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:

Kristen West

E-Mail Address:

westk@crhn.org

Organization Name:

CHOICE Regional Health Network

Phone:

(360) 493-5714   Ext.

Fax:

(360) 493-7708

Address:

PMB 212, 1910 E. 4th Avenue

City, State, Zip:

Olympia, WA    98501
Category: Your Community

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

Grays Harbor, Lewis, Mason, Pacific and Thurston counties in Washington State

What is the total population in your service area?

425,100

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

13.2%

What percentage of the total population is uninsured?

9.9%
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
Emergency room usage reduction
Access to affordable pharmaceuticals

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

All low-income have access to needed services by 2008.

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

Operational budget of $1.8 million and 19.8 staff FTEs.

Describe the operational components of your initiative:

Planning—defining goals and objectives, tools of measurement and outcomes. People—highly driven staff committed to the mission and vision; stakeholders committed or intrigued with the work. Processes—an efficient and effective method to achieve the goals and objectives. Plants—office headquarters and various offsite locations to meet with clients, stakeholders and volunteers. Parts—general supplies to support the project, including applications, hardware and software, telephone, fax, copier, etc.

Describe your initiative's staffing level:

19.8 staff FTEs, 25 volunteers and hundreds of stakeholders and other community partners. One-third is planning staff, one-third is implementation staff and one-third is operational and administrative staff.

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

Shared application for multi-partner client tracking, case management, sliding-fee screenings, resource referral, health program and coverage enrollment, assignment to medical homes, management of applications to pharmaceutical companies’ patient assistance programs, care coordination, and tracking of voluntary care commitments.

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

Stabilize safety-net providers; get small employers financially participating to cover low wage workers; find and enroll people in a medical home; reduce costs to cover more people; deliver evidence and relationship-based care through health teams; move decisions about where the health care dollars go closer to the community.
Category: Measureable 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
Social justice implications
Increased attendance at work
Increased attendance at school

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

Pooling and leveraging of resources; bringing new money into the community; and improved quality through patient-focused health care teams.
Category: Your ROCI Strategy

How do you define ROCI?

ROCI is what a community, including partners and consumers, receive as a result of an investment in a program/intervention/system.

Describe your ROCI objectives and strategy:

Improve access to health care for 93,000 low-income residents. Attract and retain investors.

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

Hospital administrators, clinic administrators, physicians, practitioners, public health administrators, employers, legislative staff, state agency program managers, clients, school nurses. Scheduled meetings with various community members and volunteers to discuss and implement initiatives.

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

Develop and utilize a logic model; complete Balanced Scorecard process; quarterly performance reports and annual outcome report.

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

See attached reports.

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

No one revenue source accounts for more than 25% of funding, cash flow reserve maintained, membership dues are paid; Medicaid administrative match arrangements in place; community partners and stakeholders request to expand initiatives (both geographically and in scope); increased stabilization of the safety-net, including locating low-income consumers in a medical home; improved access to health care for limited English-speaking proficient consumers; small employers offer their employees health insurance and contribute to part of the cost.
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

Cost of services need to be less than the value of the services; work with partners to show the qualitative and quantitative value.

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

Local data tends to be of more value and real to community partners than national research.

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

1) reduced uncompensated care; 2) increased Medicaid reimbursement; 3) more practitioners taking their fair share of low-income; 3) reduced number of uninsured; 4) less spent on administration; 5) reduced direct care costs; 6) reduced inappropriate ER use; 7) improved health status; 8) attracted new resources.

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

Financial reports.

Please briefly describe your data collection methods.

Varied, including data from hospitals and physician practices, to regional health status assessments.
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

Annual Board of Directors retreat, business planning, quarterly reports, grants monitoring.

Describe how ROCI conversations are tailored to specific audiences:

Customized by geographic location, type of organization (e.g., grantor, member, etc.).

Describe what enabled effective conversations to occur:

Trust, long standing relationships, a coordinated vision for health care for the community, ability to show improvement, lack of resources forcing innovation.
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Diversified revenue sources; new grants; multi-year stable investments; increase in local capacity; new community partners. See attached reports.
Category: Lessons

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

Making the business case, use of local data, communicating outcomes in a customized way, accountability for performance.

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

Yes.
Category: Share Your Resources

Resource Files you've shared with us:

RAP Report 8-27-03.pdf
100% Access Report.doc