Proper spelling, grammar, and APA format are used.
Points: 1.5

Marginal spelling, grammar, and APA format are used (1-3
errors are present).
Points: 1
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Points: 0
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5 points
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Required word count (at least 600 words) is met.
Points: 4
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(300–599 words).
Points: 1 to 3
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or less).
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/50
Instructor’s Comments:
Topic: Major Characteristics of U.S. Health Care Delivery
Thread: First, what are the 2 main objectives of a health
delivery system? Next, what are the 10 characteristics of the
U.S. health care system? How is access to medical care and
satisfaction improved for patients receiving care from an

accountable care organization (ACO)?
Create a thread using the topic to respond to the prompt.
Response should be at least 600 words with at least 2 peer-
reviewed sources citations, in addition to the course
textbook, in current APA format, and integration of at
least 1 biblical principle.
Chapter 14: Managing Performance and Quality
1
Objectives
Understand the importance of improving organizational
performance through performance management, program
evaluation, and continuous quality improvement (CQI)
Be able to explain the Turning Point model of performance
management
Be able to explain a logic model and how it can be used to
evaluate and improve programs
Remove “ing” on the first bullet
Objectives (continued)
Be able to define quality from the perspective of health care
delivery and from the perspective of public health
Understand CQI methods and techniques such as process maps,
the Plan-Do-Check-Act cycle, Lean, and Six Sigma

Outline
Performance Management
Evaluating Programs
Continuous Quality Improvement
Defining Quality
Overview of Quality in the United States
Six Sigma
Lean
Plan-Do-Check-Act
Performance Management
Defined as “a framework for organizational evaluation and
improvement.” Used widely in both the public health and
private health sectors.
Performance Management in Public Health
Turning Point model:
Performance standards
Performance measurement
Quality improvement process
Reporting progress
Performance Management in Health Services Delivery
Accreditation (Joint Commission) standards
Baldrige Criteria for Performance Excellence

Awards the Malcolm Baldrige National Quality Award, the
highest level of national recognition for performance
improvement
Criteria include: leadership; strategic planning; customer focus;
measurement, analysis, and knowledge management; workforce
focus, process management, and results
Performance Management System
Uses performance standards, measures employee performance
and output, regularly reports progress, and includes a quality
improvement program
Example of measures: balanced scorecard –
employee satisfaction
financial outcomes
internal efficiency and quality
client satisfaction
Evaluating Programs
Systematic assessment of the operation and/or outcomes of a
program, compared to a set of standards, in order to improve the
program
Two types of evaluation
Formative
Summative
Formative Evaluation

Used to determine whether a service or program is evolving as
intended
Involves the collection of evidence during the creation and
implementation of a program
Allows for revision that can improve a program as it is in the
development phase
Summative Evaluation
Directed towards a general assessment of the degree to which
the outcomes have been attained over the entire course of the
program
Used to determine the merit of a program by evaluating it when
at full strength
Results in a final judgment about a program
Framework for Program Evaluation
Program Evaluation Framework (Centers for Disease Control
and Prevention):
Assess
Program Implementation: what took place?
Program Effectiveness: did it improve health outcomes?
Program Accountability: cost-benefit, cost effectiveness
Logic Models

A logic model is a graphical representation of the logical
relationships among the resources that go into a program, the
activities the program undertakes, and the benefits or changes
that occur.
Depicts how program goals, activities, and expected outcomes
link together in a chain of reasoning
Continuous Quality Improvement
Use of deliberate improvement techniques, responding to health
needs, and focusing on activities that improve health
Underuse, Overuse, and Misuse
Underuse: program or service has not been fully or optimally
utilized
Overuse: program or service in which demand exceeds supply,
or when potential risks outweigh potential benefits
Misuse: otherwise appropriate program or service is provided in
ways that result in undesirable complications or outcomes
Spelling
Defining Quality
A single definition of ‘quality’ does not exist due to varying
perspectives of stakeholders
Institute of Medicine: “the degree to which health services for

individuals and populations increase the likelihood of desired
health outcomes and are consistent with current professional
knowledge”
US DHHS: “the degree to which policies, programs, services,
and research for the population increases desired health
outcomes and conditions in which the population can be
healthy”
Spelling
Defining Quality (continued)
6 Aims of the Health Services Delivery System (STEEEP)
Safe (S)
Timely (T)
Effective (E)
Efficient (E)
Equitable (E)
Patient-centered (P)
9 Aims of the Public Health System
Population-centered
Equitable
Proactive
Health promoting
Risk-reducing
Vigilant
Transparent
Effective
Efficient
Process
All quality improvement systems analyze the processes
followed in order to improve them
A process is a series of steps designed to produce activi ties

associated with a desired outcome. A process has a beginning
and end.
Consider deleting period on number 4
Process Map
Process Map – visual diagram that reflects the steps associated
with a process or activity
Process maps do not intend to show all steps but only those that
have the greatest influence on a process
Consider deleting period on number 4
Process Map
Process maps can identify 4 types of problems:
Disconnect – poor transfers of work from one group to another
Bottleneck – a point in the process where volume overwhelms
capacity
Redundancy – repeated activities at two or more points in the
process (may be beneficial if designed)
Rework – occurs when work must be repeated.
Overview of Quality in the U.S.
CQI experts estimate only 15 percent of quality problems can be
attributed to people; the rest are due to flawed processes
Health services often fail to deliver potential benefits
Public health services, while underfunded relative to clinical
services (97% of health care expenditures are devoted to
treating sick people; 3% on primary prevention), can benefit
from quality improvement as well

Overview of Quality in the U.S. (continued)
CQI was introduced in U.S. clinical health care in the 1990s
CQI is relatively new in public health
Core processes vs. support processes
Six Sigma
An approach designed to reduce the incidence or number of
defects or errors associated with a process, with a goal of 3.4
errors per 1 million operations
5 Steps:
Define
Measure
Analyze
Improve
Control
Lean
A method intended to eliminate waste in processes
Also known as Toyota Production System
Gets rid of work that does not add value; minimizes downtime
and smooths work flow
Plan-Do-Check-Act
A common QI method used to implement quality improvement
projects
Plan- Gather and analyze specific data and observations.

Do- Test appropriate solutions to the situation.
Check- Compare results of tests through measurements and
analysis.
Act- Make the change permanent. Be prepared to go through
PDCA again if needed.
Chapter 12: Collaborating Inside the Organization
1
Chapter Objectives
Be able to define collaboration within organizations.
Explain the characteristics of four types of teams.
Describe methods of collaboration used in each type of team.
Be able to apply techniques characteristic of highly
collaborative teams.
Understand the role of leadership in collaboration.
2
Outline
Types of Teams
Ongoing Teams
Microsystem Teams
Rapidly Formed Teams
Quality Improvement Teams

Techniques for Effective Collaboration within Teams
Team Leadership
Team Conflict
3
Collaboration within Organizations
Defined as “combining the knowledge, experience, and skills of
many individuals to deliver services, programs, or products”
Occurs at all levels: individual, team, department, etc.
Results in “buy-in” among team members
Management and staff must take a collaborative approach
Individuals recognize that their views alone are not sufficient to
convert an idea into a reality
4
Teams within an Organization
The most effective method for achieving collaboration within an
organization is the use of teams
The organization must promote and reinforce effective
teamwork
Four commonly encountered types of teams:
Ongoing Teams
Microsystem Teams

5
Ongoing Teams
Consist of a formally established and defined set of individuals
who work together over time
Four characteristics:
Team members have similar training and are assigned to the
same department or working group
A formal reporting relationship exists
Have an identified leader
Team members work together frequently
6
Four Phases of Ongoing Teams
Forming: members are unsure of rules and expectations;
individuals try to avoid conflict and gain acceptance
Storming: members begin to disagree and conflicts arise; often
the most difficult phase
Norming: teams resolve issues and find constructive approaches
to work
Performing: cohesive team that can reach consensus and be
highly productive
7
Microsystem Teams
A single or small component of a larger system (embedded in a
“macro” organization)
Work must result in value to the larger system
Attributes of teams include: value, cooperation, and
communication

Example: a unit that provides medical services, embedded
within the larger hospital and public health systems.
8
A group of employees that come together for a specific,
unplanned purpose
Most emerge spontaneously
Can face significant complexity and time pressures
When the immediate goal is achieved, the team usually disbands
9
A group of individuals who work together to improve a process
Cross-functional and interdisciplinary
Focused on addressing a single problem or process
Informal
Use quality improvement tools and techniques
10
Techniques and Tools for QI Teams
Write a project charter
Outlines goals and activities to be taken to reach goals
Short, but with all relevant details of the project
Identify a project champion

A champion is an executive-level manager who manages and
guides the QI project and aligns it with system priorities
Select team members
Team members should have the expertise necessary to address
the targeted problem
A team of 5-9 individuals is preferred
11
Techniques for Effective Collaboration within Teams
Communication
Training
Conducting effective meetings
Preparing an agenda
Assigning important roles
Following the agenda
Brainstorming
Structured
Unstructured
Prioritization Matrices
Six Hats Method
12
Communication
Open, concise, and effective communications are important to
all types of teams

Require channels through which information is transmitted:
Formal: created by management and defined; easily understood
but often slow
Informal: created by individuals and based on relationships;
hard to define but often rapid
13
Training
Team training involves different behaviors and skills than
training individuals
Two interdisciplinary team training methods include:
TeamSTEPPS: teaches skills that support team performance:
training, behavior, human factors, and cultural changes
In situ simulation: an experiential team training method
14
Conducting Effective Meetings
Successful meetings require three components:
Preparing an Agenda: provides guidance and helps participants
focus
Assigning Important Roles: Facilitator, Timekeeper, and
Recorder
Following the Agenda: start and end on time and prevent
distractions

15
Brainstorming
A quality improvement method used by a team to generate many
ideas around a single issue of interest
Three primary benefits:
The whole is greater than the sum of its parts
An effective way to generate ideas rapidly
Inclusive and non-judgmental
16
Two Approaches to Brainstorming
Structured
Facilitator controls the discussion and ensures critique is
withheld
Each person participates in turn until all ideas are exhausted
Unstructured
No facilitator
Ideas may be offered by participants at any time
17
Prioritization Matrices
A QI tool used to evaluate alternatives generated by
brainstorming in a systematic manner using predetermined
decision criteria
Has two components: a list of alternatives and criteria to
evaluate each alternative
Each component is decided on by the team
Generates scores that yield a ranking of alternatives

18
Six Hats Method
Used when members of a team have to evaluate a proposed
solution in a systematic way
The “six hats” represent six different roles for team members to
assume
Five team members take on roles of objective, subjective,
positive, negative, and imaginative
The sixth hat is for the leader/facilitator
19
Example: Six Hats Method
20
Team Leadership
Good leaders listen to team members and facilitate
collaboration
Accomplished by applying two important elements:
Accomplishing Tasks: ensure all assigned tasks are performed
by team members
Supporting Individuals: address the needs of all team members
and promote positive interpersonal dynamics
21

Successful Team Leaders
Team leaders can successfully achieve a goal by:
Establishing a vision that supports the goal: provides context
and boundaries; includes an outline and timeline
Communicating the vision to others: essential for motivation
and encouragement
Exhibiting confidence that the goal can be accomplished: share
enthusiasm and have a positive attitude
22
Team Conflict
Defined as tension between team members due to real or
perceived differences.
Two common sources of team conflict: relationships and tasks
Can have positive and negative consequences
The inability to resolve conflicts may cause a team to lose focus
and even disintegrate.
The type of team often determines optimum ways to manage
conflict.
23
Four Methods to Handle Team Conflicts
Set Goals
Established and agreed upon goals make it easier to resolve
problems
Assign Accountability
Delegate authority to give team members responsibility, then
evaluate their performance
Understand How Decisions Are Made

Ensure that Meetings Are Effective
24
Chapter 13: Collaborating Outside the Organization
1
Chapter Objectives
Appreciate the need for collaboration among health
organizations.
Know how to form partnerships among organizations.
Understand why local health organizations must interact with
state and federal agencies.
Know how to interact with the public.
Be able to form working relationships with members of the
media.
2
Outline
Collaborating with External Organizations
Interacting with the Public
Interacting with Traditional Media: Print and Broadcast

Collaborating with External Organizations
The Context for Collaboration
Partnerships, Balance, and Trust
Politics
Relationships with Government Agencies
Sharing Resources
Joint Programs
The Context for Collaboration
Historically, health organizations operated independently and
were territorial.
Today it is recognized that collaboration is essential:
Health problems and disasters are not geographically bound
Needs often overwhelm capacity
External resources are scarce
Partnerships can address these changing circumstances
Remove period in first sentence
5
Creating a Working Partnership
Identify potential partners
Hold meetings with senior managers and decision makers
Identify common areas of interest
Establish and earn trust over time
Create a formal memorandum of understanding (MOU) that:
Defines the purpose and goals of the partnership
Establishes formal by-laws
Facilitates exchange of resources
Considerations when Collaborating Externally
Balance of power

Can be accomplished by open communication and clear
governance documents like by-laws and MOUs
Resources
Personnel, funding, training, etc.
Budgeting is a chronic dilemma
Delivery of federally and state mandated programs
Consider changing to “Balance of Power”
7
Politics
Health organizations often underestimate the importance of
political entities.
Health leaders and organizations must attempt to earn the
respect of politicians without allowing them to dictate how
health organizations operate.
Relationships with Government Agencies
Local health organizations should develop relationships with:
Other local agencies and organizations for collaboration to
serve the community directly
State governmental agencies for key information related to
legislation, development of model programs, auditing, and
compliance with laws and regulations
Federal agencies for funding, support, and information
Sharing Resources
Sharing personnel allows organizations to acquire additional
expertise and capacity
Example: several small local health departments may share one

epidemiologist
Sharing facilities and equipment can be important for training
or emergency response
Joint Programs
Creating joint programs with other entities that serve similar
populations and have similar goals allows for:
Reducing the total cost of administration
Improved grant funding opportunities
Trust and mutual confidence must be developed
Interacting with the Public
Health organizations should collaborate with customers, clients,
and the general public by:
Providing excellent customer service
Holding informational meetings for staff
Soliciting and responding to customer and client feedback
Interacting with Traditional Media Overview: Print and
Broadcast
Integrating the Media
Developing Working Relationships
Providing Material
Avoiding Problems
Delivering Accurate Information
Final Thoughts
Integrating the Media
A solid working relationship with the media can help health
organizations better communicate with the public.

Media outlets should be investigated and understood to
determine which can be most helpful.
Consider the audience, groups, and constituencies the
organization most needs to reach.
Ensure media collaboration efforts are consistent with health
program objectives and services.
Developing Working Relationships
Health personnel should have a prime role in developing
ongoing relationships with the media
Respect and utilize the expertise and experience of media
personnel
Establish ground rules
Remember: the media can reach many people with a brief sound
bite or a few lines of text
Providing Material
Messages for television and radio should be in 10-15 second
sound bite form
Additional information should be provided in a press kit
Information should be clear, concise, and not misleading
Organizations have an ethical responsibility to provide honest
and accurate information
A single false statement can damage an organizations reputation
Avoiding Problems
Contact with the media is inevitable; prepare in advance
Avoid professional jargon and abbreviations
Keep it simple: communicate only three concepts at a time
Media experts can be used to help prepare messages and plan
for collaborating with the media

Suggestions for Working with Media Professionals
Think before speaking
Honesty may be unpleasant but cannot be challenged
“No comment” is usually heard as “I know something and won’t
share it”
Always assume that a camera or microphone is live
Assume that every conversation or statement is on the record
Admit when you don’t know an answer
Avoid speculation
Delivering Accurate Information
The media appreciate prepared press releases that include
background information.
Stories and documents must be complete and accurate.
A commitment to accuracy over time can establish trust and
build good working relationships with the media.
Types of News
Reporters are paid to seek information.
Both good and bad news should be shared with the media.
Sharing information with the media should be a priority for a
health organization.
This is a form of quality improvement.
Avoidance
Reporters should not be avoided.
If reporters cannot get information from health organizations,
they will drop the story or find another source.
Other sources may provide inaccurate or misleading
information.

Organizational executives can train subordinates and delegate
media communication duties.
Advice
Key points about the media:
Be deliberate when providing material
Discard insignificant items
Do not bury important information in an otherwise boring press
release
Honesty is genuinely appreciated by all parties
Calling media contacts in advance about an important story will
help to earn their trust
Chapter 16: Managing Information
1
Chapter Objectives
• Appreciate the interconnected nature of computerized devices
in hospitals and other organizations.
• Be able to define and explain the elements of an electronic
health record system.
• Appreciate the growing use of information systems in support
of public health activities.
• Understand that many health care providers and members of
the public do not share the same enthusiasm for information
systems that managers have.

2
Outline
Electronic Health Records
Managing Public Health Information
Managing Inventory
Managing Human Resources
Definitions
Health Information and Data
Result Management
Order Management
Decision Support
Electronic Communication and Connectivity
Patient Support
Administrative Processes
Reporting
Health Information and Data
Provide immediate access to information such as individual
diagnosis, medications, allergies, and laboratory test results to
improve the ability or service to make sound clinical decisions
in a timely manner.
Result Management
Provide access to new and past test results, thus allowing all
participating providers to make more informed decisions about
the effectiveness of treatment regimens and patient safety.

Order Management
Ensure that providers have the ability to enter and store orders
for prescriptions, tests, and other services. This capability is
intended to improve legibility, reduce duplication, and allow
orders to be completed in a timely manner.
Decision Support
Provide reminders, prompts, and alerts to facilitate diagnoses
and treatments by improving compliance with best clinical
practices, promoting regular screenings and other preventive
practices, and identifying possible drug interactions.
Electronic Communication and Connectivity
Promote secure, open, and readily accessible channels of
communication among providers and patients to improve the
continuity of care, increase the timeliness of diagnoses and
treatments, and reduce the frequency of adverse events.
Patient Support
Provide tools that give individuals access to their health
records, provide interactive education on relevant health topics,
and protocols to help people conduct home-monitoring and self-
testing activities to improve control of chronic conditions such
as diabetes and hypertension.
Administrative Processes
Include computerized administrative tools, such as scheduling
and record-keeping systems; such equipment should greatly
improve the efficiency and performance of hospitals and clinics,
allowing them to provide more timely services to patients and

other clientele.
Reporting
Provide sufficient supportive equipment (software, hardware,
and memory capacity) that meets uniform data standards and
enables health care organizations to respond more quickly to
federal, state, and private reporting requirements, including
those that support patient safety and disease surveillance.
Acceptance of Electronic Health Records
Acceptance of electronic health records has been the most
difficult barrier to overcome
Factors explaining slow acceptance include lack of user
familiarity with computers, insufficient funding problems for
purchasing equipment and software, concerns about return on
investment, and concerns about security of system
Structural Considerations
Systematic elements of an electronic health records system are
similar to those found in a paper system.
Advantages of electronic health records include quick retrieval,
far more compact, rarely lost or misplaced, reduction in error
rates, and far less expensive to operate.
Major disadvantage is constant security threats and financial
burden to implement systems.
Impact on Quality
Use of electronic health records has led to higher documentation
rates of hypertension, greater use of antihypertensive therapy,
and more successful reductions in blood pressure as well as
achieving better outcomes in treating a broad spectrum of

diseases.
Electronic health records have been used to identify errors that
are directly related to patient care.
Managing Public Health Information
Information systems serve important functions in surveillance,
program evaluation, and population outcomes assessment.
Privacy and security issues are a major concern in the use of
public health information.
Privacy requirements for health information must be respected
as a critical element of the interdependence and trust needed
between health organizations and their clients and constituents.
Managing Inventory
Information systems are used to manage a variety of other
activities in organizations, including assuring an adequate
inventory of supplies
With the use of computers the inventory process is performed
much faster and more efficiently
Managing Human Resources
Record keeping requirements have increased significantly since
passage of the Civil Rights Act in 1964.
Information systems have aided in the responsibility of
complying with record keeping and reporting requirements that
fall on shoulders of human resource departments.
Final Words
The potential for information management to improve the value
and quality of services delivered by health organizations has

dramatically increased in recent decades.
Successful managers will search for new opportunities to
employ information technology to manage quality, human
resources, inventory, and other processes and outcomes of their
units and organizations.
Florida National University
HSA-6185 Management of Health Care Organizations:
Assignment Week 6
Case Study: Chapters 14, 15 & 16.
Objective: The students will complete a Case study assignments
that give the opportunity to synthesize and apply the thoughts
learned in this and previous coursework to examine a real-world
scenario. This scenario will illustrate through example the
practical importance and implications of various roles and
functions of a Health Care Administrator. The investigative
trainings will advance students’ understanding and ability to
contemplate critically about the public relations process, and
their problem-solving skills. As a result of this assignment,
students will be better able to comprehend, scrutinize and assess
respectable superiority and performance by all institutional
employees.
ASSIGNMENT GUIDELINES (10%):
Students will critically measure the readings from Chapter 14,
15 and 16 in your textbook. This assignment is planned to help
your examination, evaluation, and apply the readings and
strategies to your Health Care organization.
You need to read the chapters assigned for week 6 and develop
a 3-4 page paper reproducing your understanding and capability
to apply the readings to your Health Care organization. Each
paper must be typewritten with 12-point font and double-spaced
with standard margins. Follow APA style 7th edition format
when referring to the selected articles and include a reference

page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (25%) Provide a brief synopsis of the meaning
(not a description) of each Chapter and articles you read, in
your own words that will apply to the case study presented.
2. Your Critique (50%)
Case Studies in Finance and Accounting
Mercy Hospital: A Case Analysis
Abstract
This is a case study which describes an account (names, other
facts changed to preserve anonymity) in which an internal
auditor in a hospital setting, due to personal biases and a lack of
objectivity, performed a substandard audit of a capital asset
acquisition and violated several standards of the International
Standards for the Professional Practice of Internal
Auditing as well as the Institute of Internal Auditors (IIA) Code
of Ethics. Students use the
Standards and Code of Ethics to form conclusions regarding
shortcomings of this audit. The
International IIA Standards and Code of Ethics are online and
easily read, with the Standards being twenty one pages in length
and the Code of Ethics being two pages. The case is designed to
be taught in one class period. Students are exposed to actual
standards and required to employ the standards in their analysis
of the case.
Mercy Hospital - Background
Mercy Hospital is a leading health-care provider and one of the
oldest hospitals in the region.
The 300-bed, acute-care facility is known for its quality of care
and respected for their expertise and innovation in the delivery
of health care. As a leader in cardiac, trauma, surgical,
orthopedic, neurologic, and vascular and cancer care, Mercy
Hospital offers patients the latest treatments by providing its
medical staff, comprising more than 600 physicians, with the

most advanced technology available. Mercy Hospital is one of
eight individual hospitals comprising a hospital network located
across seven states ranging from Pennsylvania to Mississippi.
The eight hospitals have a network headquarters which provides
many of the financial functions including internal audit
services. Collectively, the hospitals are members of the Mercy
Health Network. Management at each hospital is decentralized
except all of the hospitals participate in a consortium to
purchase medical supplies for a more competitive price than
otherwise would be available.
64-Slice CT Scanner
The 64-Slice CT Scanner is a new imaging medical device that
helps physicians diagnose and treat a variety of medical
conditions by providing a more anatomically detailed image of
the patient’s organs. Older CT scanners have been used for
years to study internal organs, bones, soft tissue and blood
vessels. They are particularly useful in trauma situations to
identify injuries to the heart and vessels, liver, kidneys or other
internal organs. The scanner is also used to plan for surgery and
monitor the treatment of tumors for cancer patients
Heart related maladies are all too common. The United States
Center for Health and Human
Services reported that in the USA for the years 2007-2008, over
5 million people arrived in emergency rooms complaining of
chest pain (United States National Center for Health
Statistics, 2010, p. 2). The new 64-Slice CT Scanner is judged
to be faster and more reliable for diagnosing chest pain. It can
evaluate a heart patient by capturing thousands of images of the
heart in less than 5 seconds or capture images of the whole body
in less than 30 seconds.
The cost of these machines is generally expected to range from
$1.5 to $2 million.
Bidding on the 64-Slice CT Scanner can be a very competitive
and costly commitment by vendors. They insist that Board
approval be granted for the machine before final bids are
submitted.

The Audit Process
Mercy Hospital’s capital-asset procurement process for any
single acquisition over $100,000 is to have a formal proposal
submitted to the board of directors (BOD) who vote on its
approval. If the proposal is approved, the funds are transferred
to the respective hospital for eventual disbursement. The
internal auditors are charged with following up within one year
of acquisition to check the propriety of the purchase and
disbursal of funds. Recently, a proposal for a new CT scanner
was submitted by Mercy Hospital’s controller. The other
hospitals were told to "wait and see" until the internal auditors
could inspect the documentation of the acquisition and the
operating effectiveness and efficiency of the new process before
being allowed to submit their own proposals. Mercy’s proposal
was the one of the larger proposals submitted over the past
several years at a total of $1.625 million dollars plus
approximately $25,000 for the labor and other necessary
expenditures to remove the old equipment to permit the
installation of the new scanner. The cost of the new scanner by
itself was listed in the proposal at $1.3 million.
The internal auditor assigned to the acquisition was Jack Jones.
Jack had been with the network for over three years performing
mostly operational audits (on existing processes), reviewing
internal controls, and payroll and travel expenses. Jack believed
that the procedures associated with this capital-asset audit
would be simple and routine.
This was not Jack's first visit to Mercy Hospital. In fact, Jack
had performed an audit on the hospital’s payroll and travel
expenditures only a year ago. Jack's recollection of the
experience was not a pleasant one. He had several
"confrontations" with the controller, mostly as a result of
clashing personalities. While all the expense issues were easily
resolved, Jack felt there was still an adversarial relationship
between them and he was “on guard” for any “preemptive
strikes” this time around.

It was a long drive to Mercy Hospital so when Jack arrived a
little late the day of his audit he was greeted by the controller
with a perceived air of indifference and promptly led to a
secluded and windowless office room. The controller calmly
explained that he was extremely busy and would answer any
questions at the end of the day. Jack merely nodded his head
and sat down in front of several tall piles of invoices that the
controller had furnished and represented the documentation
supporting the purchase, set up, and testing of this new
technology. Jack was somewhat surprised, fully expecting to see
only a handful of invoices, but did not ask for any explanations.
As Jack began looking through the myriad of statements and
canceled checks he soon found one particular invoice near the
top of the first pile which indicated that the actual price paid for
just the machine itself was only $902,000!
Jack's first reaction was to call the director of auditing. When
he found that the director was out for the day and could not be
reached, he decided to call the VP of Operations at corporate
headquarters. Jack was critical of the controller in describing
the seriousness of his suspicions based on this preliminary
information. Jack didn't realize that there was a scheduled
BOD's meeting that day and that the news would be passed on to
the Board. The Board members were outraged over the alleged
misuse of the funds and possible fraud.
Jack was unaware that the controller was soon being lambasted
by the chair of the BODs in a private conference call. Seconds
after the call, the controller walked up to Jack and had only two
words to say—“Get out." Jack was flabbergasted; he called back
to Network’s Home
Office only to receive a rather icy response from the Chair of
the BOD's secretary suggesting that he return immediately. As
Jack got into his car and drove back to the home office he
wondered what he had done so wrong.
Postscript
Three days later Jack was called in to the director of internal
audit's office. The director told the story of how he personally

visited Mercy Hospital the next day after Jack's visit and
performed the capital-asset audit himself. The director found
that there were a number of reasonable explanations for the
differences in the original proposal and the actual expenditure.
To begin with, the companies who sold the machine would not
talk about discounting the price until they knew that the funds
were available. Once the proposal was approved and the funds
were authorized for disbursement, only then did the competing
vendors begin slashing their prices because of competition for
the sale. This is what drove the cost of the machine down from
$1,300,000 to $902,000. Other accessories and services
provided by the vendor reduced the initial list price even further
by some $57,000. Training and warranty costs were not subject
to discounting. However, there were several factors that
mitigated some of these savings.
It would take close to a month before the new machine became
operational because no one really knew how difficult it was
going to be to remove the old machine which had been
embedded in the concrete floor (to minimize vibration). It was
decided that to save time and costs, the new machine would be
set up in a new room adjacent to the room for the older scanner.
The new space would have to be renovated and new electrical
connections installed.
Since the hospital could not afford to shut down for any
extended length of time, the new space had to be renovated
before the older machine could be dismantled. Then, while the
new equipment was being tested, the old scanner had to be kept
running in its temporary location. During the time that both
machines were running, machine operators and supporting
personnel were asked to work double shifts in order to test and
become familiar with the new scanner before closing down the
old machine. This took longer than expected because Mercy’s
technicians were not familiar with the new machine and had
some difficulty with even minor start-up problems. Therefore,
for the first two weeks, special outside consultants were hired

to operate the scanner at the proper specifications. These
additional and unexpected outlays were costly and brought the
total to just under $1.4 million ($1.17 million and $230,000 for
the renovations and other expenditures) which was still lower
than the original estimate of $1.65 million. Even though the list
price came in at a reasonable $902,000 (saving $398,000 and
other discounts provided additional savings of $57,000), the
renovations amounted to $230,000 and exceeded the original
estimated renovation costs of $25,000. The director went on to
explain to Jack that the reason for the abnormally large number
of invoices was due to the renovation cost, additional labor cost
associated with the new machine, and the cost of running both
machines during the transition. As it turns out, Mercy’s
controller actually did a commendable job in overseeing the
project and keeping accurate records of the disbursements. In
fact, the controller created a specialized installation guide that
will probably save hundreds of thousands of dollars when the
remaining hospitals install more of these machines. When the
director was finished, he told Jack that unless he changed his
attitude and re-considered what it means to be a professional
internal auditor, he was likely to remain a payroll auditor for
the rest of his career. The director told Jack to go back and read
a basic internal audit text on interviewing techniques, the Code
of Ethics and the Standards for Professional Practice. Jack still
didn't understand. What was the director trying to say?
CASE STUDY CHALLENGE
1. Students should be asked to read the case and discuss all
procedures done during this auditory.
2. Comment on Jack's interviewing techniques.
3. What could Jack have done differently?
4. What did Jack forget to do?

3. Conclusion (15%)
Briefly summarize your thoughts & conclusion to your critique
of the case study and provide a possible outcome for the
Finance department. How did these Chapters influence your
opinions about Managing finance and budgets?
Evaluation will be based on how clearly you respond to the
above, in particular:
a) The clarity with which you critique the case study;
b) The depth, scope, and organization of your paper; and,
c) Your conclusions, including a description of the impact of
these Case study on any Health Care Setting Organization and
managing.
ASSIGNMENT RUBRICS
Assignments Guidelines
1 Points
10%
Introduction
2.5 Points
25%
Your Case Study Critique
6 Points
50%
Conclusion
1.5 Points
15%
Total
11 points
100%

ASSIGNMENT GRADING SYSTEM
A
90% - 100%
B+
85% - 89%
B
80% - 84%
C+
75% - 79%
C
70% - 74%
D
60% – 69%
F
50% - 59% Or less.
Florida National University
HAS-6185Management of Health Care Organization:
Assignment Week 5
Organizational AnalysisSuccessful Strategies for Teams:
Chapters 12 & 13
Objective: For this assignment, you will describe and analyze
the characteristics of four types of teams, assess the methods of
collaboration used in each type of team and evaluated them in
Health care center of your choosing. The paper will be 4-5

pages long. More information and due date will provide in the
assignments link.
Students will critically evaluate the readings from Chapter 12 to
13 on your textbook. The Purpose of this Organizational
analysis is to build and generate a group of the strategies that
help to Successful work and progress for Teams in specific
areas of the Health Facility that you will be choose. You need to
choose a Health care setting and develop a 4-5-page paper long
including title page and references page that established your
understanding and ability to recount the readings to your Health
Care setting. Each paper must be typewritten with 12-point font
and double-spaced with standard margins. Follow APA style 7th
edition format when referring to the selected articles and
include a reference page.
1. Introduction (25%) Provide a brief synopsis of the meaning
(not a description) of each Chapter and articles you read, in
your own words.
2. Your Successful Strategies for Teams (50%)
a. Present the Objectives of the specific Teamwork.
b. Form, organized and Localize the Team: identifying what and
how each member can contribute to meeting the objective of the
Teams work.
c. Present the collections of Successful Strategies that
willimprove the effective management and maintain an open and
collaborative approach in order to maximize the creative
potential and advantages for the Organization.
3. Conclusion (15%)
Briefly recapitulate your thoughts & deduction to this
assignment and your assessment of the articles and Chapter you
read. How did these articles and Chapters influence your
thoughts about Collaborating and working inside the Health care
Organization as Teams? How this Organization Analysis help
you in relation to Team Leadership.

a) The clarity with which you present and analyzed the
strategies;
b) The depth, scope, and organization of your Organizational
Analysis paper; and,
these articles and Chapters on any Healthcare Organization.
A
90% - 100%
B+
85% - 89%
B
80% - 84%
C+
75% - 79%
C
70% - 74%
D
60% – 69%
F
50% - 59% Or less.

Chapter 11
Health Services for Special Populations
1
Learning Objectives (1 of 2)
Population groups facing greater challenges and barriers in
accessing health care services
Racial and ethnic disparities in health status
Children's health concerns and services
Women's health concerns and services
Rural health challenges and steps to care access
2
Health concerns of the homeless population and migrant
workers
Describe the U.S. mental health system
Summarize the AIDS epidemic in the U.S.
ACA benefits for vulnerable groups
3
Introduction (1 of 2)
Certain groups at greater risk of poor physical, psychological,
or social health
Terms used
Underserved
Medically underserved

Medically disadvantaged
Underprivileged
American underclasses
4
Population groups
Racial and ethnic minorities
Uninsured children
Women
Rural area residents
Homeless population
Mentally and chronically ill
Disabled
HIV/AIDS
5
Framework to Study Vulnerable Populations
Vulnerability
Predisposing
Enabling
Need characteristics
Three vulnerability model characteristics
Comprehensive
General
Convergence
6

Figure 11-5: U.S. life expectancy at birth, 1970–2014.
Data from Health, United States, 2015, p. 93
7
Figure 11-6: Age-adjusted maternal mortality rates.
Data from Health, United States, 2010, p. 231. Centers for
Disease Control and Prevention (CDC). 2016. Pregnancy
Mortality Surveillance System.
https://www.cdc.gov/reproductivehealth/maternalinfant health/p
mss.html.
8
Figure 11-7: Respondent-assessed health status.
Data from Health, United States, 1995, p. 172, Centers for
Disease Control and Prevention, National Center for Health
Statistics, 1996,
Health, United States, 2012, p. 168, and Health, United States,
2015, p. 182.
9
Figure 11-8: Current cigarette smoking by persons 18 years of
age and over, age adjusted, 2014.

Data from Health, United States, 2015, p. 186, Centers for
Disease Control and Prevention, National Center for Health
Statistics.
10
Table 11-2: Age-Adjusted Death Rates for Selected Causes of
Death, 1970–2014
11
Data from Health, United States, 2015, Table 17, pp. 99–101,
Centers for Disease Control and Prevention, National Center for
Health Statistics.
Table 11-3: Infant, Neonatal, and Postneonatal Mortality Rates
by Mother’s Race (per 1,000 Live Births)
Data from Health, United States, 2015, p. 86.
14
Table 11-4: Selected Health Risks Among Persons 20 Years and
Older, 2011–2014

Data from Health, United States, 2015, pp. 202, 204, 216
15
Figure 11-3: Alcohol consumption by persons 18 years of age
and older, selected years.
Data from Centers for Disease Control and Prevention (CDC).
National Health Interview Survey.
https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease20
1409_09.pdf.
16
Figure 11-4: Use of mammography by women 40 years of age
and older, 2013.
Data from National Center for Health Statistics (NCHS). 2016b.
Health, United States, 2015. Hyattsville, MD: U.S. Department
of Health and Human Services. p. 246.
17
Table 11-1: Characteristics of U.S. Mothers by Race/Ethnicity
18

Numbers are percentages.  *Data from 2008.  Source: Data
from Health, United States, 2015, p. 74; Health, United States,
2012, p. 144; Health, United States, 2009, pp. 159, 163
Racial/Ethnic Minorities: Asian Americans
In 2015, Asians accounted for only 5.6% of the U.S. population.
Asian Americans constitute one of the fastest-growing U.S.
population segments.
20
Racial/Ethnic Minorities: American Indians and Alaska Natives
Incidence and prevalence of certain diseases in the AIAN
population are a prime concern.
Higher death rates from alcoholism, tuberculosis, diabetes,
injuries, suicide, and homicide.
Indian Health Care Improvement Act.
Indian Health Service.
21
Uninsured
Ethnic minorities are more likely than whites to lack health
insurance.
Most of the uninsured population comprises young workers.
Uninsured persons are in poorer health than the general
population.
ACA made progress in reducing the uninsured.

22
Children (1 of 2)
Health insurance is a major determinant of access to and
utilization of health care.
Coverage rates vary across races and ethnicities.
Unintentional injuries are the leading cause of death for
children and adolescents.
Asthma is a common childhood chronic disease.
Depression has an impact on adolescent development.
23
Children (2 of 2)
Children’s health has certain unique aspects.
Developmental vulnerability and dependency
Children and the U.S. health care system
Programs categorized into three sectors
Personal medical and preventive services
Population-based community health services
Health-related support services
24
Women
Office on Women’s Health
Specific goals that span the spectrum of disease and disability
Women and the U.S. health care system
At a disadvantage in obtaining employer-based health insurance
See Figure 11-10

25
Rural Health (1 of 2)
National Health Service Corps
Health professional shortage areas
Health Professions Educational Assistance Act
Three types of HPSAs by geographic areas, population groups,
and medical facilities
26
Rural Health (2 of 2)
Medically underserved areas
Percentage of population below poverty income levels
Percentage of population 65 years of age and older
Infant mortality rates
Number of primary care practitioners per 1,000 population
27
Migrant Workers
Community and migrant health centers
Rural Health Clinics Act
Concern rural areas could not support a physician
Permitted PAs, NPs, and CNMs with rural clinics to practice
without the direct supervision of a physician
Enabled rural health clinics to be reimbursed by Medicare and
Medicaid

28
Homeless
Approximately 1 in 200 people became homeless in 2011.
Adult population is 63% men and 37% women.
Estimated 22.8% are children under age 18.
35.8% are families with children.
14% are veterans.
Shortage of adequate low-income housing.
Barriers to health care.
29
Mental Health
Barriers to mental health care
Uninsured and mental health
Insured and mental health
Managed care and mental health
Mental health professionals
See Table 11-7
30
Chronically Ill
Chronic diseases are the leading cause of death in the U.S.
Result in limitations on daily life activities.
Treatment accounts for 86% of U.S. health costs.
Disability
Categorized as mental, physical, or social
Disability tests

31
HIV/AIDS (1 of 3)
Number of AIDS cases reported
Increased between 1987 and 1993
Decreased between 1994 and 1999
Increased between 2000 and 2004
Decreased since 2005
HIV Infection in rural communities
HIV in children
32
HIV/AIDS (2 of 3)
HIV in women
HIV/AIDS-related issues
Need for research
Public health concerns
Discrimination
Provider training
33
HIV/AIDS (3 of 3)
Cost of HIV/AIDs
See Figure 11-12
AIDS and the U.S. health care system
AIDS is characterized by a gradual decline in physical,
cognitive, and emotional function.

As HIV disease progresses, many people become disabled and
rely on public entitlements.
34
Summary
Challenges and barriers in accessing health care services for
certain population groups.
Health needs of these population groups vary.
Gaps exist between population groups and the rest of the
population.
35
Chapter 10
Long-Term Care
1
Concept and features of long-term care (LTC)
Discuss the various types of LTC services
Describe who needs long-term care and why
Home- and community-based LTC services, and who pays
2

LTC institutions and levels of services provided
Specialized LTC facilities and continuing care retirement
communities
Institutional trends, utilization, and costs
Explore the aspects of private LTC insurance
3
Long-term care (LTC) is a complex subsystem.
Numerous sources of financing.
Community-based services.
More economical and preferred by older people
Individuals may require LTC from functional deficits arising
from chronic conditions.
4
Figure 10-1: People with multiple chronic conditions are more
likely to have activity limitations.
Reproduced from Partnership for
Solution
s and Johns Hopkins University.
2002. Chronic conditions: Making the case for ongoing care.

Baltimore, MD:
Johns Hopkins University. p. 12.
5
Cognitive impairment may lead to functional decline.
Two indicators assess functional limitations
Activities of daily living (ADLs) scale
Instrumental activities of daily living (IADLs)
6
Nature of Long-Term Care (1 of 2)
Variety of services
Individualized services
Well-coordinated total care
Maintenance of residual function
Extended period of care

7
Figure 10-3: Key characteristics of a well-designed long-term
care system.
8
Nature of Long-Term Care (2 of 2)
Holistic care
Quality of life
Loss of self-worth accompanies disability.
Patients remain in LTC settings for long periods.
Use of current technology
Personal emergency response system (PERS)
Use of evidence-based practices
9
Long-Term Care Services (1 of 2)

Medical care, nursing, and rehabilitation
Mental health services and dementia care
Caring for dementia patients is a major focus in LTC.
Social support
Preventive and therapeutic long-term care
Informal and formal care
10
Long-Term Care Services (2 of 2)
Respite care
Community-based and institutional services
Housing
Private and public housing
End-of-life care
11
Figure 10-2: Medicare enrollees age 65 and older with
functional limitations according to where they live, 2009.

Reproduced from Federal Interagency Forum on Aging-Related
Statistics.
2012. Older Americans 2012: Key indicators of well-being.
Washington, DC:
US Government Printing Office. p. 61.
12
Figure 10-4: Range of services for those in need of long-term
care.
Modified with permission from Taylor & Francis from Singh, D.
A. 1997. Nursing home administrators: Their influence on
quality of care. New York: Garland
Publishing, Inc. p. 15.
Users of Long-Term Care
50% of LTC users are younger than age 65.
Developmental disability (DD)
Intellectual disability (ID)
Patients with HIV/AIDS

14
Figure 10-5: Users of long-term care by age group.
Data from Iglehart, J.K. 2016. Future of long-term care and the
expanding role of Medicaid managed care. New England Journal
of Medicine 374: 182–187.
15
Level of Care Continuum (1 of 2)
Personal care
Paraprofessionals
Custodial care
Restorative care
Skilled nursing care
Rehabilitation is an important component.
16

Level of Care Continuum (2 of 2)
Four categories of subacute care services
Extensive care
Special
Clinically complex care
Intensive rehabilitation
17
Home- and Community-Based Services (1 of 4)
Home health care
Adult day care
Medicaid provides funding.
Adult foster care
18
Figure 10-6 Most frequently provided services to home health
patients.

Data from Jones, A. L., et al. 2012. Characteristics and use of
home health care by men and women aged 65 and over. National
health statistics reports, No. 52. Hyattsville, MD: National
Center for Health Statistics.
Figure 10-7 Sources of payment for home health care, 2014.
Data from National Center for Health Statistics. 2016. Health,
United States, 2015. Hyattsville, MD: U.S. Department of
Health and Human Services.
p. 298.
19
Senior centers
Home-delivered and congregate meals
Elderly nutrition program (ENP)
Meals-on-wheels
Homemaker services
Continuing care at home

20
Case management
Brokerage model
Managed care/integrated model
Recent policies related to community-based services
Money follows the person
Community first choice
21
Institutional Long-Term Care Continuum
Residential and personal care facilities
Assisted living facilities
Skilled nursing facilities
Subacute care facilities—three main locations
Long-term care hospitals (LTCHs)
Hospital transitional care units certified as SNFs
Freestanding nursing homes

22
Specialized Care Facilities
Intermediate care facilities for individuals with intellectual
disabilities
Most patients have disabilities in addition to ID
Alzheimer’s facilities
23
Continuing Care Retirement Communities
Three common types of CCRC contracts
Life care or extended contract
Modified contract
Fee-for-service contract
24
Institutional Trends, Utilization, and Costs
Community-based services and assisted living absorbed much of

the nursing home care.
Rising cost of institutional care.
Five nursing home chains operate more than 9% of U.S. nursing
homes.
25
Table 10-1: Trends in Number of Long-Term Care Facilities,
Beds/Resident Capacity, and Prices, Selected Years
Data from Genworth Financial, Inc. 2010. Genworth 2010 cost
of care survey. Richmond, VA: Author; Genworth Financial,
Inc. 2015. Genworth 2015 cost of care survey. Richmond, VA:
Author; Sanofi-Aventis. 2016. Managed care digest series:
Public payer digest, 2016. Bridgewater, NJ: Author.
Insurance for Long-Term Care
Medicare does not cover most LTC services.
Medicaid requires spending one’s assets to poverty levels to
qualify.
Public policy created few incentives to spur LTC insurance
growth.

ACA did little to address the LTC dilemma.
27
Summary (1 of 2)
Need for LTC increases
Due to severe chronic condition, multiple illnesses, or cognitive
impairment
LTC includes
Medical care, nursing, rehabilitation, social support, and mental
health care
Housing alternatives and end-of-life care
28
Summary (2 of 2)
Nursing homes require
SNF certification to admit Medicare patients
NF certification to admit Medicaid patients
Industry has become more competitive.
Medicaid and Medicare expenditures for LTC will be

unsustainable in the long term.
29
Chapter 12
Cost, Access, and Quality
1
Meaning of health care costs and trend review
Factors that led to past cost escalations
Describe regulatory and market-oriented approaches to contain
costs
Why some regulatory cost-containment approaches were
unsuccessful
Discuss the access to care framework and various dimensions of
access to care

2
Describe access indicators and measurements
The nature, scope, and dimensions of quality
Differentiate between quality assurance and quality assessment
Implications of the ACA for health care costs, access, and
quality
3
Three cornerstones of health care delivery
Cost
Access
Quality
Expansion of access will increase health care expenditures.
4

Costs of health care from a macro and micro perspective.
Equal access to high quality care.
Cost is important in the evaluation of quality.
Quality
Up-to-date capabilities, evidence-based processes, and
measuring outcomes
5
Cost of Health Care
Trends in national health expenditures
Should health care costs be contained?
Three sources to assess if spending too much
International comparisons
Rise in private sector health insurance premiums
Government spending on health care for beneficiaries
6

Reasons for Cost Escalation (1 of 3)
Third-party payment
Imperfect market
Growth of technology
Increase in the elderly population
Medical model of health care delivery
7
Figure 12-5 Life expectancy of Americans at birth, age 65, and
age 75, 1900–2014 (selected years).
Data from National Center for Health Statistics (NCHS). 2002.
of Health and Human Services. p. 116; National Center for
Health Statistics (NCHS). 2010. Health, United States, 2009.
Hyattsville, MD: U.S. Department of Health and Human
Services. p. 187; National Center for Health Statistics (NCHS).
2016b. Health, United States, 2015. Hyattsville, MD: U.S.
Department of Health and Human Services. p. 95.
Figure 12-6 Change in U.S. population mix between 1970 and
2014, and projections for 2030.

Data from National Center for Health Statistics (NCHS). 2013.
of Health and Human Services. p. 45; U.S. Census Bureau.
2000. Projections of the total resident population by 5-year age
groups, and sex with special age categories: middle series, 2025
to 2045. Available at:
https://www.census.gov/population/projections/files/natproj/su
mmary/np-t3-f.pdf. Accessed April 2017.
8
Multipayer system and administrative costs
Defensive medicine
Fraud and abuse
Upcoding
Anti-kickback statute
Practice variations
Small area variations (SAV)

9
Cost Containment: Regulatory Approaches
Health planning
Health planning experiments in the U.S.
Certificate-of-need statutes (CON)
Price controls
Peer review
10
Figure 12-7: Increase in U.S. per capita Medicare spending,
selected years, 1970–2014.
Data from Health, United States, 2015, p. 327; National Center
for Health Statistics.
11
Cost Containment: Competitive Approaches
Competition refers to rivalry among sellers for customers.

Technical quality, amenities, access or others
Demand-side incentives.
Supply-side regulation.
Payer-driven price competition.
Utilization controls.
12
Cost Containment under Health Reform
Medicare payment cuts to providers.
New taxes imposed.
Reforms contributed to a health care spending slowdown.
Tightening provider payment rates
Providing incentives to reduce costs
Medicare projected to spend $1 trillion less by 2020.
13
Access to Care (1 of 2)
Key implications of access for health and health care delivery
Access to medical care, along with environment, lifestyle, and

heredity factors.
Access is a benchmark in assessing the effectiveness of the
delivery system.
Measures of access reflect if delivery is equitable.
Access is linked to quality of care and efficient use.
14
Access to Care (2 of 2)
Framework of access
Five dimensions of access
Availability
Accessibility
Accommodation
Affordability
Acceptability
Figure 12-8 Framework for access in the managed care context.
Reproduced from E.R. Docteur, D.C. Colby, and M. Gold,
“Shifting the Paradigm,” Health Care Financing Review 17, no.
4 (1996): p. 12.

15
Four Main Types of Access
Potential access
Realized access
Equitable or inequitable access
Effective and efficient access
16
Measurement and Current Status of Access
Measurement of access
Using conceptual models access is measured at three levels
Individual
Health plan
Delivery system
Current status of access
17

Current State of Access
Data from US Census Bureau. Statistical Abstracts of the United
States, 2015, Washington, DC, p. 265.
18
Data from Health, United States, 2015, pp. 235, National Center
for Health Statistics, Division of Health Interview Statistics,
2016.
Affordable Care Act and Access to Care
Insurance coverage and access to health care have increased.
Fewer report problems with medical bills and financial barriers.
Gaps in access to and affordability of care.
Preventive services without cost sharing expanded.

21
Quality of Care
IOM’s quality implications
Quality performance has a range from unacceptable to excellent.
Focuses on services provided by the health care delivery
system.
Quality may be evaluated from the perspective of individuals
and populations or communities.
Emphasis on desired health outcomes.
22
Dimensions of Quality
Micro view focuses on services at the point of delivery and their
subsequent effects.
Clinical aspects
Interpersonal aspects
Quality of life
Macro view looks at quality from the standpoint of populations.

23
Quality Assessment and Assurance (1 of 2)
Quality assurance is based on the principles of total quality
management (TQM).
Referred to as CQI
Donabedian model.
See Figure 12-9
24
The Donabedian Model
Figure 12-9 The Donabedian model.
Quality Assessment and Assurance (2 of 2)
Processes that improve quality
Clinical practice guidelines
Cost-efficiency
Critical pathways
Risk management

26
Public Reporting of Quality
CMS programs on quality
Initiatives to improve care provided to Medicaid and CHIP
enrollees
AHRQ quality indicators
Prevention, inpatient, patient safety, and pediatric
States’ public reporting of hospital quality
27
Affordable Care Act and Quality of Care (1 of 2)
Three objectives
Make health care more accessible, safe, and patient centered
Address environmental, social, and behavioral influences on
health and health care
Make care more affordable

28
Affordable Care Act and Quality of Care (2 of 2)
Organizations are incentivized to provide high-quality care in
two ways.
Penalized for failing to report quality measures
Sharing in the savings generated by quality measures
The number of patient safety and medical errors has decreased
since 2010.
Patient-Centered Outcomes Research Institute (PCORI).
29
Summary
Increasing costs, lack of access, and quality concerns pose the
greatest challenges.
Lack of universal coverage negatively affects the health status
of uninsured groups.
Access to medical care is one of the key determinants of health
status.
Health care quality at the micro and macro levels.

30
Chapter 9
Managed Care and Integrated Organizations
1
Link between the development of managed care and earlier
organizational forms
Basic concepts of managed care and cost savings
Main types of managed care organizations
Distinguish between types of managed care organizations
Advantages and disadvantages of different HMO models
2

Why managed care did not achieve its cost-control objectives
Driving forces behind organizational integration and integration
strategies
Describe highly integrated health care systems
3
Introduction
Managed care fundamentally transformed the delivery of health
care in the U.S.
ACA did not obliterate managed care.
Employer-sponsored insurance enrolled fewer than 1% of
employees.
Managed care originated in the U.S. and its tools spread
internationally.
4
Figure 9-1: Percentage of worker enrollment in health plans
(selected years).

Data from Kaiser Family Foundation and Health Research and
Educational Trust (Kaiser/HRET). 2003. Employer health
benefits: 2003 annual survey. Menlo Park, CA:
Author; Kaiser Family Foundation and Health Research and
Educational Trust (Kaiser/HRET). 2016. Employer health
benefits: 2016 annual survey. Menlo Park, CA: Author.
5
What Is Managed Care?
Integration of financing, insurance, delivery, and payment
within one organization
Formal control over utilization
Financing
Insurance
Delivery
Payment
6

Figure 9-2: Integration of health care delivery functions through
managed care.
Evolution of Managed Care
Contract practice takes capitation further by incorporating a
defined group of enrollees.
Prepaid group practice
Principles of capitation, bearing of risk by provider, group of
enrollees financed by employer
Delivery of comprehensive services
Accreditation of managed care organizations.
Quality assessment in managed care.
8
Growth of Managed Care
Flaws in the fee-for-service model
Uncontrolled utilization
Uncontrolled prices and payment
Focus on illness rather than wellness
Employers’ response to rise in premiums

Weakened economic position of providers
9
Figure 9-3: Growth in the cost of U.S. health insurance (private
employers), 1980–1995.
Data from National Center for Health Statistics. 1998. Health,
United States, 1998. Hyattsville, MD: U.S. Department of
Health and Human Services. p. 348.
10
Efficiencies and Inefficiencies in Managed Care
Integrating the quad functions of health care delivery.
MCOs control costs by sharing risk with providers or extracting
discounts.
Cost savings.
Administrative inefficiencies created for providers.
Contracts with providers exclude some services.

11
Cost Control in Managed Care (1 of 3)
Choice restriction
Closed-panel
Open-panel
Care coordination
12
Figure 9-4: Care coordination and utilization control through
gatekeeping.
13
Figure 9-5: Case management function in care coordination.

14
Disease management
Pharmaceutical management
Three strategies
Use of drug formularies
Use of tiered cost sharing
Use of pharmacy benefits managers (PBMs)
15
Utilization review
Prospective utilization review
Concurrent utilization review
Retrospective utilization review
Practice profiling

16
Types of Managed Care Organizations (1 of 2)
Health maintenance organization (HMO)
Staff model
Group model
Network model
Independent practice association model
17
Types of Managed Care Organizations (2 of 2)
Preferred provider organization
Establishes contracts with a select group of physicians and
hospitals
Allows an open-panel option
Discounted fee arrangements with providers
Fewer restrictions to the care-seeking enrollees
Point-of-service plans
Combine HMO and PPO options

18
Trends in Managed Care
Employment-based health insurance enrollment
Medicaid enrollment
Primary care case management (PCCM)
Medicare enrollment and payment reforms
19
Figure 9-10: Share of managed care enrollments in employer-
based health plans, 2016.
Data from Kaiser Family Foundation and Health Research and
Educational
Trust (Kaiser/HRET). 2016. Employer health benefits: 2016
annual survey.
Menlo Park, CA: Author.
20

Impact on Cost, Access, and Quality
Influence on cost containment
Backlash from enrollees and providers prompted MCOs to end
aggressive cost control measures.
Impact on access
Medicaid-insured patients may have difficulty accessing
medical care services.
Influence on quality of care
HMO and non-HMO plans provided roughly equal quality of
care.
21
Managed Care Backlash, Regulation, and the Aftermath (1 of 2)
Three reasons for discontentment toward managed care
Employers switch to manage care to restrain costs of health
insurance premiums.
Insureds did not see a reduction in their premiums or out-of-
pocket expenses.
Physicians hostile toward managed care.

22
Managed Care Backlash, Regulation, and the Aftermath (2 of 2)
Regulation of managed care
Two types of state-legislated statutes
Any willing provider laws
Freedom of choice laws
Aftermath
23
Organizational Integration
Integration strategies
Mergers and acquisitions
Joint ventures
Alliances
Horizontal integration
Vertical integration
Figure 9-11 Organizational integration strategies.

24
Basic Forms of Integration
Major participants in organizational integration have been
physicians and hospitals.
Clinical and nonclinical entities may be involved.
Management services organizations.
Physician‒hospital organizations.
Provider-sponsored organizations.
25
Highly Integrated Health Care Systems
Integration in the U.S. health care system continues to intensify.
Organizational integration does not negatively affect the quality
of care.
Integrated delivery systems.
Accountable care organizations.
Payer–provider integration.
26

Summary
Participation in the HEDIS program improved the quality of
services provided by MCOs.
Growing power of managed care triggered integration among
health care providers.
Highly integrated organizations are held accountable.
Must achieve specific objectives related to costs, quality, and
consumer satisfaction
27
Health Services for Special populations and its Needs: Chapters
11 & 12.
Objective: To provide an overview of a Population-based
strategies and community-wide interventions make the greatest
impact on the health of communities overall. That is why Health
Services for Special populations improve both the physical and
social environments so that the healthy choice is easy choice for
all. For example, by making healthy food more accessible
through farmers’ markets and community gardens, it is easier

for community members to make healthy eating choices.
Health Services for Special populations and its Needs. For this
assignment, you will generate, designate, Establish, analyze
and, present a Health Services for Special populations and its
Needs: certain populations experience multiple barriers to
health care that require targeted interventions. These barriers
could include different cultural beliefs about health and health
care, transportation, language and more. Health Services for
Special populations has been committed to working with
vulnerable populations, including homeless persons, refugees,
seniors, and youth. Although these four populations are each
unique, they share commonalities. They each require focused
interventions to connect with a range of health and social
services, as well as opportunities. These programs reduce
isolation, connect people to services and peers, and improve
compliance with health care. Based on assessment findings, the
following report outlines the populations we serve, the needs
within these populations, interventions to date and
recommendations for the future.
The paper will be 4-5 pages long. Each paper must be
typewritten with 12-point font and double-spaced with standard
margins. Follow APA style 7th edition format when referring to
the selected articles and include a reference page.

1. Introduction (30%) Provide a short-lived outline of the
meaning (not a description) of Chapter 11 and articles you read,
in your own words.
2. Health Services for Special populations and its Needs (50%)
a. Objectives of the Health Services for Special populations
b. Racial/Ethnic Minorities.
c. The Uninsurance
d. Children
e. Women
f. The Homeless
g. Mental Health
h. Chronically Ill and Disable
i. HIV/AIDS
3. Conclusion (20%)
Quickly recapitulate your thoughts & statement to your critique
of the articles and Chapter you read. How did these articles and
Chapters impact your thoughts about Health care Services for
special populations?
a) The precision with which you analyses the chapters;
b) The complexity, possibility, and organization of your paper;
and,

these articles and Chapters on any Health Care Setting.
ASSIGNMENT RUBRICS
1.0 Points
10%
Introduction
3.0 Points
30%
Health Services for Special populations and its Needs
5.0 Points
50%
Conclusion
2.0 Points
20%
Total
11 points
110%
A
90% - 100%

B+
85% - 89%
B
80% - 84%
C+
75% - 79%
C
70% - 74%
D
60% – 69%
F
50% - 59% Or less.
Manage Care Control Cost Plan: Chapters 9 & 10
Objective: Managed health care as it has developed in the USA,
and the current backlash against it, must be viewed in the
context of the traditional US health care system.
This system of employer-based, indemnity insurance and fee-

for-service health care conditioned both providers ‘and patients
‘expectations of unlimited resources and unrestrained choice.
Not surprisingly, the constraints and controls imposed by
managed care have resulted in outrage by doctors and their
patients (and by doctors through their patients).
For this assignment, you will generate, designate, Organize,
investigate and, present a Manage Care Control Cost Plan:
Under traditional indemnity insurance, the money follows the
patient. Patients select health care providers and visit them as
they choose. Providers then bill the private insurer or public
payer and are reimbursed on a fee-for-service or per case basis.
Most indemnity plans attempt to limit demand through financial
barriers to the patient, such as deductibles and co-insurance,
rather than constraints on the provider. Many also require the
patient to pay the provider directly and seek reimbursement
from the insurer, often with payments less than charges.
Due to growing popular discontent with managed care
organizations, many critics believe that the system will not
continue in its current state. No one, however, expects managed
care to disappear completely and indemnity plans to rise to their
former prominence. Changes are expected to occur as managed
care programs begin competing among themselves. Cost and
efficiency will no longer be the main selling point; quality of
services will take precedence. One researcher has suggested that

along with new systems of managed care and continuing
systems of indemnity plans, health care providers may even
organize and offer services directly to employers, thus
eliminating the middlemen. This development would be
beneficial to all involved: employers would pay less; providers
would be better compensated; and clients would receive better
care
The paper will be 4-5 pages long. More information and due
date will provide in the Fifth Week assignments link.
1. Introduction (30%) Provide a short-lived outline of the
meaning (not a description) of Chapter 9 and 10 in your own
words. Types and classifications of managed care models.
2. Manage Care Control Cost Plan: (50%)
a. Cost savings
‘‘Structural changes centered around the expansion of managed
care have been the major transformative force in health markets
in recent years and have played a major role in restraining
growth in health spending’’
b. Provider reimbursement
This complaint has two dimensions: hospital profitability, and
physician compensation. As far as hospitals are concerned,
administrators are worried about profitability or surplus for
reinvestment, and consumers are worried about the threat of

hospital closures. Few things stir as much public outcry as the
prospect of closing a community hospital.
c. Quality of care
Much recent legislation and many legal reforms havebeen aimed
at preventing managed care’s perceivedquality abuses. The
Patient Bill of Rights, which hasbeen heavily debated in
Congress, defines, amongother things, the rights of consumers
with complexconditions to access directly a qualified
specialist,continuity of provider for patients who are
underregular treatment, and self-referral to certain types
ofspecialists.
3. Conclusion (20%)
Quickly recapitulate your thoughts & statement to your critique
of the Chapter you read. How did these Chapters impact your
thoughts about Manage Care? What did you learn about manage
care and how you will apply all these knowledge?
a) The precision with which you analyses the articles;
b) The complexity, possibility, and organization of your paper;
and,
these articles and Chapters on any Health Care Setting.

ASSIGNMENT RUBRICS
1.0 Points
10%
Introduction
3.0 Points
30%
Manage Care Control Cost Plan
5.0 Points
50%
Conclusion
2.0 Points
20%
Total
11 points
110%
A
90% - 100%
B+
85% - 89%
B
80% - 84%
C+

75% - 79%
C
70% - 74%
D
60% – 69%
F
50% - 59% Or less.

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