Specialization in Health Management for Older Adults
May 8, 2013
Mary Guthrie, MBA

Why discussion prioritization?
• Builds on development of a Strategic Plan of Action and subsequent implementation plans.
• Plan of Action has set goals/outcomes to be achieved within a predetermined timeframe (usually 3-5 years).
• Need to develop plans that are achievable for many reasons: accountability; enstill confidence; support advocacy; make stakeholders happy; enhance quality of life for older persons……
• May have to defer objectives to subsequent Plan.
• Need to create measurable milestones to give the team smaller tangible goals and targets. This facilitates focus and encouragement by seeing results.

Factors that may influence the prioritization process:
• Politics – both internal and external
– Charters, trade agreements, resolutions, i.e. UN and Human Rights issues.
– Special interests/projects of political nature, e.g. First Ladies’
– Presence of “champions” to promote
• Budget/Funding allocated in order to meet needs/objectives (internal) and/or external support is offered for targeted objectives.
• An objective(s) being implemented will be critical to the success of attainment of subsequent objectives.
– Building infrastructure to support changes in system
– Undertaking major organizational transitions/realignments prior to implementing programming

Factors that may influence the prioritization process:
• Determine objectives that require additional study, data, analyses before a decision can be made. Start process to acquire what you need as soon as possible.
– Hire consultants for a study or technical assistance
– Assignment responsibility for “white papers” or other analyses
– Determine need for legislation/regulation
– Collect data; surveys; etc.
– Tool: Conduct cost/benefit analysis
– Tool: Develop a business plan
• Availability of strong evidence to support the objective and achieving measured outcomes versus less evidence or no outcomes (innovations).

Factors that may influence the prioritization process:
• “Low hanging fruit” - Can you Identify where you can derive greatest benefit by expending the least relative effort (or cost or resources)? Potential opportunity to have a quick turnaround and show of success.
• Determine if additional/new stakeholders need to have input in the prioritization process and implementation activities and/or assist internal group process.
– Tool: Nominal Group

Factors that may influence the prioritization process:
• Opportunity for a strong partnership to meet objectives by sharing resources (NGO; University). Obtain Memorandum of Understanding to make a go/no go decision on priority.
• Advocacy or special circumstances have brought the objective to the forefront, e.g. press coverage or emergency or terrible incident.

Cost-Benefit Analysis
• Method of economic evaluation that asks whether the costs of an intervention can be justified by the value of the benefits it provides. As with other types of economic evaluation it first estimates the total costs of the intervention from a specific decision making perspective. It then determines the benefits of the intervention, and translates those benefits into monetary terms.
• Both costs & benefits are expressed in the same units (e.g. dollars)
• Usually the comparison is made from the ratio of benefits to costs. If the ratio is greater than one, then benefits outweigh costs and the intervention is recommended.
• Application to health care issues.

Tobacco Report Cost Benefit
• Cigarette smoking is the single leading cause of preventable disease and preventable death in the United States. Accounts for more than 400,000 deaths annually.
• The CDC and the HHS issued guidelines on smoking cessation to help people to quit smoking that include: access to counseling, access to all FDA-approved overthe-counter and prescription medications; multiple quit attempts; and reduced or eliminated co-pays.
• The national average price for a pack of cigarettes in 2009 was $5.51, but the real cost to society of that pack of cigarettes is $18.05 -- more than three times the retail price -- when the costs for productivity loss, absenteeism, and smokingrelated illness and death are factored in.

Tobacco Report Cost Benefit
• Comprehensive study conducted by researchers Penn State
University (copy provided). To assist States in making decision around payment for Smoking Cessation.
• FINDINGS: "For every dollar states spend on comprehensive smoking cessation programs they will see a return on their investment of $1.26," said Paul Billings of the American Lung
Association.

Business Planning: Can you sustain what you
“build”?
• Program development, public or private sector, requires business planning to ensure sustainability .
• Promotes better understanding of initiative and helps to identify strengths and weaknesses.
• Encourages an entrepreneurship in public agencies and nonprofits.
• You know the true cost so you can “sell” (self-pay).

Business Planning: Can you sustain what you
“build”?
• Communicates ideas, and strengthens the documentation of the need in the community.
• Enhances credibility to stakeholders, potential partners and/or funders.
• Identifies the level of resources needed (staff; space; money) in order to successfully develop.
• Business plan can be used as the operational plan.

Components of Business Plan
• Description of the
Business (Program)
• Market Analysis &
Marketing Plan
• Environmental Scan
• Org. Structure, Mgt. &
Personnel
• Business Operations
• Financial Planning &
Sustainability
• Appendices

Business Planning: Can you sustain what you
“build”?
• Business plans being used to create national network of
Aging & Disability Resource Centers (ADRC). Government & non-profit entities serving as “impartial” source for information and assistance for aged and disabled individuals; caregivers; civil society. Entry point to long term services and supports.
• Business plans being used in development of CDSMP &
DSMP.
• Will discuss as group this session.

Gaining Consensus: Nominal Group Technique
• NGT is a structured, small-group discussion that allows for reaching consensus.
• Encourages total group participation and results in set of prioritized solutions or recommendations.
• Has very broad applications for use particularly when working with stakeholders; committees; staff etc.
• CDC Evaluation Brief fully explains.

Priority Areas Identified by Key Stakeholders
Univ.Health
Dignity
Cont.Care
HumanRi
Poverty
Education
NatPolicy
Housing
Access

• Individually read the handout document: Business Planning Tools for Aging &
Disability Resource Centers
• Questions for group discussion:
– Initial impression – have you previously engaged in business planning approach?
– Could you see the application of this approach to development of an infrastructure for similar functions as part of your long term services and supports system?
– What other programs/planning initiatives might benefit from applying a business plan approach?
– Do you see challenges/barriers to implementing a business plan approach in your working environment?