Task 1: Financial Management

Population Health Management

Population Risk Assessment Summary

Corazon y Alma’s mission statement provides that, “Build the health of the community by providing the highest standard of quality care for all residents of Miami-Dade County.” The facility’s main goal is aided by population health management, a financially feasible endeavor. Corazon y Alma has an opportunity to enhance the health of Miami-Dade County’s children and women. Particularly, the facility will target pregnant women as the primary target population: Task 1: Financial Management.

Part of this target population is characterized by poverty, lack of insurance, does not communicate in English, and has low literacy levels. A major reason behind targeting this part of the population is the high prevalence of premature births, a rise in C-section deliveries, and inadequate outpatient prenatal care. Notably, all these are factors that influence health operations.

Healthcare for this target population is limited by geography, socioeconomic standing, education, transportation, and cost. Geographical barriers exist for those who do not reside near parks, grocery shops, or healthcare services. Even though 32.5% of people live in cities, they are far from access to good food and medical care (U.S. Census Bureau, 2019). A sizable portion of the population cannot afford medical treatment.

In addition, the U.S. Census data show that 5.1% of people are jobless, 12.2% lack insurance, and 14% live in poverty in Miami-Dade County (U.S. Census Bureau, 2019; United States Census Bureau, n.d.). About 20% of people walk, carpool, take public transit, or utilize other modes of transportation to get about (U.S. Census Bureau, 2019). Restrictions on transportation limit the healthcare services accessibility.

Due to educational barriers, it is a challenge for this target population to gain comprehension of their healthcare needs. According to the U.S. Census Bureau (2019), the percentage of people lacking a high school diploma ranges around 18%. Further, the U.S. Census Bureau provides that 75.1% do not speak English in their households in Miami-Dade County (United States Census Bureau, n.d.).

Therefore, this group is presented with many barriers that they should find ways to overcome. These include substantial levels of poverty, lack of insurance, housing instability, and pre-existing conditions. Prioritizing the county’s pregnant women will enhance prenatal care and decrease the need for urgent inpatient OB treatments.

Adding more auxiliary services and specialized doctors to outpatient treatment will result in long-term cost reductions. They now have a 48.6% C-section rate. Prenatal service line pursuit is justified by the fact that better prenatal care can result in shorter stays in the hospital and fewer c-sections.

Recommendation for a Value-Based Payment Model

A comprehensive bundled payment model will hold doctors accountable for performance risk. Under this arrangement, doctors may manage the care plans for their patients while sharing risks with the patients (Scheefhals et al., 2024). Notably, this payment scheme combines the concepts of episodes of care and classical capitation.

The price to be paid is determined by the patient’s health. Healthcare providers who attend to complex and critical patients get more remuneration. Based on this model, all OB services will be paid for using a single payment. Essentially, more compensation will be offered for complicated pregnancies and cesarean births.

Financial Feasibility

Financial Feasibility Analysis

Variance Analysis

Corazon y Alma Health may use variance analysis to establish service or operational line adjustments to reduce risk. Further, variance analysis will ensure that its interim assumptions reflect the true performance. Notably, an operating margin of 9.1% is expected.

Essentially, the system must monitor the anticipated revenue reductions closely to ensure contracted reimbursement rates are optimized. Therefore, there will be a need for further analysis regarding the desired results quality and billing filings to attain more than expected results.

Projected Operating Budget

Corazon y Alma will adopt a comprehensive bundled payment method to have an excellent chance to make the project appealing. Patients in Corazon face challenges such as the need for extensive outpatient prenatal care, obesity, and poor health. Using the bundled payment approach, such challenges can be catered for and many others, like antepartum, postpartum, and birth treatments.

Funding Options

The CAPS4KIDS Program and the Healthy Start initiative form two financing bodies for the endeavor (Endalamaw et al., 2024). The two funding partners require positive health outcomes so that they can guarantee the underprivileged population proper healthcare attention. It is worth noting that both partners offer services for babies and expectant women. Additionally, grant money will be sought from the state and federal governments.

Anticipated Impact

Adopting a comprehensive bundled payment model will influence Corazon y Alma’s revenue since the cost curve will shift because of better outpatient prenatal care, and their operational costs will be impacted (Homauni et al., 2023). Corazon y Alma Health’s department and investment will initially rise because of the new service line’s launch costs. According to the pro forma, Corazon y Alma’s operating margin for the recently acquired line should rise in comparison to service.

Healthy living and patient engagement will be supported by strategic partnerships such as Healthy Start Florida (Florida Department of Health, n.d.) and CAPS4KIDS (CAP4Kids, n.d.). A new line of prenatal care will distinguish Corazon y Alma Health from other medical facilities and provide access to a population that is poor.

Regulatory Agencies

The Department of Health and Human Services, which is tasked with safeguarding Americans’ health, and the Agency for Health Care Administration, which runs the Medicaid program in Florida, are likely to influence Corazon y Alma Health operations (Howard & David, 2024).

New Infrastructure Requirements

Sonographers, midwives, nurse practitioners, obstetric specialists, and other specialized provides will form part of the new infrastructure network. Essentially, this group will ensure that high-quality healthcare is provided. A physician advocate will be needed to promote the new service line.

To ensure that patients receive the treatment they require at the appropriate time, a strategy to eliminate any obstacles to care will be developed after the patient’s access has been examined. The digital medical record will need a new information systems architecture, including templates for documentation that collect quality measures, generate reports to monitor vital metrics, and handle all data analytics.

Key Financial Benchmarks

Charity care deductions, number of lives saved, and labor management will be the three financial benchmarks to be included in the scorecard. Notably, measurements around the three benchmarks can be used to understand the overall performance of the new service line.

Change Management Plan

Group of Leaders

A physician advisory committee will be established to seek early and continued feedback regarding the service line. The vice president of women’s services will head this advisory board. Other members of the committee will include female care providers, an OB/GYN, and a general care physician.

Internal and External Stakeholders

Speciality and primary care doctors, information technology department, senior management, clinical staff, midwives, nurse practitioners, and human resource management will all form part of the internal stakeholders. On the other hand, community physicians, insurance bodies, financial institutions, and community agencies will be part of the external stakeholders.

Stakeholder Engagement

Quarterly meetings will be held, and all stakeholders will be expected to take part. Second, economic, operational, and quality evaluation indicators will be reviewed at monthly meetings. Stakeholders will be informed through the sessions.

Strategies to Empower Others

Three empowerment strategies for problem-solving and decision-making include resource availability, communication channel provision, and timely feedback. Resources, including remuneration to all involved stakeholders, will be available to assist in decision-making. Resource allocation will also ensure that all materials required to evaluate operations and make decisions are available.

Further, proper communication channels will be provided to ensure a seamless flow of critical information that is required during the problem-solving activities. Lastly, timely feedback on all activities will be provided to empower all the teams to take corrective measures in line with implementing the service line.

Strategies to Address Barriers to Change

Change in the facility will be thoroughly communicated to all affected parties. There will be a need to communicate why the change is necessary, and all reasons behind the change will be made clear to the affected parties. Constant communication and feedback requests will be embraced to ensure everyone feels part of the change process.

Benchmarks for Success

Within the first half year to one year, the percentage of C-sections will be cut to 16.5% from 24.3%. Additionally, the percentage of preterm deliveries will be reduced to 6% from 8.6% 11 months. A satisfaction rating of 90% will be the aim for all OB patients for every review that will be done quarterly.

References

CAP4Kids. (n.d.). Pregnancy resources and infants. CAP4Kids Miami. https://www.cap4kids.org/miami/parent-handouts/pregnancy-resources-and-infants/

Endalamaw, A., Khatri, R. B., Mengistu, T. S., Erku, D., Wolka, E., Zewdie, A., & Assefa, Y. (2024). A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact. BMC Health Services Research, 24(1), 487. https://doi.org/10.1186/s12913-024-10828-0

Florida Department of Health. (n.d.). Healthy Start. Florida Health. https://www.floridahealth.gov/programs-and-services/childrens-health/healthy-start/index.html

Homauni, A., Moghaddam, N. M., Mosadeghkhah, A., Noori, M., & Abbasiyan, K. (2023). Budgeting in healthcare systems and organizations: A systematic review. Iranian Journal of Public Health, 52(9). https://doi.org/10.18502/ijph.v52i9.13571

Howard, D. H., & David, G. (2024). Hospital ownership and admission rates from the emergency department, evidence from Florida. Health Services Research, 59(2), e14254. https://doi.org/10.1111/1475-6773.14254

Scheefhals, Z. T. M., Struijs, J. N., Wong, A., Numans, M. E., Song, Z., & De Vries, E. F. (2024). Integrating maternity care through bundled payments in the Netherlands: Early results and policy lessons. Health Affairs, 43(9), 1263–1273. https://doi.org/10.1377/hlthaff.2023.01637

U.S. Census Bureau. (2019). U.S. Census Bureau QuickFacts: Miami-Dade County, Florida. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/PST045219#

United States Census Bureau. (n.d.). Miami-Dade County, Florida. data.census.gov. https://data.census.gov/profile/Miami-Dade_County,_Florida?g=050XX00US12086#education

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