HPM EMP End of Term Simulation
Lenovo Instructional Innovation Grant
Center for Faculty Excellence, UNC-Chapel Hill
Curriculum Integration
Master of Healthcare Administration (MHA)
BaseCamp I
½
F
A
L
L
S
P
R
I
N
G
S
U
M
M
E
R
BaseCamp II
½
Year 1
The Healthcare Context: Macro Level
4 (Hobbs) HPM 754
Healthcare Statistics
3 (Porto) HPM470
Financial and Managerial Accounting
5 (Zelman) HPM746
Leadership and Workforce Man
4 (Paul/Fried) HPM728
Finance and Economic Analytics
4 (Vernon) HPM 747
Public Health Concepts
3 (Porto/Biddle/Wells) HPM 611
Applied
Leadership
Integrative
Module
Applied
Leadership
Integrative
Module
Applied
Leadership
Integrative
Module
L
e
a
d
e
r
s
h
i
p
L
e
a
d
e
r
s
h
i
p
P
r
a
c
t
i
c
u
m
P
r
a
c
t
i
c
u
m
Year 2
Strategic Planning and Marketing
3 (Thomas) HPM 725
Healthcare Policy and Economics of
Healthcare Insurance
3 (Vernon/Reiter) HPM748
Advanced Analytics
4 (Wheeler/Hassmiller Lich)
HPM777
H I & Quality
Tools HPM758
2 (Mandelkehr)
H I & Quality
Apps HPM 763
2 (Mandelkehr)
Health Law
3 (Harris) HPM 710
Capstone
4 (Sloate/Levy) HPM 736
Applied
Leadership
Integrative
Module
Applied
Leadership
Integrative
Module
Business
Plan
Program Foundation (On-Campus Workshops & Seminars)
Distance Learning Coursework
On-Campus Integrated Exercise
Leadership Practicum & Journaling
Project Team
• Steering Committee
–
–
–
–
–
–
–
Jim Porto (EMP Program Director/Faculty)
Roger Ackers (Sheps/Lineberger)
Libby Evans (ITS)
Bob Henshaw (CFE)
Sue Hobbs (HPM Faculty)
Steve Sloate (HPM Faculty)
Scott Williams (ITS)
• Development
– Jay Levy (Project Manager)
– Larry Mandelkehr
– Jason Morningstar
Initial project funding provided by a Lenovo Grant awarded by the Center for Faculty Excellence (CFE)
Monroe County, State of Franklin
Diverse Population
Population Distribution
Filmore - Super rich 1%
Unincorporated County
4%
Filmore - Upper middle
class
7%
Dover
6%
Lake Monroe
6%
Apple Grove
4%
Beverly
4%
Filmore - Middle class
26%
Filmore
60%
Filmore - Almost middle
class
13%
Elm Park
6%
Easttowne
10%
Filmore - Working poor
8%
Filmore - Destitute
5%
City of Easttowne
Governance Environment
Monroe County
Board of
Commissioners
Board of
Education
Board of Public
Health
McPherson
Hospital Board
of Directors
Sheriff
Clerk of the
Courts
Board of
Assessment
Decision Variables (Inputs)
• County Property Tax Rate per $100 Assessed Value
• Poverty Level Household Income Cutoff
– Established that State has exemption to self-fund Medicaid above
federal Poverty Level Income Cutoff
• County Public Health Budget Allocation (% of property tax
collections)
• County Public Hospital Budget Allocation (% of property tax
collections)
Outcome Variables (Outputs)
Variable
Objective
Number of Uninsured
Minimize
Number of ED Visits
Minimize
STD Cases
Minimize
Public Hospital Operating Margin
Maximize
System Hospital Operating Margin
Maximize
Public Health Clinics Operating Margin
Maximize
Public Support Index **
Maximize
** Public Support Index serves as a proxy for public opinion based
on political affiliation and changes in variables
Linkage Matrix
FranklinStateSim
Version 1.0 Fall 2011
Linkage Matrix
Input Variables
Outputs
Tax Rate
Direct Impact
Number of Uninsured
Indirect Impact
Direct Impact
Number of ED Visits
Indirect Impact
Direct Impact
WFHS Operating Margin
Indirect Impact
Direct Impact
McPherson Hospital
Operating Margin
Indirect Impact
Direct Impact
STD Cases
Indirect Impact
Direct Impact
PH Clinic Operating Margin
Indirect Impact
Direct Impact
Public Support Index
Indirect Impact
Household Income Poverty Level
Allocation to Public Health (Clinics &
Education)
Allocation to McPherson Hospital
Simulator Rounds
• Round 1
– Single Decision Variable Input
• Tax Rate
• Round 2
– Multiple Decision Variables Input
• Tax Rate
• Poverty Level
• Round 3
– All Decision Variables Input
• Round 4
– All Decision Variables Input
– Introduce Shock
• Round 5
– All Decision Variables Input after integration of shock
Input Document – Round 1
Team Input Sheet
Team:
Input Variables
Variable
Initial Values
County Property Tax
Rate (per $100 Value)
$
1.2500
Poverty Level
Household Income
$
22,350
County Public Health
Budget Allocation(% of
tax collections)
McPherson Hospital
Budget Allocation (% of
tax collections)
Outcome Variables
Input
Anticipated Results
Objective
Anticipated Results
6.41%
Initial Values
Number of Uninsured
Persons in Monroe
County
Number of ED Visits at
McPherson Hospital &
WFHS
McPherson Hospital
Operating Income
(Margin)
Reported cases of
Sexually Transmitted
Disease
Public Health Clinics
Operating Income
(Margin)
Fillmore Examiner
Public Health Support
Index
Round:
19.00%
Variable
WFHS Operating
Income (Margin)
Team01
99,771
Minimize
113,978
Minimize
$
22,263,005
Maximize
$
(8,797,000)
Maximize
3,630
Minimize
(3,501,903)
Maximize
51.35
Maximize
$
1
Decision and Output Variables
Business Rules
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
New Tax Collections
Number of Direct Pay Change due to Tax Rate (Offset in Uninsured)
New Percent Below Poverty Level
Change to Poverty Population
Change to Medicaid Covered (Offset by Uninsured)
Change in West Franklin Hospital System ED Visits from Change in Uninsured
Change in McPherson Hospital ED Visits from Change in Uninsured
Change in West Franklin Hospital System ED Visits from Change to Allocations
Change in McPherson Hospital ED Visits from Change to Allocations
Change in West Franklin Hospital System Charity Write-off Amount from Change in Uninsured
Change in McPherson Hospital Charity Write-off Amount from Change in Uninsured
New Tax Burden on West Franklin Hospital System
Change to West Franklin Hospital System ED Costs
Change to McPherson Hospital ED Costs
Change to McPherson Hospital Allocation
Change to PH Clinic Costs based on Uninsured
Change to PH Allocation
Change in STD cases from Change in Uninsured
Change in STD cases from Change in PH Allocation
Public Support Business Rules
Approximate Change in Favorable Support
Conservative
Liberal
Independent
Tax Rate Increase
-50%
5%
0%
Poverty Level Cutoff Increase (Increase in Medicaid Eligible Population)
-10%
20%
10%
Allocation to Public Health Increase
0%
15%
10%
Allocation to County Clinics Increase
-8%
8%
0%
West Franklin Healthcare System Operating Margin Increase
15%
3%
5%
McPherson Hospital Operating Margin Increase
10%
10%
5%
Number of Uninsured Increase
-30%
30%
8%
STD Increase
-10%
-50%
-25%
ED Visit Increase
-30%
-15%
-5%
Public Health Clinic Losses Increase
-15%
0%
-5% to
Independent
-5%
Movement of affiliation for greater than 15% Tax Increase
-10% to Liberal
Movement of affiliation for greater than 15% increase to Poverty Level
Movement of affiliation for greater than 20% increase in PH Allocation
-10% to Conservative
-10% to
Independent
-5% to Conservative
Round Results
with Introduction of Shock
Recap Results
Team 01
Results
Round 1
99,192
115,326
$
21,708,738
$
(9,103,623)
4,018
PH Clinic
Operating
Income
$ (3,863,631)
Round 2
Round 3
111,386
111,386
121,092
121,092
$
$
38,393,477
38,393,477
$
$
(713,527)
(713,527)
3,259
3,259
$
$
Round 4
Round 5
117,694
120,519
138,011
136,759
$
$
39,673,551
43,742,505
$
$
4,006
3,276
$ (5,651,300)
$
-
Uninsured
WFHS Operating
Income
ED Visits
MCP Operating
Income
5,911,275
10,302,724
STD Cases
-
Public
Support
Index
48.13
62.68
63.14
72.69
96.65
Rank
Uninsured
Round 1
Round 2
Round 3
Round 4
Round 5
1
7
7
9
9
WFHS Operating
Income
ED Visits
6
9
10
10
10
10
4
3
5
3
MCP Operating
Income
10
4
8
4
8
STD Cases
10
9
9
10
9
PH Clinic
Operating
Income
10
1
1
10
1
Public
Support Aggregate
Index
10
57
9
43
10
48
9
57
9
49
Rank
10
7
10
10
9
Preliminary Survey Results
• Because of this two day integrated exercise, I am better
prepared and able to apply the concepts from my courses
this fall semester
– 91% agreed or strongly agreed
• The Franklin State Simulation is an effective way to
visualize the complexity of public health issues in the real
world
– 94% agreed or strongly agreed
• Overall, the Franklin State Simulation is an effective way to
bring together all the topics covered this semester
– 94% agreed or strongly agreed
Evaluation performed by the Center for Faculty Excellence
n=53
Three pronged approach
Integrate
across HPM
EMP
curriculum
•Work with Spring Semester
Faculty
• Paul / Fried
• Zelman
•Develop next scenario
•Analyze options for continued
operation of distressed innercity hospital
Explore interdisciplinary
uses
Port to webbased
platform
•Operations Analysis (HPM)
•Integrate with HPM
Residential MPH/MHA
•School of Education
•College of Arts and Sciences
•Multiple gaming modes
•More robust back-end
•Additional population
attributes
•750,000 individual records
•Refresh from real data
sources
•ICISS GUI module integration