Return on Community Investment (ROCI):
A High Impact Institute

Pre-Conference Data Collection
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Return on Community Investment Survey Responses

Respondent Name:

Shannon Harvey

E-Mail Address:

sharvey@chwg.org

Organization Name:

Community Health Works of Georgia

Phone:

(478) 994-1914   Ext.

Fax:

(478) 994-8302

Address:

233 Medical Court   

City, State, Zip:

Forsyth, GA    31029
Category: Your Community

What is the service area of your initiative (counties, city, etc.)?

Bibb, Crawford, Houston, Jones, Monroe, Peach and Twiggs counties

What is the total population in your service area?

356,801

What percentage of the total population lives below the federal poverty level?

14.95

What percentage of the total population is uninsured?

13
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Outreach and navigation
Securing public and private insurance coverage
Primary care capacity and access
Volunteer physician networks
Emergency room usage reduction
Case management of chronic disease
Access to affordable pharmaceuticals

Describe the purpose of your initiative (in one sentence, if possible):

A vertically integrated health network targeting chronically ill uninsured adults with an emphasis on access, disease management, and holistic care management

Describe the scale of your initiative in terms of budget, capacity, etc.:

Network partners: 5 hospitals, 90 MDs, 22 pharmacies, 2 behavioral health providers and 7 public health departments Annual budget: $860K; Persons served annually: 2022 averaging 3 co-morbidities, 5 scripts PMPM;

Describe the operational components of your initiative:

Screening/linkage, enrollment, assessment, medical home, linkage to necessary specialty, labs/diagnostics, pre-emergent hospital care and social supports as well as pharmaceuticals through holistic care management that includes health promotion and disease management education Use network partnerships and infrastructure to mobilize a voice and vehicle for systemic change in the financing and delivery of care to the uninsured and to address broader community health initiatives

Describe your initiative's staffing level:

16.5 FTEs - CEO, COO/CFO, AP/AR, IT Director, Data Manager, Care Managers, Pharmaceutical Benefits Specialists

If applicable, please describe your strategic use of an information system:

CHW-developed open, scalable, state-of-the-art, web-based, HIPAA compliant, partner-linking information technology platform automates screening, enrollment, PCP and pharmacy provider assignment, assessment, care planning, care management, network management and TPA functions (including care tracking by dollar value of service, fund source of payment, CPT and ICD-9 across the continuum). The software's EDI capability allows further integration, accuracy and efficiency. Its underlying evaluation utility makes the rigorous external evaluation of changes in health status, access, utilization and costs possible. Our next step is to interface our already-automated financial accounting system into this platform.

Please list the major, time-framed, measurable objectives your initiative is designed to achieve:

1. By 12/03, enroll 2000 multiply diagnosed chronically ill uninsured patients. 2. By 12/03, deliver sufficient cost savings to provider system to offset operational costs.
Category: Measurable Results

Which of the following results can be attributed to your program initiative? Please check all that apply.

Coordinated System of Care Savings
Reduction of ER usage for non-urgent care
Savings from operational improvements within integrated system
Qualifying people for government subsidized programs
Increasing awareness of programs and services
Services brought into the community
Pharmaceuticals acquired on behalf of clients
Increased reimbursements
Volunteer contributions
Improved health status
Improved productivity
Economic development factor
Social justice implications
Increased attendance at work

Please list any other actual, measurable results of your initiative:

Reduction of hospitalization Increased diversified revenue (not just reimbursement)
Category: Your ROCI Strategy

How do you define ROCI?

What is the net gain to the system and community(ies) for network investments?

Describe your ROCI objectives and strategy:

Objectives: Generate $860K net gain to investors/partners to allow continued operations. Use any positive margin for R and D of community health initiative expansion to deliver further gains. Initial strategy: By expanding access, coordinating care within the system, make and save the provider system enough money to foster network maintenance and growth. Developed strategy: Leverage developed standing, competencies or tools to improve margin and deliver further regional, state and national gains.

Describe the players involved in the ROCI conversation (by title and/or function):

Hospital CEOs, county commission representatives, physicians, local foundations, local businesses, regional social service agencies, consultants with special information technology, legal, and economic experience and expertise, legislators, high level state agency leaders, successful network directors

List the milestones in your ROCI strategy that pertain to deal making (a prospective approach):

Continuance of previous key partnerships and deliveries Market for developed competencies Successful R and D of new partnerships and competencies

List the milestones in your ROCI strategy that are tied to outcomes (a retrospective approach):

Cost savings through ER/hospitalization avoidance Generated revenue (reimbursement or other source)

List the milestones in your ROCI strategy that are linked to sustainability:

All of the above
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

If chronically ill patients receive coordinated continuum of outpatient primary care, labs/diagnostics, necessary specialty care, labs/diagnostics, and pre-emergent hospital care, overall costs to the system will decrease over time. If there is greater information-sharing across the care continuum, care will improve and data will be more readily available to unlock available health coverage revenues.

Is your method supported by scientific research? If yes, please describe:

Yes. William s. Custer, Ph.D., a health economist at Georgia State University, is the principal investigator. Using the BRFSS published by the CDC as well as health care utilization data, our ROCI evaluation measures changes in access, health status, utilization and costs. The access and health status changes are evaluated against the baseline BRFSS administration at enrollment and every six months. The changes in utilization and costs are measured, through submitted HCFA 1500s and UB 92s, every six months and over time against a representative control group from the Medical Expenditure Panel Survey as well as against members' own utilization over time. Also, in terms of generated revenue, we count dollars returned.

Describe the measures that you used to define "returns" or value:

Self-reported change in access and health status. Changes in utilization and costs based on submitted HCFA 1500s and UB 92s. Dollars of generated revenue returned to the network partners through network activity.

Describe the measures that you used to define investments or costs:

Value of services invested, actual cash dollars invested.

Please briefly describe your data collection methods.

Developed IT tool automates, stores, aggregates and reports BRFSS histories as well as serves as TPA data repository for HCFA1500 and UB92s received from across the system of care (by member and in aggregate). BRFSS is administered at enrollment and every 6 months through personal interview by care manager. HCFA 1500s and UB92s are submitted to network by participating providers and entered into the CHW IT system (electronically from largest partner, manually received and entered by network staff from smaller partners). Underlying evaluation utility of CHW IT system facilitates data review and analysis by evaluator.
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

''I will if you will.'' ''Rigorous evaluation is required.'' ''It's about taking care of patients and adding value to partners: make them money, save them money, be easy to deal with and make them look good.''

Describe how ROCI conversations are tailored to specific audiences:

Put ''picture of the day'' in ''audience frame''

Describe what enabled effective conversations to occur:

1. Relationally influential leader conducted initial convening; 2. Facilitative and content capable technical assistance during early days; 3. Perceived forward action and success; 3. Organizational neutrality of network; 4. Entrepreneurial, partner-honoring approach to work; 5. Concurrent attention to the ''head and the heart of the business''.
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Recovered more than $1M in otherwise lost reimbursement to network partners. Generated more than $500K in other revenue directly to partners. External evaluation documents more than $1M annual savings to provider system for served patients. 22 months capital in network bank now, with additional commitments firm but not received.
Category: Lessons

What do you see as the critical success factors that can guide others?

Local Entrepreneurial Board and Managerial Leadership; Local Tangible Commitment; Community-honoring Opportunity, Relational and Content Facilitation;

Do you believe that your results can be replicated successfully with other similar initiatives? Can you suggest how replication may be facilitated?

Yes. Policy environment that fosters community success: seeds new network development, sustains key leadership infrastructure including fosters community/state/national gain-sharing arrangements, and reimburses targeted technical assistance (both academic and peer-to-peer pragmatic, information dissemination);
Category: Share Your Resources

Resource Files you've shared with us:

Transforming Health Together.ppt