2010 UBO/UBU Conference
Title: MEPRS Strategic Plan Update
Session: W-4-0800
Objectives
Gain an understanding of the MEPRS Strategic Plan Become familiar with the purpose, process and
components of the MEPRS Annual Operational Plan Gain an understanding of how the MEPRS Strategic
Plan supports the MHS Strategic Plan
2
Overview
What Is a Strategic Plan? About the MEPRS Strategic Plan
– Conceptual Framework– Goals– Annual Operational Plan
MEPRS Strategic Plan Supports Quadruple Aim
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What Is a Strategic Plan?
A Strategic Plan is … A process Used to focus / guide an organization A map leading to a desired state
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5
MEPRS Policy & Business Rules Oversight
MEPRS Management Improvement Group (MMIG)– Established in 1999– Provides Functional Oversight– Tri-Service Integration, Standardization and
Compliance—now includes JTF CAPMED representatives
– Automated Information System Oversight– Coordinates Policy / Action with Resource
Management Steering Committee (RMSC)– Meeting Minutes and Information on
www.meprs.info
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TMA P
rogr
am
Offi
ces
(DH
IMS
/ DH
SS) Chartered W
orkgroups
(UBU / UBO)
HA / TMA Directorates
MMIG
MEPRS Policy & Business Rules Oversight
MEPRS Strategic Plan
7
MHS-MEPRS Execution Model
MEPRS Strategic Plan
8
Conceptual Framework for An Integrated Cost System
Experience and research show the Military Health System (MHS) has struggled to effectively use its only managerial cost accounting system to support a variety of external reporting and managerial requirements. This conceptual framework for evolving the Expense Assignment System (EAS) to better support a comprehensive integrated cost accounting system for the MHS is predicated on improving the current system to meet the three fundamental information requirements of any cost accounting system. This model is an adaptation of Kaplan’s Four Stage Cost Model1 which begins with data quality and ends with a fully integratedcost system. Instead of employing the linear construct used by Kaplan, our model emphasizes that evolution can be non-linear meaning one stage does not have to be completed prior to progressing to the next and that modifications affecting one stage can have profound effects on the other three stages. The greatest benefit of this model is its flexibility in supporting enhancements as small as updating an algorithm or as large as implementing multiple costing systems if needed to meet diverse user needs.
1Finkler, Steven A., Ward, David, and Baker, Judith J. Essentials of Cost Accounting for Health Care Organizations. 3rd Ed. Sudbury, MA: Jones and Bartlett Publishers, Inc., 2007.
EASInformation for Financial Statements
Information for Management
Decisions
Information to Motivate and Evaluate
Managers
Exte
rnal
Report
ing
Data Quality
Innovatio
n an
dM
anage
rial Rele
vance
Integrated Cost System
MEPRS Strategic Plan
“LEARNING AS WE GROW”
Process
Why a Strategic Plan?– MHS Strategic Plan, MMIG Charter, Last Plan 2006
Who was involved?– MMIG, Senior MHS Stakeholders (PPS, MERHCF…)
How was the plan developed?– Identified goals, objectives and initiatives– Categorized each objective based on priority– Selected initiatives for the FY11 Operational Plan
What is the expected outcome?– Our work will support Efficiencies, Compliance, and Cost
Measurements – Our progress will be Measurable, Accountable and Transparent
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MEPRS Strategic Plan
Goals Goal 1: Enhance data quality by systematically
eliminating data compilation errors. Goal 2: Sustain and enhance Tri-Service data uniformity,
integrity, consistency and compliance with DoD MEPRS policy.
Goal 3: Transform MEPRS to produce managerially relevant data to support the MHS Strategic Goals and Senior MHS Stakeholders' operational objectives.
Goal 4: Support financial reporting and product cost management through linked databases.
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MEPRS Strategic Plan
FY11 Operational Plan – Score Card
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MEPRS Strategic Plan
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MHS Strategic Plan
The Quadruple Aim
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ReadinessEnsuring that the total military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions.
Experience of CareProviding a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always of the highest quality.
Population HealthReducing the generators of ill health by encouraging healthy behaviors and decreasing the likelihood of illness through focused prevention and the development of increased resilience.
Per Capita CostCreating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity.
MEPRS Supporting Quadruple Aim
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MEPRS Supporting Quadruple Aim
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MHS Quadruple Aim
• Readiness: Ensuring that the total military force is medically ready…• Experience of Care: Providing a care experience that is patient and family centered…• Population Health: Reducing the generators of ill health by encouraging healthy
behaviors…• Per Capita Cost: Creating value …quality, eliminating waste, and reducing unwanted
variation…
Patient Centered Medical Home Policy
Memo, Sep 2009
• Supersedes Individual Assignments to PCM By Name Policy Memo• Implements PCMH model of primary care delivery for the MHS• Improves Continuity of Care/enhances access through patient-centered care• Improves outcomes, reduced mortality, fewer admissions, and lower utilization• Cornerstone of PCMH implementation
Use of 4th-Level MEPRS Code per PCMH TEAM, Feb
2011
• Unique 4th Level Per PCMH Team…Key pillar to analyzing team performance• Enables MHS to measure all aspects of PCMH• Consistent manner and allow for studying variation within each MTF and the MHS• Requires more granular dataset based on MEPRS “Chart of Accounts”
• 4th Level codes will populate Team data across MHS Automated Info Systems (AIS): EAS, DMHRSi, DMLSS, CHCS/AHLTA
• Data will be viewed in multiple MHS data repositories for performance benchmarking and analyses
PCMH-MEPRS Interactive Way Forward
“LEARNING AS WE GROW ”
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Fiscal Month
Skill Type Code
Skill Type Suffix Description
Service Occupation Description BGZA - Green BGZB - Blue BGZC - Gold
02 1 Intern-Medical FAMILY PRACTICE, GENERAL 0.1
GENERAL MEDICINE 0.4 0.3 0.4
Physician FAMILY PRACTICE, GENERAL 0.6 0.6 0.8
MEDICAL OFFICER 0.5 0.5 1.1
Resident-Medical FAMILY PRACTICE, GENERAL 0.5 0.7 0.5
GENERAL MEDICINE 0.1 0.0
2 All Others in Skill Type 2 CLINICAL PSYCHOLOGY 0.3 0.2 0.2
PHARMACIST-CIVILIAN 0.3 0.3 0.3
Clinical Nurse Specialist RN CLINICAL SPECIALIST-CIV 1.3 0.1 0.1
Nurse Practitioner FAMILY NURSE PRACTITIONER 0.1 1.2 0.9
NURSE PRACTITIONER-CIV 1.8 0.6
Occ Health Nurse (Cred) OCCUPATIONAL HEALTH RN-CIV 0.9
Total Providers 6.6 4.5 4.3
PCMH ClinicProvider Detail
EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02
EASIV PCMH PROVIDER DETAIL – FY11/FM02
4th-Level FCC
4th Level FCC Description
Performance Metric Oct Nov Dec
BGZA MED HOME GREEN CLINIC Total Expenses $203,558 $316,384 $297,837 Total Visits 7 1,742 1,712 Personnel Direct Expense $43,601 $40,564 $38,255 Providers 6.0 6.6 5.4 Cost per Visit $29,079.73 $181.62 $173.97 Support per Provider 1.7 1.4 1.7 Admin per Provider 0.2 0.2 0.2
BGZB MED HOME BLUE CLINIC Total Expenses $177,868 $315,558 $295,463 Total Visits 3 1,689 1,589 Personnel Direct Expense $63,048 $60,567 $59,228 Providers 4.6 4.5 3.7 Cost per Visit $59,289.27 $186.83 $185.94 Support per Provider 2.3 2.4 3.5 Admin per Provider 0.1 0.1 0.1
BGZC MED HOME GOLD CLINIC Total Expenses $161,599 $314,590 $347,146 Total Visits 1 1,552 1,833 Personnel Direct Expense $63,228 $55,041 $57,598 Providers 4.6 4.3 3.6 Cost per Visit $161,598.50 $202.70 $189.39 Support per Provider 2.0 2.4 4.0 Admin per Provider 0.0 0.1 0.3
EASIV PCMH MTF SUMMARY – FY11
PCMH NAVY“Learning as We Grow”
DA DB DC DH EA EB ED EE EF EG EK EL
P HARMACY SERVICE
P ATHOLOGY RADIOLOGYREHAB
SERVICESDEP RECIATION
COMMAND, MANAGEMENT,
AND ADMINISTRATION
SUP P ORT SERVICES
MATERIEL SERVICES
HOUSE-KEEP ING
BIOMEDICAL EQUIP MENT
REP AIR
AMBULATORY CARE P ATIENT
ADMIN.
MANAGED CARE
BGZA - GREEN 1,742 $37.68 $69.28 $12.55 $9.45 $0.76 $3.94 $25.57 $4.31 $0.90 $1.58 $0.34 $10.61 $4.66 $181.62
BGZB - BLUE 1,689 $47.86 $71.07 $10.83 $6.34 $0.61 $3.94 $25.00 $4.01 $0.22 $1.44 $0.35 $10.61 $4.54 $186.83
BGZC - GOLD 1,552 $47.15 $71.01 $14.96 $15.95 $1.66 $3.94 $25.85 $4.70 $0.07 $1.74 $0.38 $10.61 $4.69 $202.70
PURIFIED DIRECT
COST PER VISIT
TOTAL VISITS
4th Level Functional Cost Code
STEPDOWN EXPENSES - COST PER VISIT
TOTAL COST PER
VISIT
EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02
EASIV PCMH PROVIDER DETAIL – FY11/FM02
EASIV PCMH MTF SUMMARY – FY11
Fiscal Month
Skill Type Code
Skill Type Suffix Description
Service Occupation Description
BGAD - FAMILY
PRACTICE BLUE TEAM
BGAE - FAMILY
PRACTICE YELLOW
TEAM
BGAZ - FAMILY
PRACTICE BEHAVIORAL
HEALTH
02 1 Physician FAMILY PHYSICIAN 1.0 2.3
GENERAL PRACTICE PHYSICIAN 1.1
RESIDENCY TRAINED FLIGHT SURGEON 0.0 0.0
2 All Others in Skill Type 2 CLINICAL PSYCHOLOGIST 0.9
Nurse Practitioner CLINICAL NURSE, ADULT NURSE PRACTITIONER 0.0 0.9
CLINICAL NURSE, FAMILY NURSE PRACTITIONER 0.8
Physician Assistant PHYSICIAN ASSISTANT 1.0 2.0
Grand Total 3.9 5.1 0.9
Provider Detail PCMH Clinic
4th-Level FCC
4th Level FCC Description Performance Metric Oct Nov Dec
BGAD FAMILY PRACTICE BLUE TEAM Total Expenses $652,604 $732,245 $971,193 Total Visits 2,019 1,680 1,396 Personnel Direct Expense $140,548 $163,294 $182,997 Providers 4.8 3.9 2.6 Cost per Visit $323.23 $435.86 $695.70 Support per Provider 3.5 4.8 7.5 Admin per Provider 0.2 0.2 0.3
BGAE FAMILY PRACTICE YELLOW TEAM Total Expenses $494,571 $587,349 $630,309 Total Visits 2,644 2,433 2,323 Personnel Direct Expense $105,178 $91,328 $91,450 Providers 6.2 5.1 5.3 Cost per Visit $187.05 $241.41 $271.33 Support per Provider 2.9 3.2 3.1 Admin per Provider 0.2 0.3 0.3
BGAZ FAMILY PRACTICE BEHAVIORAL HEALTH Total Expenses $4,450 $3,939 $5,022 Total Visits 164 118 169 Personnel Direct Expense $33 $31 $31 Providers 0.9 0.9 0.9 Cost per Visit $27.13 $33.38 $29.72 Support per Provider 0.0 0.0 0.0 Admin per Provider 0.0 0.0 0.0
DA DB DC EA EB ED EE EF EG EH EK EL
P HARMACY SERVICE
P ATHOLOGY RADIOLOGY DEP RECIATION
COMMAND, MANAGEMENT,
AND ADMINISTRATION
SUP P ORT SERVICES
MATERIEL SERVICES
HOUSE-KEEP ING
BIOMEDICAL EQUIP MENT
REP AIR
LAUNDRY SERVICE
AMBULATORY CARE P ATIENT
ADMIN.
MANAGED CARE
BGAD - FAMILY PRACTICE BLUE TEAM
1,680 $236.56 $101.75 $19.37 $21.98 $5.26 $19.38 $3.90 $0.05 $3.42 $0.00 $0.03 $9.42 $14.73 $435.86
BGAE - FAMILY PRACTICE YELLOW
TEAM2,433 $58.81 $93.83 $22.35 $21.86 $5.26 $13.13 $2.63 $1.71 $2.30 $0.10 $0.03 $9.42 $9.98 $241.41
BGAZ - FAMILY PRACTICE
BEHAVIORAL HEALTH 118 $0.26 $0.00 $0.54 $0.00 $5.26 $10.08 $0.15 $0.00 $0.00 $0.00 $0.00 $9.42 $7.66 $33.38
TOTAL VISITS
PURIFIED DIRECT
COST PER VISIT
STEPDOWN EXPENSES - COST PER VISIT
4th Level Functional Cost Code
TOTAL COST PER
VISIT
PCMH AIR FORCE“Learning as We Grow”
EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02
4th Level Functional Cost
CodeDoD SEEC DoD SEEC Description Total
11.10 CIVILIAN PERSONNEL COMP $51,334
11.72 MILITARY PERSONNEL COMPENSATION $111,960
21.00 TRAVEL & TRANSPORT OF PERSONS $1,423
25.50 CONTRACT HEALTH CARE $232,494
26.15 MED/DENT SUPPLIES $209
11.10 CIVILIAN PERSONNEL COMP $26,922
11.72 MILITARY PERSONNEL COMPENSATION $64,406
25.50 CONTRACT HEALTH CARE $42,278
26.15 MED/DENT SUPPLIES $9,469
BGAZ - FAMILY PRACTICE
BEHAVIORAL HEALTH
11.10 CIVILIAN PERSONNEL COMP $31
BGAD - FAMILY PRACTICE BLUE
TEAM
BGAE - FAMILY PRACTICE YELLOW
TEAM
Closer examination of Direct Expenses suggest that Labor Expense and FTEs may not be aligned properly – affecting team-level cost per visit.
DA DB DC EA EB ED EE EF EG EH EK EL
P HARMACY SERVICE
P ATHOLOGY RADIOLOGY DEP RECIATION
COMMAND, MANAGEMENT,
AND ADMINISTRATION
SUP P ORT SERVICES
MATERIEL SERVICES
HOUSE-KEEP ING
BIOMEDICAL EQUIP MENT
REP AIR
LAUNDRY SERVICE
AMBULATORY CARE P ATIENT
ADMIN.
MANAGED CARE
BGAD - FAMILY PRACTICE BLUE TEAM
1,680 $236.56 $101.75 $19.37 $21.98 $5.26 $19.38 $3.90 $0.05 $3.42 $0.00 $0.03 $9.42 $14.73 $435.86
BGAE - FAMILY PRACTICE YELLOW
TEAM2,433 $58.81 $93.83 $22.35 $21.86 $5.26 $13.13 $2.63 $1.71 $2.30 $0.10 $0.03 $9.42 $9.98 $241.41
BGAZ - FAMILY PRACTICE
BEHAVIORAL HEALTH 118 $0.26 $0.00 $0.54 $0.00 $5.26 $10.08 $0.15 $0.00 $0.00 $0.00 $0.00 $9.42 $7.66 $33.38
TOTAL VISITS
PURIFIED DIRECT
COST PER VISIT
STEPDOWN EXPENSES - COST PER VISIT
4th Level Functional Cost Code
TOTAL COST PER
VISIT
PCMH AIR FORCE (CONT.)“Learning as We Grow”
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EASIV PCMH WORKLOAD AND EXPENSE DETAIL – FY11/FM02
CHCS Workload – TOC Report – FY11/FM02EASIV PCMH MTF SUMMARY – FY11
PCMH ARMY“Learning as We Grow”
4th-Level FCC
4th Level FCC Description
Performance Metric Oct Nov Dec
BGZB AMH **** FAMILY MED Total Expenses $1,659,023 $2,215,181 Total Visits 6,062 8,128 Personnel Direct Expense $485,913 $733,673 Providers 16.5 25.8 Cost per Visit $273.68 $272.54 Support per Provider 1.8 1.6 Admin per Provider 0.5 0.5
MEPRS4 Clinic Name (Place of Care) VisitsBGZB PCMH COURAGE 1,024
PCMH OCS 46PCMH HONOR 636AMH RACH INTEGRITY 625PCMH LOYALTY 884PCMH RESPECT 742PCMH SERVICE 635
BGZB Total 4,702
Task NameTask Fcc
ProvidersSupport to Providers
Ratio
Admin to Providers
Ratio
Total FTEs
PCMH COURAGE BGZB 2.5 1.5 0.0 6.2
PCMH FM OCS BGZB 2.0 2.2 3.6 13.4
PCMH HONOR BGZB 2.0 1.8 0.0 5.4
PCMH INTEGRITY BGZB 1.5 2.5 0.0 5.4
PCMH LOYALTY BGZB 3.2 2.4 0.0 10.9
PCMH RESPECT BGZB 2.6 1.2 0.0 5.5
PCMH SERVICE BGZB 2.7 1.5 0.0 6.9
Grand Total 16.4 1.8 0.4 53.8
DMHRSi Task-Level Labor – FY11/FM02
DA DB DC DD DE DH DI EA EB ED EE EF EG EH EK EL
P HARMACY SERVICE
P ATHOLOGY RADIOLOGYSP ECIAL
P ROCEDURE SERVICES
CENT STERILE SUP P LY/MATERIEL
SERV
REHAB SERVICES
NUCLEAR MEDICINE
DEP RECIATION
COMMAND, MANAGEMENT,
AND ADMINISTRATION
SUP P ORT SERVICES
MATERIEL SERVICES
HOUSE-KEEP ING
BIOMEDICAL EQUIP MENT
REP AIR
LAUNDRY SERVICE
AMBULATORY CARE P ATIENT ADMIN.
MANAGED CARE
BGZB -- PCMH 6,062 $94.34 $85.85 $13.89 $23.75 $1.43 $0.60 $3.66 $3.12 $1.22 $19.33 $14.23 $1.72 $5.53 $0.13 $0.01 $3.64 $9.51 $281.96
TOTAL COST PER
VISIT
4th Level Functional Cost Code
TOTAL VISITS
PURIFIED DIRECT
COST PER VISIT
STEPDOWN EXPENSES - COST PER VISIT
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Summary
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What Is a Strategic Plan? About the MEPRS Strategic Plan
– Conceptual Framework– Goals– Annual Operational Plan
MEPRS Strategic Plan Supports Quadruple Aim
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Questions?
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JTF-CAPMED-Joint Task Force National Capital Region Medical
GFEBS-General Fund Enterprise Business System
SFIS-ERPs-Standard Financial Information Structure, Enterprise Resource Planning System
DEAMS-Defense Enterprise Accounting & Management System
CHCS/AHLTA-Composite Health Care System/Armed Forces Health Longitudinal Technology Application
EAS IV Repository – Expense Assignment System IV Repository
MEWACS - MEPRS Early Warning and Control System
Six Sigma - MEPRS Management Metrics (S2M3)
EHR-WA – Electronic Health Record - Way Ahead BOXi-Business Objects XI
MERHCF - Medicare Eligible Retiree Health Care Fund
CCR-Consolidated Cost Report
PPS - Prospective Payment System PCMH – Patient Centered Medical Home
DMHRSi-Defense Medical Human Resource System-internet
DMLSS-Defense Medical Logistics Standard Support
Acronym List
Bibliography
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