hpm emp end of term simulation lenovo instructional innovation grant center for faculty excellence,...
TRANSCRIPT
HPM EMP End of Term SimulationLenovo Instructional Innovation Grant
Center for Faculty Excellence, UNC-Chapel Hill
Curriculum Integration
Year 1 Year 2
FALL
SPRING
SUMMER
The Healthcare Context: Macro Level 4 (Hobbs) HPM 754
Healthcare Statistics3 (Porto) HPM470
Applied Leadershi
p Integrative Module
Financial and Managerial Accounting5 (Zelman) HPM746
Leadership and Workforce Man4 (Paul/Fried) HPM728
Applied Leadershi
p Integrative Module
Public Health Concepts3 (Porto/Biddle/Wells) HPM 611
Finance and Economic Analytics4 (Vernon) HPM 747
Strategic Planning and Marketing 3 (Thomas) HPM 725
Healthcare Policy and Economics of Healthcare Insurance
3 (Vernon/Reiter) HPM748
Applied Leadershi
p Integrative Module
Health Law3 (Harris) HPM 710
Capstone4 (Sloate/Levy) HPM 736
Business Plan
Master of Healthcare Administration (MHA)
Program Foundation (On-Campus Workshops & Seminars)Distance Learning CourseworkOn-Campus Integrated Exercise
Applied Leadershi
p Integrative Module
BaseCamp II½
BaseCamp I½
Leadership Practicum & Journaling
Advanced Analytics4 (Wheeler/Hassmiller Lich)
HPM777
H I & Quality Tools HPM758
2 (Mandelkehr)
H I & Quality Apps HPM 763
2 (Mandelkehr)
Leadership Practicum
Leadership Practicum
Applied Leadershi
p Integrative Module
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
Easttowne10%
Elm Park6%
Beverly4%
Apple Grove4%
Lake Monroe 6%
Dover6%
Unincorporated County4%
Filmore - Super rich 1%
Filmore - Upper middle class7%
Filmore - Middle class26%
Filmore - Almost middle class13%
Filmore - Working poor8%
Filmore - Destitute5%
Filmore60%
City of Easttowne
Governance Environment
Monroe County Board of
Commissioners
Board of Education
Board of Public Health
McPherson Hospital Board
of DirectorsSheriff Clerk of the
CourtsBoard of
Assessment
Funded by Property Taxes Funded by Sales Taxes and Fees
Decision Variables (Inputs)
• County Property Tax Rate per $100 Assessed Value• Poverty Level Household Income Cutoff
– Established that State has exemption to self-fund Medicaid above federal Poverty Level Income Cutoff
• County Public Health Budget Allocation (% of property tax collections)
• County Public Hospital Budget Allocation (% of property tax collections)
Outcome Variables (Outputs)
Variable Objective
Number of Uninsured Minimize
Number of ED Visits Minimize
STD Cases Minimize
Public Hospital Operating Margin Maximize
System Hospital Operating Margin Maximize
Public Health Clinics Operating Margin Maximize
Public Support Index ** Maximize
** Public Support Index serves as a proxy for public opinion based on political affiliation and changes in variables
Linkage Matrix
FranklinStateSimVersion 1.0 Fall 2011
Linkage Matrix
Tax Rate Household Income Poverty LevelAllocation to Public Health (Clinics &
Education)Allocation to McPherson Hospital
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
Direct Impact
Indirect Impact
STD Cases
PH Clinic Operating Margin
Public Support Index
Input Variables
Outputs
Number of Uninsured
Number of ED Visits
WFHS Operating Margin
McPherson Hospital Operating Margin
Simulator Rounds
• Round 1– Single Decision Variable Input
• Tax Rate
• Round 2– Multiple Decision Variables Input
• Tax Rate• Poverty Level
• Round 3– All Decision Variables Input
• Round 4– All Decision Variables Input– Introduce Shock
• Round 5– All Decision Variables Input after integration of shock
Input Document – Round 1
Team Input Sheet
Team: Team01 Round: 1
Poverty Level Household Income 22,350$
County Public Health Budget Allocation(% of tax collections)
19.00%
Variable Initial Values Input Anticipated ResultsIn
pu
t V
ari
ab
les
County Property Tax Rate (per $100 Value) 1.2500$
McPherson Hospital Budget Allocation (% of tax collections)
6.41%
Variable Initial Values Objective Anticipated Results
22,263,005$ Maximize
McPherson Hospital Operating Income (Margin)
(8,797,000)$ Maximize
Minimize
WFHS Operating Income (Margin)
Fillmore Examiner Public Health Support Index
51.35 Maximize
Ou
tco
me
Va
ria
ble
s
Number of Uninsured Persons in Monroe County
99,771 Minimize
Number of ED Visits at McPherson Hospital & WFHS
113,978
Reported cases of Sexually Transmitted Disease
3,630 Minimize
Public Health Clinics Operating Income (Margin)
(3,501,903)$ Maximize
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%
Movement of affiliation for greater than 15% Tax Increase-5% to
Independent-10% to Conservative
Movement of affiliation for greater than 15% increase to Poverty Level -10% to Liberal
Movement of affiliation for greater than 20% increase in PH Allocation-10% to
Independent-5% to Conservative
Round Resultswith Introduction of Shock
Recap Results
Uninsured ED VisitsWFHS Operating
IncomeMCP Operating
IncomeSTD Cases
PH Clinic Operating Income
Public Support Index
Round 1 99,192 115,326 21,708,738$ (9,103,623)$ 4,018 (3,863,631)$ 48.13
Round 2 111,386 121,092 38,393,477$ (713,527)$ 3,259 -$ 62.68
Round 3 111,386 121,092 38,393,477$ (713,527)$ 3,259 -$ 63.14
Round 4 117,694 138,011 39,673,551$ 5,911,275$ 4,006 (5,651,300)$ 72.69
Round 5 120,519 136,759 43,742,505$ 10,302,724$ 3,276 -$ 96.65
Uninsured ED VisitsWFHS Operating
IncomeMCP Operating
IncomeSTD Cases
PH Clinic Operating Income
Public Support Index
Aggregate Rank
Round 1 1 6 10 10 10 10 10 57 10
Round 2 7 9 4 4 9 1 9 43 7 Round 3 7 10 3 8 9 1 10 48 10 Round 4 9 10 5 4 10 10 9 57 10 Round 5 9 10 3 8 9 1 9 49 9
Team 01
Results
Rank
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 Excellencen=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 inner-city hospital
Explore inter-disciplinary
uses
•Operations Analysis (HPM)•Integrate with HPM Residential MPH/MHA
•School of Education•College of Arts and Sciences
Port to web-based platform
•Multiple gaming modes•More robust back-end•Additional population attributes
•750,000 individual records•Refresh from real data sources
•ICISS GUI module integration