This document provides an overview of leading an organization to fiscal health and wellness through priority based budgeting. It discusses the current fiscal challenges facing many governments, including operating deficits, eroding tax bases, and rising health care and student loan costs. It then outlines five key approaches to achieving fiscal health: 1) spending within available revenues, 2) establishing and maintaining reserves, 3) understanding variances between budgets and actuals, 4) determining the true cost of programs and services, and 5) incorporating long-term economic analysis and planning. Specific diagnostic questions and treatment options are provided for each approach.
Ontario Municipal Leadership Institute (OMLI) and Alliance for Innovation for...Chris Fabian
This document discusses achieving fiscal health and wellness through priority based budgeting based on a presentation given by Jon Johnson and Chris Fabian. It outlines four key approaches to achieving fiscal health: 1) spending within your means by distinguishing ongoing and one-time revenues, 2) establishing and maintaining appropriate reserves, 3) understanding variances between budgets and actuals, and 4) being transparent about the true cost of doing business through full cost allocation. The presentation provides diagnostics and treatment options for organizations to assess their current practices and make improvements in each of these areas to achieve long-term fiscal wellness.
PUBLIC FINANCIAL ASSESSMENT OF HIV SPENDING: NASARAWA STATE, NIGERIAHFG Project
This document assesses public financial management of HIV spending in Nasarawa State, Nigeria. It identifies several bottlenecks in the planning, budgeting, and budget execution processes. Bottlenecks include highly centralized decision making, lack of cohesive planning, and absence of evidence-based advocacy. It also notes differences in priorities between government officials and program managers. Recommendations include advocating for HIV program needs, preparing medium-term sector strategies, making budgets and revenue forecasts more realistic, and building capacity of HIV agencies to improve financial management processes.
Idaho ICMA - Fiscal Health PresentationChris Fabian
This document provides an overview of achieving fiscal health and wellness through priority based budgeting. It discusses four key approaches to achieving fiscal health: 1) spending within your means by distinguishing ongoing vs one-time revenues and expenditures, 2) establishing and maintaining reserves, 3) understanding variances between budgets and actuals, and 4) being transparent about the true cost of doing business. For each approach, it provides diagnostics to assess an organization and available treatments to improve. The document is intended to help elected officials think strategically about key fiscal questions and make financially sound decisions.
PUBLIC FINANCIAL ASSESSMENT OF HIV SPENDING: AKWA IBOM STATE, NIGERIAHFG Project
This document summarizes a public financial assessment of HIV spending in Akwa Ibom State, Nigeria. It identifies bottlenecks in planning, budgeting, and budget execution processes that hinder optimal resource allocation and spending for HIV/AIDS initiatives. Key bottlenecks include a lack of cohesive planning, poor stakeholder engagement, non-evidence-based advocacy, unrealistic budgeting, and challenges requesting cash for budget execution. It concludes with recommendations such as building capacity for requesting funds, preparing a state development plan and sector strategies, implementing realistic budgets and quarterly work plans, and restructuring reporting for HIV/AIDS agencies.
The document discusses Indiana's fiscal policy goals of balancing budgets through discipline, maintaining reserves, and providing tax relief. It summarizes Indiana's improved fiscal condition under Governor Daniels, from deficits and low reserves to surpluses and top credit ratings. The policy proposes continuing balanced budgets without tax increases, maintaining at least 12.5% reserves, and allocating surpluses to a 10% income tax cut phased in over two years and bolstering reserves further.
This document outlines a policy goal of continuing fiscal discipline in Indiana by balancing budgets, maintaining reserves, and providing tax relief. It recommends passing structurally balanced budgets without tax increases, maintaining reserves of at least 12.5% of appropriations, and allocating budget surpluses to a 10% income tax cut and increasing reserves. It also calls for performance reviews of government programs and moving to performance-based budgeting to ensure funds are spent effectively.
This document discusses proposed changes to GASB 45 rules for reporting other post-employment benefits (OPEB). It covers the motivation for changes due to criticisms of GASB 45, an overview of the key proposed changes including bringing the unfunded liability to the balance sheet and using a single discount rate, preparations districts can make, and a timeline for implementation. The proposed changes would substantially revise OPEB accounting and reporting to be more similar to the new pension reporting rules.
The document discusses how HSAs can boost retirement plans. It provides an overview of HSA plan designs, trends in the HSA marketplace, and how rising healthcare costs and longer lifespans are affecting retirement savings needs. Integrating HSAs into retirement planning can help offset these costs and provide additional tax-advantaged savings opportunities for employees.
Ontario Municipal Leadership Institute (OMLI) and Alliance for Innovation for...Chris Fabian
This document discusses achieving fiscal health and wellness through priority based budgeting based on a presentation given by Jon Johnson and Chris Fabian. It outlines four key approaches to achieving fiscal health: 1) spending within your means by distinguishing ongoing and one-time revenues, 2) establishing and maintaining appropriate reserves, 3) understanding variances between budgets and actuals, and 4) being transparent about the true cost of doing business through full cost allocation. The presentation provides diagnostics and treatment options for organizations to assess their current practices and make improvements in each of these areas to achieve long-term fiscal wellness.
PUBLIC FINANCIAL ASSESSMENT OF HIV SPENDING: NASARAWA STATE, NIGERIAHFG Project
This document assesses public financial management of HIV spending in Nasarawa State, Nigeria. It identifies several bottlenecks in the planning, budgeting, and budget execution processes. Bottlenecks include highly centralized decision making, lack of cohesive planning, and absence of evidence-based advocacy. It also notes differences in priorities between government officials and program managers. Recommendations include advocating for HIV program needs, preparing medium-term sector strategies, making budgets and revenue forecasts more realistic, and building capacity of HIV agencies to improve financial management processes.
Idaho ICMA - Fiscal Health PresentationChris Fabian
This document provides an overview of achieving fiscal health and wellness through priority based budgeting. It discusses four key approaches to achieving fiscal health: 1) spending within your means by distinguishing ongoing vs one-time revenues and expenditures, 2) establishing and maintaining reserves, 3) understanding variances between budgets and actuals, and 4) being transparent about the true cost of doing business. For each approach, it provides diagnostics to assess an organization and available treatments to improve. The document is intended to help elected officials think strategically about key fiscal questions and make financially sound decisions.
PUBLIC FINANCIAL ASSESSMENT OF HIV SPENDING: AKWA IBOM STATE, NIGERIAHFG Project
This document summarizes a public financial assessment of HIV spending in Akwa Ibom State, Nigeria. It identifies bottlenecks in planning, budgeting, and budget execution processes that hinder optimal resource allocation and spending for HIV/AIDS initiatives. Key bottlenecks include a lack of cohesive planning, poor stakeholder engagement, non-evidence-based advocacy, unrealistic budgeting, and challenges requesting cash for budget execution. It concludes with recommendations such as building capacity for requesting funds, preparing a state development plan and sector strategies, implementing realistic budgets and quarterly work plans, and restructuring reporting for HIV/AIDS agencies.
The document discusses Indiana's fiscal policy goals of balancing budgets through discipline, maintaining reserves, and providing tax relief. It summarizes Indiana's improved fiscal condition under Governor Daniels, from deficits and low reserves to surpluses and top credit ratings. The policy proposes continuing balanced budgets without tax increases, maintaining at least 12.5% reserves, and allocating surpluses to a 10% income tax cut phased in over two years and bolstering reserves further.
This document outlines a policy goal of continuing fiscal discipline in Indiana by balancing budgets, maintaining reserves, and providing tax relief. It recommends passing structurally balanced budgets without tax increases, maintaining reserves of at least 12.5% of appropriations, and allocating budget surpluses to a 10% income tax cut and increasing reserves. It also calls for performance reviews of government programs and moving to performance-based budgeting to ensure funds are spent effectively.
This document discusses proposed changes to GASB 45 rules for reporting other post-employment benefits (OPEB). It covers the motivation for changes due to criticisms of GASB 45, an overview of the key proposed changes including bringing the unfunded liability to the balance sheet and using a single discount rate, preparations districts can make, and a timeline for implementation. The proposed changes would substantially revise OPEB accounting and reporting to be more similar to the new pension reporting rules.
The document discusses how HSAs can boost retirement plans. It provides an overview of HSA plan designs, trends in the HSA marketplace, and how rising healthcare costs and longer lifespans are affecting retirement savings needs. Integrating HSAs into retirement planning can help offset these costs and provide additional tax-advantaged savings opportunities for employees.
Fiscal Space and Financing for National Health Insurance in Botswana - ReportHFG Project
This document provides background on Botswana's macroeconomic and fiscal situation as it relates to fiscal space for health financing. It notes that while Botswana has relatively unconstrained fiscal space in the short-term due to diamond exports, economic growth has averaged only 4% in recent years and is highly dependent on minerals. As diamond revenues decline gradually, Botswana will need to generate new sources of export-led growth and increase domestic revenue generation. The long-term challenge is ensuring fiscal sustainability as Botswana transitions its economy away from reliance on minerals.
Fiscal Space and Financing for National Health Insurance in Botswana - BriefHFG Project
This document summarizes a fiscal space analysis conducted for Botswana's Ministry of Health and Wellness on establishing a national health insurance program. The analysis found that proposed health insurance contribution levies would only generate about 11.5% of the estimated costs of a universal health services package. Even doubling contribution rates only increased revenues to about 31% of costs. This indicates that Botswana would still need to subsidize most of the costs of a national health insurance program through the existing public health budget, reducing funds available for other health services. The analysis suggests that Botswana's national health insurance proposals in their current form are unlikely to significantly increase health funding or enable cross-subsidies between insurance plans as initially expected.
This document provides an overview of priority based budgeting and achieving fiscal health for elected officials. It discusses diagnosing a jurisdiction's financial situation and developing treatment plans to improve fiscal health. Key areas of focus include spending within available revenues, establishing and maintaining reserves, understanding variances between budgets and actuals, and ensuring transparency around the true costs of programs and services. The document aims to help elected officials make informed financial decisions for their communities.
This document provides a financial plan for Mr. Sumantra Pal. It analyzes his current financial situation, outlines goals and recommendations, and projects his financial status into retirement. Key areas assessed include investment allocation, assets, liabilities, net worth, education savings needs, retirement income needs, asset depletion over time, life insurance needs, and risks of long term care costs. The plan finds his current retirement plan may leave him with only a marginal amount at life expectancy and recommends actions to improve his financial arrangements and protection.
Walker Alaska Feb 2015 ratings presentation final 1.31.2015Brad Keithley
The document provides an overview of Alaska's revenue forecast and budget outlook. It notes that FY2015 unrestricted revenue forecasts declined 43.6% from spring to fall 2014 due to lower oil prices. The state is reducing general fund spending by 9% for FY2016 and may target 25% cumulative reductions if revenues remain subdued. Reserve balances are projected to remain over 200% of general fund expenses through FY2023 despite budget gaps. The long-term production and price forecasts indicate ongoing challenges.
ACCI 2016-Positive Health and Financial Behaviors PresentationBarbara O'Neill
This study explored relationships between positive health behaviors like physical activity and financial behaviors like budgeting that require time or avoiding negative behaviors. It found moderate correlations between health and financial indices and supported the hypotheses that time-commitment behaviors in one area relate to the other, as do avoidance behaviors. The implications are that health behaviors provide insight into financial behaviors and vice versa, and promoting conscientious behaviors may help both areas.
1) Federal sequestration cuts will reduce funding for many of San Antonio's federally-funded city grant programs by 5.1-8.2%, potentially impacting $7-11 million of the city's FY2014 budget.
2) Air traffic control towers at San Antonio airports face closures or reduced hours.
3) Build America Bond subsidies will be cut by 8.7%, costing San Antonio $166,000 in FY2013. Changes to municipal bond tax exemption could also increase city borrowing costs.
Increasing Domestic Investment in AIDS, Tuberculosis and Malaria: Global Fund...theglobalfight
Increasing Domestic Investment in AIDS, Tuberculosis and Malaria: Global Fund Resource Mobilization in Implementing Countries
Among other things, we discuss:
-New Global Fund policies that promote implementing country investments
-Financing leveraged to date and expectations for additional increases
-On-the-ground examples of domestic resource mobilization
Unit one of Floyd Saunders' Personal Money Management Seminars - Learn the basics of budgeting and why managing your money starts with controlling spending. This is the first unit in a series of six that include: buying your first home, credit cards, living on your own, handling credit and savings/investing. Contact me for the instructor's guide and participant workbooks.
Developing Haiti’s First Health Financing StrategyHFG Project
The Ministry has an approved National Health Policy, known as the Politique Nationale de Santé, which addresses “what” is to be done. In addition, the Ministry is developing a National Health Plan that lays out “how” the National Health Policy will be made operational. However, the Ministry of Health does not yet have a national health financing strategy that outlines “where” resources will come from and “how” they will be used to achieve the country’s health objectives.
To bridge this important gap, the HFG project is working with the Planning and Evaluation Unit of the Ministry of Health to develop a national health financing strategy that will include an operational plan consisting of specific activities, timelines, and an overall health budget. The strategy will focus on the three core functions of health financing: mobilization of resources; pooling of risks and financial protection; and purchasing and provider payment. A strategy mapping out these core health financing functions will enable Haiti to raise the necessary resources, better protect people from the financial consequences of ill health, and make optimum use of resources to achieve the National Health Plan’s vision.
The health financing strategy will serve as a road map, particularly when it is combined with data from the second National Health Accounts, which the HFG project is also supporting, and a fully costed National Health Plan. Together, they will provide strong evidence and powerful justification for increased health financing in the future to improve Haiti’s health outcomes.
Health and budget analysis for civil societyEsther Agbon
The document discusses Nigeria's health budget. It notes that the federal health budget averages 5% over the last 5 years, but health sectors are not prioritized at both federal and state levels. Recurrent budgets, which fund operations, take up about 80% of health allocations, leaving less than 20% for capital expenditures like infrastructure and training. The document analyzes trends in budget allocations, outlines steps in budget analysis for advocacy, and discusses tools like community scorecards, public expenditure tracking surveys, and social audits that can be used to monitor budgets.
2016 Maternal and Child Health budget analysis Esther Agbon
An analysis of the 2016 health budget proposal for Maternal and Child Health allocations carried out revealed that previous budget lines for midwives service scheme, family planning and maternal and child health insurance have been scrapped, meaning there is NO budget for these items. A major public private partnership that the government will be involved in has no details on what those allocations are for.Lump sum budgeting smacking of poor transparent allocation is what you find across key MDAs reviewed.
This document provides a financial analysis of Good Samaritan Health Center of Gwinnett (GSHCG) over 2004-2014. It finds that while the center experienced losses in early years and during the financial crisis, revenues have exceeded expenses since 2011. The center relies heavily on contributions, which account for over a third of revenues. Expenses have increased along with services provided and patient encounters. The center has expanded locations and services while maintaining its mission of providing affordable healthcare to the uninsured.
Proposed FY 2014 Budget and Multi-Year FY 2014-FY 2015 Budget PlanFairfax County
The document summarizes the County Executive's presentation of Fairfax County's FY 2014 Advertised Budget Plan, which includes projections for FY 2015. It notes ongoing budget challenges and the use of a multi-year budget approach. Key aspects of the budget proposal include protecting critical services, addressing unknown factors like federal sequestration, reducing reliance on one-time funds, and making strategic investments to take advantage of opportunities from development projects. The budget proposes a 2 cent real estate tax rate increase to fund requirements in FY 2014 and 2015.
The Indiana Family & Social Services Administration (FSSA) oversees a $8.6 billion biennial budget across five divisions serving over 4,400 employees. The Healthy Indiana Plan (HIP) provides coverage to over 42,500 individuals with over 55,000 more on the waitlist. HIP members have high rates of preventive care completion and emergency room utilization decreased for members making required payments. The Division of Disability and Rehabilitative Services serves over 25,000 children through waivers and Medicaid waivers now serve over 9,300 individuals, a significant increase over nursing facility clients.
Health Reform Bulletin - PCOR & Transitional Reinsurance Fee RemindersCBIZ, Inc.
This HRB is a reminder of the following upcoming Affordable Care Act (ACA) fees due yet in 2014:
1. The Patient-Centered Outcomes Research (PCOR) Fee
2. The Transitional Reinsurance Fee
This contains a summary chart that can be used as a quick reference of who this fee applies to, when it is due, how it is paid and links to the complete Health Reform Bulletins pertinent to each fee.
The document is a multi-product brochure from Manulife aimed at consumers transitioning to retirement. It provides an overview of retirement products and highlights key things for readers to consider when planning for retirement, such as when to retire, estimating expenses, understanding sources of income, and reviewing insurance needs. The brochure uses a magazine format with different sections to make the large amount of information easier for readers to navigate and find what interests them most. This format was well-received by clients and marketing teams.
This document discusses state health care policy issues in 2012, including:
1. State budgets have faced large cumulative budget gaps between 2002-2013 totaling over $820.5 billion, putting pressure on states to cut programs.
2. The Affordable Care Act provides opportunities for states through expanding Medicaid eligibility and benefits, establishing health insurance exchanges, and pilot programs.
3. Key policy issues for states in 2012 include implementing health reform, addressing ongoing budget shortfalls, and debating scope of practice and workforce laws.
Financing public health in India is a vital challenge. As a response, the Union government transfers funds to the lower tiers of government, specifically meant to improve the public health services. The stated goal of specific transfers is to ensure that at least certain minimum standards of healthcare are achieved all across the country. However, our analysis of this category of funds in the period 2005 to 2015 highlights several problems that make this goal difficult to achieve.
First, the transfers are poorly targeted, as these are not linked to health indicators. Instead, such transfers by and large tend to be incremental. Second, the specific purpose transfer system has not been very helpful in offsetting the fiscal disabilities of the poorer states. Third, there is evidence to suggest that States substitute grants received from the Union government for their own spending with the result that there has not been a commensurate increase in overall spending on healthcare.
ICMA Conference 2013 - Center for Priority Based Budgeting Presentation (2/2)Chris Fabian
This document outlines steps for priority-based budgeting. It discusses determining community results that a government aims to achieve, clarifying definitions of results through "result maps", identifying specific programs and services, and valuing programs based on their influence on results. The document provides examples from various cities. It emphasizes that priority-based budgeting allows allocation of resources based on prioritization of programs according to their influence on important community results.
The document showcases French Connection Home's autumn/winter 2015 collection. It features photographs and descriptions of furniture, lighting, textiles, and accessories with an industrial yet elegant aesthetic. Concrete, wood, and metal materials are used alongside softer touches like mercurised mirrors, burnt wood, and marble accents. Styles include bistro, contemporary eclectic, soft industrial, and classic yet modern designs intended to age gracefully and be mixed and matched in different settings.
Fiscal Space and Financing for National Health Insurance in Botswana - ReportHFG Project
This document provides background on Botswana's macroeconomic and fiscal situation as it relates to fiscal space for health financing. It notes that while Botswana has relatively unconstrained fiscal space in the short-term due to diamond exports, economic growth has averaged only 4% in recent years and is highly dependent on minerals. As diamond revenues decline gradually, Botswana will need to generate new sources of export-led growth and increase domestic revenue generation. The long-term challenge is ensuring fiscal sustainability as Botswana transitions its economy away from reliance on minerals.
Fiscal Space and Financing for National Health Insurance in Botswana - BriefHFG Project
This document summarizes a fiscal space analysis conducted for Botswana's Ministry of Health and Wellness on establishing a national health insurance program. The analysis found that proposed health insurance contribution levies would only generate about 11.5% of the estimated costs of a universal health services package. Even doubling contribution rates only increased revenues to about 31% of costs. This indicates that Botswana would still need to subsidize most of the costs of a national health insurance program through the existing public health budget, reducing funds available for other health services. The analysis suggests that Botswana's national health insurance proposals in their current form are unlikely to significantly increase health funding or enable cross-subsidies between insurance plans as initially expected.
This document provides an overview of priority based budgeting and achieving fiscal health for elected officials. It discusses diagnosing a jurisdiction's financial situation and developing treatment plans to improve fiscal health. Key areas of focus include spending within available revenues, establishing and maintaining reserves, understanding variances between budgets and actuals, and ensuring transparency around the true costs of programs and services. The document aims to help elected officials make informed financial decisions for their communities.
This document provides a financial plan for Mr. Sumantra Pal. It analyzes his current financial situation, outlines goals and recommendations, and projects his financial status into retirement. Key areas assessed include investment allocation, assets, liabilities, net worth, education savings needs, retirement income needs, asset depletion over time, life insurance needs, and risks of long term care costs. The plan finds his current retirement plan may leave him with only a marginal amount at life expectancy and recommends actions to improve his financial arrangements and protection.
Walker Alaska Feb 2015 ratings presentation final 1.31.2015Brad Keithley
The document provides an overview of Alaska's revenue forecast and budget outlook. It notes that FY2015 unrestricted revenue forecasts declined 43.6% from spring to fall 2014 due to lower oil prices. The state is reducing general fund spending by 9% for FY2016 and may target 25% cumulative reductions if revenues remain subdued. Reserve balances are projected to remain over 200% of general fund expenses through FY2023 despite budget gaps. The long-term production and price forecasts indicate ongoing challenges.
ACCI 2016-Positive Health and Financial Behaviors PresentationBarbara O'Neill
This study explored relationships between positive health behaviors like physical activity and financial behaviors like budgeting that require time or avoiding negative behaviors. It found moderate correlations between health and financial indices and supported the hypotheses that time-commitment behaviors in one area relate to the other, as do avoidance behaviors. The implications are that health behaviors provide insight into financial behaviors and vice versa, and promoting conscientious behaviors may help both areas.
1) Federal sequestration cuts will reduce funding for many of San Antonio's federally-funded city grant programs by 5.1-8.2%, potentially impacting $7-11 million of the city's FY2014 budget.
2) Air traffic control towers at San Antonio airports face closures or reduced hours.
3) Build America Bond subsidies will be cut by 8.7%, costing San Antonio $166,000 in FY2013. Changes to municipal bond tax exemption could also increase city borrowing costs.
Increasing Domestic Investment in AIDS, Tuberculosis and Malaria: Global Fund...theglobalfight
Increasing Domestic Investment in AIDS, Tuberculosis and Malaria: Global Fund Resource Mobilization in Implementing Countries
Among other things, we discuss:
-New Global Fund policies that promote implementing country investments
-Financing leveraged to date and expectations for additional increases
-On-the-ground examples of domestic resource mobilization
Unit one of Floyd Saunders' Personal Money Management Seminars - Learn the basics of budgeting and why managing your money starts with controlling spending. This is the first unit in a series of six that include: buying your first home, credit cards, living on your own, handling credit and savings/investing. Contact me for the instructor's guide and participant workbooks.
Developing Haiti’s First Health Financing StrategyHFG Project
The Ministry has an approved National Health Policy, known as the Politique Nationale de Santé, which addresses “what” is to be done. In addition, the Ministry is developing a National Health Plan that lays out “how” the National Health Policy will be made operational. However, the Ministry of Health does not yet have a national health financing strategy that outlines “where” resources will come from and “how” they will be used to achieve the country’s health objectives.
To bridge this important gap, the HFG project is working with the Planning and Evaluation Unit of the Ministry of Health to develop a national health financing strategy that will include an operational plan consisting of specific activities, timelines, and an overall health budget. The strategy will focus on the three core functions of health financing: mobilization of resources; pooling of risks and financial protection; and purchasing and provider payment. A strategy mapping out these core health financing functions will enable Haiti to raise the necessary resources, better protect people from the financial consequences of ill health, and make optimum use of resources to achieve the National Health Plan’s vision.
The health financing strategy will serve as a road map, particularly when it is combined with data from the second National Health Accounts, which the HFG project is also supporting, and a fully costed National Health Plan. Together, they will provide strong evidence and powerful justification for increased health financing in the future to improve Haiti’s health outcomes.
Health and budget analysis for civil societyEsther Agbon
The document discusses Nigeria's health budget. It notes that the federal health budget averages 5% over the last 5 years, but health sectors are not prioritized at both federal and state levels. Recurrent budgets, which fund operations, take up about 80% of health allocations, leaving less than 20% for capital expenditures like infrastructure and training. The document analyzes trends in budget allocations, outlines steps in budget analysis for advocacy, and discusses tools like community scorecards, public expenditure tracking surveys, and social audits that can be used to monitor budgets.
2016 Maternal and Child Health budget analysis Esther Agbon
An analysis of the 2016 health budget proposal for Maternal and Child Health allocations carried out revealed that previous budget lines for midwives service scheme, family planning and maternal and child health insurance have been scrapped, meaning there is NO budget for these items. A major public private partnership that the government will be involved in has no details on what those allocations are for.Lump sum budgeting smacking of poor transparent allocation is what you find across key MDAs reviewed.
This document provides a financial analysis of Good Samaritan Health Center of Gwinnett (GSHCG) over 2004-2014. It finds that while the center experienced losses in early years and during the financial crisis, revenues have exceeded expenses since 2011. The center relies heavily on contributions, which account for over a third of revenues. Expenses have increased along with services provided and patient encounters. The center has expanded locations and services while maintaining its mission of providing affordable healthcare to the uninsured.
Proposed FY 2014 Budget and Multi-Year FY 2014-FY 2015 Budget PlanFairfax County
The document summarizes the County Executive's presentation of Fairfax County's FY 2014 Advertised Budget Plan, which includes projections for FY 2015. It notes ongoing budget challenges and the use of a multi-year budget approach. Key aspects of the budget proposal include protecting critical services, addressing unknown factors like federal sequestration, reducing reliance on one-time funds, and making strategic investments to take advantage of opportunities from development projects. The budget proposes a 2 cent real estate tax rate increase to fund requirements in FY 2014 and 2015.
The Indiana Family & Social Services Administration (FSSA) oversees a $8.6 billion biennial budget across five divisions serving over 4,400 employees. The Healthy Indiana Plan (HIP) provides coverage to over 42,500 individuals with over 55,000 more on the waitlist. HIP members have high rates of preventive care completion and emergency room utilization decreased for members making required payments. The Division of Disability and Rehabilitative Services serves over 25,000 children through waivers and Medicaid waivers now serve over 9,300 individuals, a significant increase over nursing facility clients.
Health Reform Bulletin - PCOR & Transitional Reinsurance Fee RemindersCBIZ, Inc.
This HRB is a reminder of the following upcoming Affordable Care Act (ACA) fees due yet in 2014:
1. The Patient-Centered Outcomes Research (PCOR) Fee
2. The Transitional Reinsurance Fee
This contains a summary chart that can be used as a quick reference of who this fee applies to, when it is due, how it is paid and links to the complete Health Reform Bulletins pertinent to each fee.
The document is a multi-product brochure from Manulife aimed at consumers transitioning to retirement. It provides an overview of retirement products and highlights key things for readers to consider when planning for retirement, such as when to retire, estimating expenses, understanding sources of income, and reviewing insurance needs. The brochure uses a magazine format with different sections to make the large amount of information easier for readers to navigate and find what interests them most. This format was well-received by clients and marketing teams.
This document discusses state health care policy issues in 2012, including:
1. State budgets have faced large cumulative budget gaps between 2002-2013 totaling over $820.5 billion, putting pressure on states to cut programs.
2. The Affordable Care Act provides opportunities for states through expanding Medicaid eligibility and benefits, establishing health insurance exchanges, and pilot programs.
3. Key policy issues for states in 2012 include implementing health reform, addressing ongoing budget shortfalls, and debating scope of practice and workforce laws.
Financing public health in India is a vital challenge. As a response, the Union government transfers funds to the lower tiers of government, specifically meant to improve the public health services. The stated goal of specific transfers is to ensure that at least certain minimum standards of healthcare are achieved all across the country. However, our analysis of this category of funds in the period 2005 to 2015 highlights several problems that make this goal difficult to achieve.
First, the transfers are poorly targeted, as these are not linked to health indicators. Instead, such transfers by and large tend to be incremental. Second, the specific purpose transfer system has not been very helpful in offsetting the fiscal disabilities of the poorer states. Third, there is evidence to suggest that States substitute grants received from the Union government for their own spending with the result that there has not been a commensurate increase in overall spending on healthcare.
ICMA Conference 2013 - Center for Priority Based Budgeting Presentation (2/2)Chris Fabian
This document outlines steps for priority-based budgeting. It discusses determining community results that a government aims to achieve, clarifying definitions of results through "result maps", identifying specific programs and services, and valuing programs based on their influence on results. The document provides examples from various cities. It emphasizes that priority-based budgeting allows allocation of resources based on prioritization of programs according to their influence on important community results.
The document showcases French Connection Home's autumn/winter 2015 collection. It features photographs and descriptions of furniture, lighting, textiles, and accessories with an industrial yet elegant aesthetic. Concrete, wood, and metal materials are used alongside softer touches like mercurised mirrors, burnt wood, and marble accents. Styles include bistro, contemporary eclectic, soft industrial, and classic yet modern designs intended to age gracefully and be mixed and matched in different settings.
Embracing the decade of local govt 11-21-13 webinarChris Fabian
This document discusses tools and strategies for local governments to achieve fiscal health and long-term fiscal wellness in the coming decade. It outlines two strategic initiatives - fiscal health and long-term fiscal wellness. To achieve fiscal health, the document recommends analyzing revenues and expenditures, establishing reserves, conducting variance analyses, and creating long-range financial forecasts. To achieve fiscal wellness, it suggests identifying community priorities or "results", evaluating programs based on their influence on priorities, and allocating resources accordingly through a "resource alignment diagnostic tool". The tools and frameworks presented aim to help local governments make sound financial decisions and align their budgets with community needs.
Technology & Tools of Priority Based Budgeting - 2013 conferenceChris Fabian
This document outlines the agenda and topics for the 2013 annual conference of the Center for Priority Based Budgeting. The conference will focus on bringing a new "lens" of priority based budgeting to government budgeting and resource allocation. Priority based budgeting uses data and performance metrics to identify priority programs and allocate funding accordingly. The conference will discuss tools and strategies for identifying priority programs, measuring results, and aligning resources and budgets with community priorities.
This document discusses priority based budgeting and looking at budgets through a new lens. It introduces priority based budgeting and emphasizes defining community results and program priorities. It outlines steps for success, including determining results, clarifying result definitions with "result maps", identifying programs and services, valuing programs based on results, and allocating resources based on priorities. The document cautions against "across the board" budget cuts and emphasizes targeted cuts after serious discussion of community values and program benefits.
The document provides background information on Douglas County, Nevada and Wheat Ridge, Colorado. It outlines Douglas County's strategic priorities of financial stability, public safety, economic vitality, infrastructure, natural environment/resources, and managing growth. It also outlines Wheat Ridge's strategic priorities of economically viable commercial centers, financially sound city, and desirable neighborhoods. The document then provides detailed definitions and explanations for each strategic priority for both Douglas County and Wheat Ridge.
Priority Based Budgeting - City of CincinnatiChris Fabian
Confronted with the 'new normal' of flat or declining revenues, spiraling health care and pension costs, and persistent structural imbalances, the City of Cincinnati chose Priority Based Budgeting an alternative to the traditional incremental budgeting approach that automatically makes this year's budget the basis for next year's spending plan.
Council approved the administration's recommendation to hire the Center for Priority Based Budgeting (Center for PBB) to help with the intensive citizen engagement that drives the new approach. According to Council: “Priority-driven budgeting offers a common-sense, strategic alternative to conventional budgeting. It creates a fundamental change in the way resources are allocated by using a collaborative, evidence-based approach to measure services against community priorities. By bringing together community leaders and citizens to determine strategic priorities, the city can align resources with what the community values most, and create service efficiencies and innovation.”
For 2013, the City faces a projected $34.0 million budget deficit for the General Fund Operating Budget and will need to cut spending and increase revenues to fill this need.
The document discusses the fiscal sustainability of Ontario's health care system. It notes that health care spending has been growing faster than government revenue, creating a long-term sustainability problem. It analyzes key drivers of health spending such as hospitals, physician compensation, and pharmaceutical drugs. Recent reforms aim to tie hospital funding to quality and activity levels, transition physicians away from fee-for-service payments, and reduce drug costs through generic pricing caps. However, sustaining the public health system remains an ongoing challenge.
The memorandum from Curtis Healy, head of the Michigan Health Department, summarizes proposed budget cuts to the department for the next fiscal year. Healy met with staff and senior leadership, who proposed initial cuts totaling $1,000,000 across several programs. Healy then proposed additional cuts of $525,000 to specific programs highlighted in yellow. The total proposed cuts amount to $2,317,500 across various department programs and services. Healy's goal was to do the least overall harm following criteria of low political feasibility. He requests Governor Yersy Yersinian's consideration and approval of the proposed cuts.
This document outlines a project scenario for developing an implementation plan to promote health and prevent chronic diseases like asthma, diabetes, and obesity among children in Michigan. Participants are asked to choose a county, define services provided, and identify delivery methods. The plan should forecast population data, reduce absenteeism and ER visits, project healthcare savings over 10 years, and include incentives for developing healthy habits in youth. Funding may come from private businesses, government, non-profits, and retailers.
The New Mexico Human Services Department's strategic plan for fiscal year 2011 outlines goals to: 1) insure more New Mexicans through expanding access to affordable health coverage options; 2) improve health outcomes and family support through initiatives like school-based health services; and 3) combat hunger and improve nutrition by reducing hunger among children through programs like SNAP and school meal programs. Performance measures and targets are established to track progress towards these goals.
Money Matters: Financial Literacy for Healthcarenathanieldporter
Slides for Financial Literacy for Healthcare workshop with Dr. Daad Rizk, Penn State Financial Literacy Coordinator. The workshop took place April 16, 2015 and was hosted by the GPSA Student Health Insurance Committee
This document provides performance data for Cook County departments in the second quarter of 2013. It includes budgets, expenditures, goals, and metrics for departments that handle finance and administration, human rights and ethics, justice programs, emergency management, environmental programs, medical examiner services, transportation, animal control, and other countywide services. Departments aim to operate efficiently while achieving goals in areas like public safety, healthcare, taxation, and economic development. The report seeks public feedback on county services and performance.
This document summarizes Oregon's experience increasing primary care spending through legislative and collaborative efforts. It outlines how Oregon created a patient-centered medical home program, increased transparency of primary care spending across payers, and eventually mandated a minimum primary care spending threshold of 12% of total medical expenditures. Key lessons included starting with less controversial policies, using data to drive transparency and goals, and engaging a multi-stakeholder collaborative. The presentation recommends similar best practices for other states seeking to invest more in primary care.
This document discusses strategies for healthcare practices to improve financial viability through increased transparency and improved front-end collection methods. It recommends defining costs and billing upfront to set clear patient expectations. Practices should invest in tools to check insurance benefits and eligibility in real-time. Staff should be trained to educate patients on their financial responsibilities. Providing cost transparency builds trust with patients and increases referrals through positive word-of-mouth. Overall, transparency can lead to higher profitability through reduced bad debt and improved revenue cycle management.
Weight watchers international case study by jack ngJack Ng
A Strategic Management analysis of Weight watchers international using tools like PEST, 5 Forces, Core competencies, Value Chain Analysis and recommendations.
This document summarizes information from Imagine!'s 2015 Community Forum. It provides data on the number of people served by Imagine! across various programs which have generally increased from 2014 to 2015. It also discusses Colorado legislature bills related to I/DD, the state government's FY16 budget proposal which will expand HCBS services and transition people from regional centers, and workforce and job market data for Boulder County. Finally, it outlines Imagine!'s goals in addressing the new federal conflict free case management rule to maintain services and choice for those served while complying with federal standards.
The document summarizes highlights from Ohio's proposed state budget bill HB 153 for fiscal years 2012-2013. It discusses funding cuts to areas like education, Medicaid, and mental health services while Medicaid caseloads increase. Concerns are raised that more cuts may come in the next budget and the long-term impacts on health and human services are uncertain given over 5,000 pages of policy changes with little detail. Advocates call for more investment in areas like child welfare, mental health, and foodbanks to adequately meet growing needs.
Mastering Personal Finance: The Key to Financial SuccessTheGoodStuff1
Mastering personal finance is essential for achieving financial success and security. One crucial aspect of this is budgeting, which forms the foundation of effective financial management. In this comprehensive article, we will explore the significance of budgeting, provide practical tips for creating a budget, and offer relevant online resources, podcasts, books, and YouTube channels for you to lean for support and further enrichment.
Week 3 - Fiscal Sustainability of Ontario's Health Care SystemAlexandre Mayer
The %growth in Ontario's HC spending for 2011 was greater than the %growth in Ontario's revenue. This suggests that without further action, Ontario will not have a fiscally sustainable health care system under McGuinty.
HFG DRM for Health Workshop: IntroductionHFG Project
Recently, the Health Finance and Governance (HFG) Project organized a multi-country workshop to support policymakers from public health and finance agencies in developing concrete action plans for mobilizing domestic resources for health. Marty Makinen led an introduction presentation focusing on the importance of relationships between Ministries of Finance and Health in mobilizing domestic resources.
Roadmap to Financial Stability: Personal & Household BudgetingTodd Christensen
This document provides an overview of a financial education session on budgeting fundamentals. It discusses budgeting basics like tracking income and expenses, distinguishing needs from wants, prioritizing expenses, and minimizing "budget busters." Tips are provided on keeping good spending records, comparing budgets to actual spending, adjusting budgets and behaviors accordingly, developing savings habits, and establishing supportive family financial routines. The goal is to help people gain greater control over their finances through budgeting.
This document discusses strategies for improving financial wellness for disadvantaged communities. It notes that lower-income clients have different priorities and mindsets compared to upper-income clients. They are more focused on present needs due to income volatility and scarcity mindsets. The document provides tips for financial educators, such as using irregular income budgeting, telling success stories of similar people overcoming challenges, and connecting clients to local assistance resources. It also reviews costs of living in New Jersey and benefits available from programs like SNAP, SSDI, SSI, TANF, Section 8 housing, utility assistance programs, and warning signs of financial trouble.
The document provides an overview of Ontario's health care system. It discusses how the Ontario government operates under a Westminster system with a Liberal minority government led by Premier Dalton McGuinty. It outlines the roles of the Ministry of Health and Long-Term Care and Local Health Integration Networks in developing health policy and overseeing service delivery. It also describes how physicians and hospitals are major private providers that receive public financing in Ontario's mixed public-private system.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ICMA Conference 2013 - Center for Priority Based Budgeting Presentation (1/2)
1. Jon Johnson, Chris Fabian & Kathie Novak
ICMA Conference Presenters
Leading Your Organization (and Elected Officials) to
“FISCAL HEALTH and WELLNESS through
PRIORITY BASED BUDGETING - Part I
6. Latest Headlines…
States and localities will record operating balances with an aggregate deficit of
1.6 percent of gross domestic product this year
To close the fiscal gap, governments would need to trim current expenditures by
14.2 percent and maintain that level of spending
On the revenue side, eroding tax bases have “buried” states. The economy has
slowly shifted from goods to services, which governments traditionally are
reluctant to collect taxes on
A slowdown of health care cost increases or an economy that gains momentum
could help considerably. On the other hand, changes to federal mandates, tax
policy or funding cuts could make a dent in state and local government coffers for
years to come
“They need to tackle these programs bit by bit, year after year,” Boyd said.
“Governments don’t have the luxury of waiting 10 years.”
11. So - as an Elected Official:
– What does this mean for me?
– What should be I be paying attention to?
– Who should be watching?
– What else is on the horizon?
20. What are your Elected Officials really
thinking?
• What does all this financial information really tell
me?
– Are you saying everything is fine ?
– Are you saying we need to make cuts ?
– Are you saying we need to raise taxes ?
– Are you saying we have more money to spend ?
• What are you asking me to decide ?
OR
• Are you just wanting my “rubber stamp” of
approval ?
21. Are We Headed in the Right Direction?
• “If you don’t know where you are and you don’t
know where you are going – any road will get you
there.”
• "You've got to be very careful if you don't know
where you're going, because you might not get
there.” Yogi Berra
- SO -
Show me where we ARE and show
me where we are GOING!
22.
23. Achieving Fiscal Health & Wellness
2Strategic Initiatives
Fiscal Health Long-term Fiscal Wellness
Fiscal
Health
“Spend Within
Our Means”
Understand
Variances
(Budget vs. Actual)
Incorporate Economic
Analysis and Long-term
Planning into Decision-
Making
Establish and
Maintain Reserves
Transparent About
the “True Cost of
Doing Business”
ACHIEVING FISCAL HEALTH
Fiscal
Wellness
Achieve
Fiscal Health
Value Programs
Based on Evidence
of their Influence
on Results
Support Resource
Allocation Decision
Making with Prioritization
of Programs
Identify, Define and
Value the Results
of Government
Identify Programs
and Services
ACHIEVING LONG-TERM FISCAL WELLNESS
25. Who is Looking through the “New Lens”
ARIZONA - Chandler (2 ); Queen Creek
CALIFORNIA - Walnut Creek (3) ; San Jose (3);
Sacramento (2); Monterey (3); Salinas;
Seaside; Fairfield; Placentia; Mission Viejo
CANADA - Edmonton; Alberta Ministry of
Health
COLORADO - Boulder (3); Longmont (3);
Fort Collins (2); Wheat Ridge (2);
Jefferson County; Thornton; Victor;
Mountain View Fire Protection District:
Manitou Springs; Denver International
Airport; Dillon Valley Water/Sewer District
FLORIDA - Lakeland (3); Delray Beach (2);
Plantation; Pasco County
IDAHO – Post Falls
ILLINOIS - Boone County
KANSAS - Shawnee
MISSOURI - Branson
MONTANA - Billings (2)
NEBRASKA - Grand Island (3)
NEW MEXICO - San Juan County
NEVADA - Douglas County (2)
NORTH CAROLINA - Cary
OHIO - Blue Ash; Cincinnati
OREGON - Springfield, Tualatin
PENNSYLVANIA - Lehigh County
TEXAS - Plano (3), Southlake
VIRGINIA - Chesapeake (2); Christiansburg (2)
WYOMING - Green River
29. DOES THIS LOOK FAMILIAR ?????
$(150,000,000)
$(100,000,000)
$(50,000,000)
$-
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
$300,000,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fund Balance
Uses of Funding
Sources of Funding
2009-2010ProjectedBudget
2010-2011BudgetForecast
30. “Over the Counter” Treatments
Treatment Options:
Fees for Service = Cost of
Delivery
Freeze Vacant Positions
(Temporaries?)
Across the Board “Cuts”
Defer/Delay Capital Projects
“Sharpen” Revenue
Billing/Collection
Consolidated
Purchasing/Contracting
Sell Underutilized Assets
Cost Allocation/Overhead
Transfers
Freeze Salaries/Overtime
Treatment Considerations:
• Only a Short-Term “Fix” to
Relieve Pain
• Safe to apply with minimal
diagnosis
• Must have follow up
diagnosis
31. Emergency-Room” Treatments
Treatment Options:
Across the Board Budget
“Amputation”
Hiring Freeze/Furloughs
Reduction in Workforce
4-Day work weeks
Reduce Services
Spend “Savings” Reserves
Early Retirement Incentives
Outsourcing/Shared
Services
Resize or Restructure
Treatment Considerations:
• Don’t apply without
diagnosis
• Don’t be guilty of malpractice
• Only to “Stop the Bleeding”
32. “Cosmetic” Treatments
(Not a Solution!!!)
Accounting Gimmicks
Shifting Operational Costs to Capital Budgets
Deferring Compensation
Underfund Accrued Liabilities
Short –term borrowing
“Distort” estimates or projections
33. Become a Diagnostician
Fiscal Health & Wellness
Diagnostic:
q
Spending Within Our Means?
q
Start with Revenues?
q
Differentiate Ongoing vs. One-time?
q
Distinguish Program vs. General Gov’t?
q
Establishing and Maintaining Our
Reserves?
q
Reserve Requirements?
q
Reserve Inventory?
q
Understanding Variances?
q
Too Many Contingencies?
q
Forecasting Tools?
q
True Cost of Doing Business?
q
Internal Service Funds?
q
Full Cost Plan?
q
Long-term Decision Making?
q
Trend Analysis?
q
Scenario Planning?
q
Decision Support Tools?
q
Results of Government?
q
Clear, comprehensive Results?
q
Clear “Value” of Results?
q
Program Valuations?
q
Program Inventory?
q
Strategy Maps – Cause & Effect?
q
Resource Allocation Based on
Prioritization?
Fiscal
Health
“Spend Within
Our Means”
Understand
Variances
(Budget vs. Actual)
Incorporate Economic
Analysis and Long-term
Planning into Decision-
Making
Establish and
Maintain Reserves
Transparent About
the “True Cost of
Doing Business”
ACHIEVING FISCAL HEALTH
Fiscal
Wellness
Achieve
Fiscal Health
Value Programs
Based on
Evidence of their
Influence on
Results
Support Resource
Allocation Decision
Making with
Prioritization of
Programs
Identify, Define
and Value the
Results of
Government
Systematically
Evaluate Program
Efficiency
ACHIEVING LONG-TERM FISCAL WELLNESS
Prescription of Fiscal Health
Treatment Options to:
ü Spend Within Our Means
ü Establish and Maintain Reserves
ü Understand Variances
ü Establish True Cost of Doing
Business
ü Integrate Long-term Planning into
Decision Making
Prescription of Fiscal Wellness
Treatment Options to:
ü Sustain Fiscal Health Achievements
ü Identify, Define and Value Results of
County
ü Value Programs (Based on Results)
ü Evaluate Program Efficiency
ü Support Resource Allocation
Decision Making with Program
Prioritization
Solano County, California
Achieving Fiscal Health & Wellness
Phase I: Initial Diagnosis, Prescription and Treatment Plan
35. 1. How much do we have available to spend?
(not “How much do you need”?)
Strategic Questions
36. Approach to Fiscal Health #1:
“Spend Within Your Means”
Apply Diagnostics – DO YOU…
– Start with revenues?
• Know what “drives” each major revenue source?
• Prepare a formal organization-wide Revenue Manual?
– Distinguish one-time from ongoing sources and uses?
• Have a process in place to “track” them separately?
• Demonstrate this differentiation in your forecasts and
other financial documents?
– Differentiate Program Revenues from General
Government Revenues?
• Adjust budget allocations to departments for changes
in associated Program Revenues?
37. Approach to Fiscal Health #1:
“Spend Within Your Means”
Available Treatments:
– Achieve ongoing alignment
• Fund operating expenditures with reliable ongoing
revenues
• Prevent reliance on volatile revenues (that might not
come in!)
– Achieve one-time alignment
• Fund one-time costs with one-time sources
• Ensure reserves aren’t used for ongoing expenses
– Promote revenue diversification and enhancement
39. Strategic Questions
1. How much do we have available to spend? -
(not “How much do you need”?)
2. Why do we need to keep “money in the bank”?
40. Approach to Fiscal Health #2:
Establish and Maintain Reserves
Apply Diagnostics – DO YOU…
– Understand what makes up Fund Balance(s) and why you hold
reserves?
• Have a formal “inventory” of all restricted or designated
fund balance reserves, stating their purpose, the authority
establishing them and how they are to be calculated?
– Have a written fund balance reservation policy?
• Monitor fund balances to ensure that reserves are
maintained?
• Ensure established working capital reserves are sufficient to
meet emergency needs or short-term revenue shortfalls?
– Monitor Fund Balance levels to ensure they “aren’t too little”
OR “too much”, but “just right”?
41. Determining the “Right” Level
Baseline recommendation (General Fund)–
5% to 15% of operating revenue
1 to 2 months operating expenditures
Adjust for:
Historic Events and Past Experience
Government Size
Revenue Stability
Future Capital Needs
42. Standard & Poor's Views
Low = 0% or “below”
Adequate = 1% to 4%
Good = 4% to 8%
Strong = 8% to 15%
Very Strong = Above 15%
43. Approach to Fiscal Health #2:
Establish and Maintain Reserves
Available Treatments
Establish a written Working Capital/Emergency Reserve policy
Provides back-up plan for emergencies, revenue shortfalls, or
other unforeseen changes
Identify, document and understand all reserves
Review adequacy of Fund Balance levels
Hold only appropriate amount in reserve to establish credibility
with internal and external stakeholders
Set aside funding for long-range plans, major maintenance and
asset replacement
44. Strategic Questions
1. How much do we have available to spend? -
(not “How much do you need”?)
2. Why do we need to keep “money in the bank”?
3. What’s the “difference”?
45. Approach to Fiscal Health #3:
Understand Variances
Apply Diagnostics – DO YOU…
Allow Departments to budget for contingencies rather
than appropriating at the fund level?
Have large capital project “carry-forwards” at year end?
Utilize a formal Compensation Plan to establish employee
salary/wage ranges?
Update the plan on a regular basis?
Include employee benefit packages as part of total
personnel costs when assessing the adequacy of employee
compensation?
46. Types of Variance Analysis
Revenues & Expenditures
Budget to Actual
Historical year to year actuals
Cyclical trends
Ongoing vs. one-time occurrence
Multi-year Capital Projects
Eliminate Carry-forwards
Avoid excessive “change orders”
47. Types of Variance Analysis
Employee Compensation
Comp Plan vs. Actual Wages Paid
Hiring Range
Maximum Range
Market Comparison - based on total compensation
Approved FTE Count
Accounts Receivable
Difference between amounts due and
amounts billed?
Difference between amounts billed and
amounts collected
48. Approach to Fiscal Health #3:
Understand Variances
Available Treatments:
Strive to align budget with actuals (a source of “hidden
treasure”)
Refine salary and benefit projections, to align with actual costs
incurred
Provide more effective budget monitoring and management to
eliminate variances
Identify and eliminate the “fluff”
Fund cyclical expenditures with one-time funding sources
Consolidate contingencies maintained in department budgets
Analyze and understand revenue & expenditure variances
Promote multi-year budgeting for capital projects
49. Strategic Questions
1. How much do we have available to spend? -
(not “How much do you need”?)
2. Why do we need to keep “money in the bank”?
3. What’s the “difference”?
4. “It costs how much”????????
50. Approach to Fiscal Health #4:
Transparent About “True Cost of Doing Business”
Apply Diagnostics – DO YOU…
Allocate overhead and administrative costs to Funds and/or
Departments that benefit from those services?
Identify total cost (direct AND indirect) for all programs?
Prepare a Full Cost Allocation plan in addition to an OMB A-87
Cost Allocation Plan?
How is this Plan incorporated into the budget process?
Establish fees for service that recapture appropriate level of
total costs of providing that service?
51. Approach to Fiscal Health #4:
Transparent About “True Cost of Doing Business”
Apply Diagnostics – DO YOU…
Utilize Internal Service Funds to align delivery and cost of
internal services with customer demand?
Know what services are best adapted to an Internal Service
Fund approach?
Understand how internal charges are established and
distributed?
Ensure that internal customers perceive that costs are
transparent and there is an ability to influence those costs
by altering their own demand?
52. Approach to Fiscal Health #4:
Transparent About “True Cost of Doing Business”
Available Treatments:
Establish Internal Service Funds and engage Departments in
assessing demands for these services
Promote enhancement of cost recovery for programs where
appropriate
Diversify cost burden from General Fund by appropriately
sharing costs among other dedicated revenue streams
Inventory and cost all programs
Utilize Full Cost Plans to better determine the true cost(direct
and indirect) of offering programs/services
53. Strategic Questions
1. How much do we have available to spend? -
(not “How much do you need”?)
2. Why do we need to keep “money in the bank”?
3. What’s the “difference”?
4. “It costs how much”????????
5. “What’s the plan and what could cause it to
change?
6. What does the future look like?
7. What if………..???
54. Approach to Fiscal Health #5:
Economic Analysis & Long-term Planning
Apply Diagnostics – DO YOU…
Incorporate ALL long-term plans developed within the
organization into your financial forecasts?
Prepare comprehensive, multi-year Capital Improvement
Plan, and clearly identify associated ongoing operating costs?
Understand how the CIP impacts the budget process and
your long-term financial forecasts?
Identify only relevant economic indicators to monitor?
Effectively utilize appropriate “tools” to communicate
financial position to all stakeholders (elected officials, citizens
and staff)?
55. KEY ECONOMIC INDICATORS
Both External and Internal
Focus on only what is relevant!!!!!!
Utilize TRENDS over Benchmarks
Demonstrate organizational impacts
56. Approach to Fiscal Health #5:
Economic Analysis & Long-term Planning
Available Treatments:
Prepare a 5 to 10 year financial forecast
Use relevant key indicators and trend analysis to improve
decision-making
Update and present on regular basis throughout the year
Identify potential points of failure and plan for needed
changes
Utilize simple, graphic communication tools to illustrate fiscal
health position to all stakeholders
Help keep decision makers focused on high-level stewardship
role
Access impact of “today’s” decisions on future financial
sustainability
Allow scenario-planning which encourages flexible and
adaptive decision-making
57. Looks like a Financially “Healthy”
Organization – Right?
62. DIAGNOSTIC QUESTIONS TO ASK
? Does your organization differentiate between
one-time and ongoing revenues and
expenditures?
? If yes, how are they tracked? Does your forecast
demonstrate this differentiation?
? How does your organization differentiate
“program” revenues from “enterprise” revenues
such as taxes, earnings on investments, franchise
fees, etc.?
? Does your organization prepare a formal Revenue
Manual?
? If yes, what type of information is included?
63. ? Does your organization have a written fund balance
reservation policy?
? If yes, how are you monitoring to ensure that reserves
are maintained?
? Check to see if established working capital reserves are
sufficient to meet emergency needs or short-term
revenue shortfalls.
? Check to see if there is an inventory of all other restricted
or designated fund balance reserves, stating their
purpose, the authority establishing them and how they
are to be calculated.
DIAGNOSTIC QUESTIONS TO ASK
64. DIAGNOSTIC QUESTIONS TO ASK
? Are variances between budgeted and actual
revenues and expenditures analyzed and
explained?
? If yes, how do those variances impact future
budget cycles?
? Does your organization utilize a formal
Compensation Plan to establish employee
salary/wage ranges?
? How often is the plan updated?
? When assessing the adequacy of employee
compensation, are employee benefit packages
included in this assessment?
65. ? Does your organization utilize Internal Service Funds?
? If yes, what are the services provided by each fund and
how are the internal charges established and distributed?
? Check to see if appropriate demand metrics are evaluated
when determining costs.
? Check to see if customers perceive that costs are
transparent, and they have the ability to influence those
costs by altering their own demand.
? Does your organization prepare a Full Cost Allocation plan in
addition to an OMB A-87 Cost Allocation Plan?
? If yes, how is this plan incorporated into the budget
process?
DIAGNOSTIC QUESTIONS TO ASK
66. ? Does your Five-Year forecast incorporate other long-
term plans developed by your organization?
? Does your organization prepare a Capital
Improvement Plan?
? If yes, what information is included and how is it
utilized in your budget process and your financial
forecasts?
? What tools does your organization use to
communicate financial information to its elected
decision-makers?
DIAGNOSTIC QUESTIONS TO ASK