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Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 1 Expansion Introduction: Bright Road Health Care System is experiencing an increase in numbers of older adult patients and also has a problem with a high readmission rate within 30 days of discharge for Medicare patients. The Board of Directors of Bright Road Health Care System is thinking of expanding services to include a home health agency in the community. The Board of Directors has charged the Chief Executive Officer (CEO) to wo rk with you, their health care consultant, to help determine whether or not to develop this service. You must analyze overall health care trends, population trends, disease trends, local trends and competitors, utilization of services, and other factors to determine whether or not to recommend opening a home care service. Your recommendation will include specific services provided, staff required, financial concerns, and a plan to build patient referrals. Characters: 1. Tanya Morales, Student’s Mentor 2. Kevin Stewart, Marketing Director 3. Ken Bloom, Chief Nursing Officer (CNO) 4. Kimberly O’Neill, Chief Financial Officer (CFO) 5. Dr. Tiffany Halpert, Chief of Medical Staff Locations: 1. Student’s Office 2. Hospital Conference Room 3. Chief of Medical Staff’s Office 4. Tanya’s Office Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 2 Scene 1: Email from Mentor In this scene, the Student receives an email from their mentor figure, Tanya, who assigns the Student the new project of assessing the need and implications of Bright Road’s expansion into home health care. The student will be asked to prepare a recommendation to the Board. Location Student’s Office Scene setup Tanya is standing across from the student. On -screen characters Tanya Morales Off -screen characters None Student receives an email from Tanya Morales. From: Tanya Morales Subject: New Project at Bright Road Body of Email: From: Tanya Morales Subject: New Project at Bright Road Good evening! Bright Road has a new project for our team, and since I’m in the middle of the Medicaid audit, I thought this would be a good opportunity for you. I need you to gather information from the staff of Bright Road and make a recommendation by week’s end on a new expansion project they’re considering. Bright Road has not entered the home health care market, and they want to see if now would be a good time to do so. Specifically, they are looking at delivering postacute care and rehabilitation therapies to patie nts in their home setting, rather than having them come to the hospital or another facility. This is a growing market that may be a good revenue stream for Bright Road. But the main reason they’ve decided to consider it now is because they’re being hit wi th penalties from Medicare for having a high readmission rate. When a Medicare patient is readmitted to the hospital within 30 days of their first discharge, Medicare will reduce the amount of their reimbursement to Bright Road. This is a significant penal ty – enough that they’re considering adding an entirely new division to address it. Part of what you’ll need to do is determine whether the cost and risk of adding home health care services to Bright Road will be offset by the benefits. I suggest reaching out to the contacts below for information: Kevin Stewart – Marketing Director. He’ll be able to help you see how the market for home health care has evolved recently. He should also have info on changes to the main target population and challenges to mod ern caregivers. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 3 Kimberly O’Neill – Chief Financial Officer. She’s always good at filling in the numbers and providing an honest look at the financials. Dr. Tiffany Halpert – Chief of Medical Staff. She’s not the biggest supporter of the expansion project, so it will be good to understand her reasons why. Ken Bloom – Chief Nursing Officer. For another perspective to counterbalance Dr. Halpert’s input. I’ll be back in town on Friday, so let’s go over what you’ve gathered then, okay? Don’t hesitate to call or email me during the week, if you need anytying. Good luck! Regards, Tanya Morales Scene 2: Discussion with Marketing Director The student meets with Kevin Stewart and they talk about the state of the market, regarding home health car e. Kevin is favorable toward the expansion, but is not necessarily aware of the financial implications and risks. Location Student’s Office Scene setup The Student faces Kevin who sits on the other side of the desk. On -screen characters Kevin Stewart Off -screen characters None. On -screen text: Meeting with Kevin Stewart, Marketing Director for Bright Road . . . Student must select correct option to continue. KEVIN So, home health care, huh? I was wondering when we’d finally start to look into that. STUDENT CHOICE 1 (INCORRECT) Have you been interested in home health care for a while? STUDENT CHOICE 2 (INCORRECT) Do you think now’s a good time for Bright Road to enter that market? STUDENT CHOICE 3 (CORRECT) What are the biggest changes recently in the marketplace? Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 4 KEVIN RESPONSE 1 Well, not exactly. I know it had a huge boom in the 60s and 70s. Then some legislation in the late 90s slowed it down a bit. But now with the changes in population and needs of the community, it’s really picked up again. This will only continue as the population ages. Response 1 kicks Student back to options. KEVIN RESPONSE 2 Yes. I think it’s just the right time, actually, for Bright Road to step in. We’ve only got two other agencies competing in this region. There’s definitely room for another. Response 2 kicks Student back to options. KEVIN RESPONSE 3 The biggest one is that people are living longer. There are more elderly people alive now than ever, and they’re the ones who use home health care most. Americans aged 65 and older make up 15% of the population. That’s expected to rise to 20% by the year 2030. Plus, the technology has gotten to a point where home health care can help a broader range of people and their needs. It’s not just the elderl y who have been taking advantage of it in recent years. Response 3 allows the Student to continue. Student must select all options to proceed. STUDENT CHOICE 1 Are you saying that young people are using home health care a lot too? STUDENT CHOICE 3 What ar e the main selling points of home health care? KEVIN RESPONSE 1 Not as much as the aging populations, but it is significant. Take home dialysis for example. Instead of having to go to the hospital and lose a major chunk of their day, young patients can get this service at home, even at night. This helps them maintain their independence and flexibility, something they value greatly. KEVIN RESPONSE 2 We’ve touched on some big ones, already, namely the flexibility and control over the schedule, and time sav ed. Those are huge. But, just as big, if not bigger, is the benefit of cost savings. Across the board, it’s a much cheaper alternative to hospitalization or institutionalization. And it keeps people in their homes where most are more comfortable. STUDENT It sounds like there are more and more reasons for a home health care agency to move in and provide the care. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 5 KEVIN Yes, and it’s also a matter of families depending on two incomes. If a family member or close friend gets sick, it can put a h uge hardship on the family if someone has to stay home from work or cut back on hours in order to provide care. Student must select correct option to continue. STUDENT CHOICE 1 (INCORRECT) What about the sick or elderly – what do they prefer? And, can you tell me about the financial and legal risks involved in home health care delivery? STUDENT CHOICE 2 (INCORRECT) Are there policies coming in the future that could have an impact on this market? STUDENT CHOICE 3 (CORRECT) Have you looked at the number of people using home health care in our region specifically? KEVIN RESPONSE 1 Well, I don’t know too much about the legal risks. Obviously, there are insurance riders for this sort of thing. As far as financial risks, I see them as minimal. We’re basically expanding our occupancy rate to include every home in our region. And, the demand is there for sure. It’s clear that people widely prefer receiving care at home instead of in the hospital. And in our case the same physicians can supervise their care. Response 1 kicks the Student back to options. KEVIN RESPONSE 2 You know, nothing’s for certain when it comes to the future of health care in our country. But, if people are going to pay directly for health care, you’d think they’d gravitate toward a lower cost alternative in the setting they prefer: their home. Response 2 kicks the Student back to options. KEVIN RESPONSE 3 I can dig up some of those figures, I think. Give me a little time and I’ll get you the data. Response 3 allows the Student to proceed. STUDENT This is great information, Kevin. Thank you for stopping by! KEVIN You’re welcome. Like I said, I’ll send you some data soon. In the meantime, let me know if you need anything else! Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 6 Scene 3: Meeting with CNO Next, the student meets with the Ken Bloom. They discuss primarily the types of services Ken sees Bright Road delivering through home health care. They also talk about the rise in certain diseases that are affecting the marketplace. Location Conference room Scene setup Student faces Ken across the table. On -screen characters Ken Bloom Off -screen characters None On -screen text: Next you meet with Chief Nursing Officer, Ken Bloom in the conference room. KEN Good morning! What can I help you with? Student can click o n any option to proceed. Student will need to visit all branches. STUDENT CHOICE 1 [BRANCHING 1] Tell me your thoughts on the proposed home health care expansion. Do you think it will help reduce your 30 day readmission rate? STUDENT CHOICE 2 [BRANCHING 2] Can you give me some details on what types of services Bright Road would offer through home health care? STUDENT CHOICE 3 [BRANCHING 3] What are the drawbacks to expanding into home health care? KEN RESPONSE 1 I think it’s a pretty complicat ed issue, but yes, overall it will help. Response 1 allows the Student to proceed to Branching 1 Options. KEN RESPONSE 2 There are a lot of home health care services we can provide, mainly post -acute care, rehabilitation therapies and nursing services. Response 2 allows the Student to proceed to Branching 2 Options. KEN RESPONSE 3 That’s a good question. There are always risks involved and I’ve talked to nurses on the front lines who have plenty to share about that. Response 3 allows the Student to proceed to Branching 3 Options. BRANCHING 1 Student must select correct option to proceed. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 7 B1: STUDENT CHOICE 1 (INCORRECT) Can you expound on that? B1: STUDENT CHOICE 2 (CORRECT) But is it necessary? Aren’t there other ways to improve the readmission rate? B1: KEN RESPONSE 1 Well, you’re giving Medicare patients another option to coming back to the hospital, and it’s an option they would probably prefer, too. If we can lay out a plan on discharge that included home health care service s to assist them with recovery, or whatever medical condition they have, I’m sure they’d prefer it over coming back and getting readmitted to the hospital. Response 1 kicks the Student back to Branching 1 options. B1: KEN RESPONSE 2 Sure, there are certai nly other factors at play. For instance, we tend to rush people through our hospital system too fast. An extra day to make sure our elderly patients are stable could help reduce readmission within 30 days. Also, better education during discharge and making nurses more available by phone could go a long way too. Bottom line: if a patient feels supported when they’re wheeled out of the hospital, they’ll be less likely to come rushing back. Response 2 kicks the Student back to Main Branching options. BRANCHING 2 Student must select correct option to proceed. B2: STUDENT CHOICE 1 (CORRECT) Any new therapies that are now available in the home? B2: STUDENT CHOICE 2 (INCORRECT) What are examples of postacute care services? B2: STUDENT CHOICE 3 (INCORRECT) What about rehabilitation therapies? What are those like? B2: KEN RESPONSE 1 Yes. In fact, new technologies can deliver therapies that could never be done before outside the hospital setting. Things like pulmonary care, Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 8 oncology therapy, intravenous antibiotics, hemodialysis, and even ventilator care. Not only are patients saving money by receiving these services at home, but they’re improving their quality of life by being allowed to stay in a more comforting and preferr ed setting. Response 1 kicks the Student back to Main Branching options. B2: KEN RESPONSE 1 Postacute care is meant to help people transition from the hospital back to the community. It provides attention to physical and emotional needs, usually at the en d of the hospital stay when patients are not quite ready to be on their own. Things like changing dressings, checking vitals, dispensing medication, even help with eating and bathing or shopping and cleaning. Response 2 kicks the Student back to Branching 2 options. B2: KEN RESPONSE 3 Rehabilitation therapies are sometimes bundled with postacute care. Things like physical therapy, occupational therapy and speech therapy. Response 3 kicks the Student back to Branching 2 options. BRANCHING 3 Student must select correct option to proceed. B3: STUDENT CHOICE 1 (INCORRECT) What do nurses on the front lines say? B3: STUDENT CHOICE 2 (CORRECT) Do you think the benefits outweigh the risks? B3: KEN RESPONSE 1 It depends on the agency. Let’s just say some have had less stringent standards than others in the past. Thankfully, the Balanced Budget Act in ’97 (which cut back Medicare reimbursements) weeded out many of those agencies that placed profit over people. There are also issues of nursing burnout – it c an be more emotionally and physically taxing to travel and provide care in people’s homes. But, the flipside is that patient satisfaction is generally higher than in hospital settings. Nurses often see the patient over a longer time period with less hospit al hassles, so there can be more rewards on a daily basis. Response 1 kicks the Student back to options. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 9 B3: KEN RESPONSE 2 I do. It’s not like we’re building a new wing of the hospital that won’t be used. We’re sending nurses out into people’s homes. If it doesn’t pan out, we can simply stop offering the service. Of course, I understand we’ll need to invest a good deal in training as well as the equipment needed. But, DMEs are providing the specialized equipment in most cases anyway. We ’d just need the basics and transportation and then contract with a DME. Response 2 kicks the Student back to Main Branching options. END OF BRANCHING. Student must select correct option to proceed. STUDENT CHOICE 1 (CORRECT) What about diseases and medical conditions that are on the rise? STUDENT CHOICE 2 (INCORRECT) What are DMEs? KEN RESPONSE 1 Unfortunately, we’ve seen autoimmune diseases like rheumatoid arthritis and Type 2 diabetes on the rise recently. Alzheimer’s will increase nearly 43% from 5.4 million Americans afflicted in 2011 to an estimated 7.7 million in 2030. Respiratory and cardiac problems are also more prevalent. So, like I said, we have a need for home health care now that is only going to grow in the future. Response 1 allows Student to move on. KEN RESPONSE 2 DME stands for Durable Medical Equipment. Home health agencies are responsible for arranging DME for a patient, but there are many private companies who actually provide the equipment. We wouldn’t have to. Response 2 ki cks the Student back to options. STUDENT You’ve been a great help Ken. KEN Glad to hear it. Good luck with the recommendation! Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 10 Scene 4: Web Meeting with CFO The student has a web meeting with the CFO, Kimberly O’Neill, who discusses the financial implications of the expansion. They review the statistics that Kevin Stewart sent. Location Student’s Office Scene setup Student is at their desk, looking at their computer screen. On -screen characters None Off -screen characters Kimberly O’Neill On -screen text: Kimberly O’Neill meets with you online the next day… NOTE: View zooms into full -screen close -up of computer and a web call opens up. It’s an audio call, but Kimberly’s “avatar” image is onscreen. KIMBERLY Thanks for meeting with me online to talk about home health care – I actually have to meet with a contractor at home here this afternoon. Kind of ironic, huh? So, how has the investigation been going? STUDENT It’s coming along well. Home health care seems to be a growing market wit h a lot of demand now and more in the future. KIMBERLY Sure seems that way. Did you see the email from Kevin with some statistics about our area? I can put them up on the screen if you want. STUDENT That would be great. Note: Transition shows screen shar e in the “skype” app, with end of transition being the statistics from Kevin. Stats: Regional Patients using home health care per year in our area: 55,000 Expected increase by 2022: 35% Money spent in region on home health care in 2017: $2 billion Expected increase by 2022: $2.7 billion Estimated 1st year market share: 2% Expected market share increase by 2022: 15% Student must select correct option to continue. STUDENT CHOICE 1 The money spent seems high, doesn’t it? Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 11 (INCORRECT) STUDENT CHOICE 2 (INCORRECT) What would it cost us to provide these services? STUDENT CHOICE 3 (CORRECT) What risks are involved? KIMBERLY RESPONSE 1 Well, not really when you consider that almost 120 billion dollars is paid to home health care every year. It’s not all from the patients – only 7.9% of that is out -of-pocket. The rest is paid by federal programs like Medicare. Response 1 kicks the Student back to options. KIMBERLY RESPONSE 2 That’s a good question. The cost to provide this service is something I’m still looking into, but my initial estimate is coming in at around 20 million a year. This includes salaries, training, equipment, licenses, marketing and the costly insurance rider. Response 2 kicks the Student back to options. KIMBERLY RESPONSE 3 This is the biggest drawback in my opinion. While we’d have extensive (and expensive) insurance coverage in place, the risk of errors and malpractice suits really goes up outside of a controlled hospital setting. Aside from this legal r isk, we also have the financial risk that we will not be able to penetrate the market effectively, or that economic or political factors will negatively affect the market in coming years. Response 3 allows the Student to proceed. Student must select correc t option to continue. STUDENT CHOICE 1 (INCORRECT) Can you project legal costs for the future in this area? STUDENT CHOICE 2 (CORRECT) Are there ways to reduce the risk of not penetrating the market like Kevin is projecting? STUDENT CHOICE 3 (INCORRECT) Do you agree that the demand is only going to rise, like Kevin and Ken Bloom are saying? Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 12 KIMBERLY RESPONSE 1 This is tricky. We have malpractice coverage that can extend to this service, but there are other types of lawsuits that can hit hard. For example, a home health care provider in Tennessee just had to pay over 9 million dollars to resolve a lawsuit regarding false claims they had allegedly made. Response 1 kicks the Student back to options. KIMBERLY RESPONSE 2 Sure. We just need to make a huge splash very quickly, in my opinion. That means spending a great deal on marketing, training, staffing and equipment. Then, if smaller players try to encroach on our region, we can outperform and outprice them. If that doesn’t work , we could even buy them out. We can also market as a package, providing care across the continuum of needs with better communication at each level of care. Response 2 allows the Student to proceed. KIMBERLY RESPONSE 3 All evidence points to a rising dema nd. I’ve seen the stats on the aging population increase, as well as the rise in certain types of diseases that could be treated with home care. The question is, are we going to be able to grow steadily with the market? Kevin seems confident that there is room in our region for another major player, but who knows if a whole slew of other agencies could arrive on the scene as well. That’s where the risk is. The more players, the fewer patients and profits to go around. Response 3 kicks the Student back to o ptions. Student must select correct option to continue. STUDENT CHOICE 1 (INCORRECT) What about the issue with Medicare reimbursements being cut due to readmission within 30 days? Do you think expanding into home health care will help with that? STUDENT CHOICE 2 (CORRECT) Can’t we factor the revenue from increasing Medicare reimbursements we’ll be gaining into the expansion picture? KIMBERLY RESPONSE 1 There’s no doubt in my mind that this will help. Instead of coming back to the hospital, patients will be able to receive Bright Road’s care and attention in their home setting. It only follows that our reimbursements from Medicare won’t be reduced as much as they have been lately. Response 1 kicks the Student back to options. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 13 KIMBERLY RESPONSE 2 Of course it’s a benefit. The question is, how big of a benefit? I really haven’t thought about putting a number to it yet. Response 2 allows the Student to proceed. STUDENT If you had to take a guess at increased revenue from fixing the Medi care reimbursement process, what would it be? KIMBERLY You don’t let up easily, do you? (laughs) Okay, here’s the deal. It’s not a guarantee. We can’t force patients to take the home health care service option. They have the freedom to choose. And especially among our older population, it’s hard to change long -held beliefs about how they receive medical care. They may believe that the level of care at home won’t be as good as at the hospital. They may not feel comfortable with nurses coming into their home. What do we do, then, if that’s how most of our patients feel? Student can choose either option to continue. STUDENT CHOICE 1 Good question! I guess that’s where good communication, education and marketing will come into play. STUDENT CHOICE 2 Well, I suppose you can say that at least you gave it a try. KIMBERLY Right. Let me think about it a little more and I’ll see if I can get you a number on the revenue increase. I know you’re trying to factor in everything, to make a solid recommendation, and I appreciate that. STUDENT I appreciate your help and your time, Kimberly. KIMBERLY No problem at all. I’ll be in touch soon! Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 14 Scene 5: Meeting with Chief of Medical Staff The student meets with Dr. Tiffany Halpert, the Chief of Medical Staff for Bright Road. Dr. Halpert is against the expansion and explains why. Student gets a text from Kimberly at the end of the scene. Location Chief of Medical Staff’s Office Scene setup Dr. Halpert sits by her desk. Student faces Dr. Halpert. On -screen characters Dr. Halpert Off -screen characters None On -screen text: Your last interview is with Dr. Tiffany Halpert, Chief of Medical Staff… STUDENT Thank you for taking the time to meet with me, Dr. Halpert. I’ve heard you have a unique opinio n about the home health care expansion. DR. HALPERT Well, you could say that. I seem to be the only one willing to go against the grain and raise a few red flags. Student must select correct option to proceed. STUDENT CHOICE 1 (CORRECT) Don’t you think that it will help with the poor readmission rate? STUDENT CHOICE 2 (INCORRECT) Do you think expanding into home health care is the wrong move? STUDENT CHOICE 3 (INCORRECT) What are your biggest concerns with the expansion? DR. HALPERT RESPONSE 1 It may help somewhat with the readmission rate, but I don’t think it is the best answer to that problem. Response 1 allows the Student to proceed. DR. HALPERT RESPONSE 2 I’m not saying the expansion is entirely wrong at this point. I think there are factors that shouldn’t be ignored, that’s all. Response 2 kicks the Student back to options. DR. HALPERT RESPONSE 3 My biggest concerns are with quality, liability and financial risks. Response 3 kicks the Student back to options. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 15 STUDENT Why do n’t you think home health care is the best answer? DR. HALPERT I think the problem we’re having with losing Medicare reimbursements could be easily managed if we simply make our doctors and nurses more aware, and if we adjust some policies. Training on this issue has been totally lacking. We send out a memo, or we mention it here and there, but nothing solidifies a point like a few hours of training. Then we can implement some policy changes, like the level of education we provide to our patients on discharge and the amount of time spent for that. Sure, home health care can be a part of the solution, but we’re already referring patients out to other agencies for that. It doesn’t have to be Bright Road who provides it. Student must select both branches to continue. STUDENT CHOICE 1 [BRANCHING 1] Can you talk to me about your concerns with quality? STUDENT CHOICE 2 [BRANCHING 2] What about your concerns with liability and financial risks? DR. HALPERT RESPONSE 1 There’s just less supervision in home he alth care. Nurses are not monitored as closely, and this could lead to lapses in quality. Response 1 allows the Student to proceed to Branching 1 Options. DR. HALPERT RESPONSE 2 Well, legal costs are tied closely to how well quality is ensured. But accid ents happen, mistakes happen despite the best efforts to prevent them. Add to that the risk of a crowded market, and that knocks this option out of the consideration, in my opinion. Response 2 allows the Student to proceed to Branching 2 Options. BRANCHING 1 Student must select correct option to continue. B1: STUDENT CHOICE 1 (INCORRECT) Isn’t quality more about training and proper accountability, and less about micromanagement? Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 16 B1: STUDENT CHOICE 2 (CORRECT) I’m assuming that there would be nursing managers and supervisors making regular quality inspections, right? B1: DR. HALPERT RESPONSE 1 You’re right. We don’t breathe down anyone’s neck here at the hospital, either. But there’s just a more relaxed environment in the home and I worry that this will translate into the level of care provided. I mean, things got so bad with quality during the Clinton administration that they had to put something into effect called Operation Restore Trust. All I’m saying is, why go down th at road if we don’t have to? Response 1 kicks the Student back to BRANCHING 1 options. B1: DR. HALPERT RESPONSE 2 Yes, of course. And then you have surveyors from outside agencies, too. Response 2 kicks the Student back Main options. BRANCHING 2 Studen t must select correct option to continue. B2: STUDENT CHOICE 1 (CORRECT) Have you seen the market data from Kevin Stewart? B2: STUDENT CHOICE 2 (CORRECT) Are these risks any greater than if you added another wing or another department or specialty to the hospital? B2: DR. HALPERT RESPONSE 1 Kevin did mention some of those statistics in the break room the other day. I guess I could take a closer look and maybe that would make me feel better. I just think that we need to shore up our processes and our staff here at the hospital first before we start looking to expand in this way. Who knows? If we can get our act together here, we may find that we don’t need to branch out in this way. B2: DR. HALPERT RESPONSE 2 I see what you’re saying. If we want to expand at all, there will always be added risk and cost involved; cost to insure, cost to handle legal issues. And the risk of patients not showing up. That’s a big one in my book. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 17 It just seems like the risk of adding a new specialty or division to the hospital is still less than starting an entirely new and external service. Response 2 kicks the Student back to BRANCHING 2 options. Student must select correct option to continue. STUDENT CHOICE 1 (INCORRECT) You don’t think we could do b oth simultaneously? Home health care is not just a good way to fix the readmission rate problem, it’s also a good opportunity, I think. STUDENT CHOICE 2 (CORRECT) I see what you mean. That’s a bigger decision that the higher -ups need to decide. DR. HALPERT RESPONSE 1 Does Bright Road really need to diversify more at this stage? I don’t think so. We’ve got a huge share of the market as it is, and last I checked, we were a profitable company. Response 1 kicks the Student back to options. DR. HALPERT RESPONSE 2 Definitely. I’m glad you were able to stop by today, so I could add my two or three cents to your evaluation! STUDENT You’ve definitely added a lot! Thanks, Dr. Halpert! NOTE: Student sees their phone appear with the following message from Kim berly, once they click on the flashing icon to view the text. TEXT FROM KIMBERLY I think a safe number for increased revenue from saving those Medicare reimbursements is about $3 million a year. STUDENT TEXT RESPONSE Perfect! Thank you, Kimberly! Student is given the option to send the response to close out the scene. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 18 Scene 6: Analysis with Mentor In this scene, the Student meets with Tanya to review the information they’ve discovered. Tanya will ask questions to help the Student analyze and prepare for writing a recommendation. Location Tanya’s Office Scene setup Student is sitting across desk from Tanya On -screen characters Tanya Morales Off -screen characters None On -screen text: Meeting in Tanya’s office at the end of the week… STUDENT How are things at corporate? Did the Medicaid audit go well? TANYA Yes, thanks. I’m glad that’s over. And, I hear your investigation has gone well, too. Student can click on either option to proceed. STUDENT CHOICE 1 Yes, I gathered a lot of very good information. Do you mind if I run some of it by you before I give you a written recommendation? STUDENT CHOICE 2 I’ve gathered some good information. I’m not sure if I have enough for a recommendation yet. Will you help me put it together? TANYA Sure! I’m anxious to hear the juicy details. Student must select all branches to proceed. STUDENT CHOICE 1 [BRANCHING 1] First of all, the market seems prime for home health care. STUDENT CHOICE 2 [BRANCHING 2] Economic and policy changes seem to be favorable to ward a move into home health care. STUDENT CHOICE 3 [BRANCHING 3] There are some who think that the risks won’t outweigh the benefit to fixing the Medicare readmission problem. BRANCHING 1 TANYA RESPONSE B1 What factors convinced you of that? Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 19 Student must select correct option to proceed. STUDENT CHOICE 1 (INCORRECT) Demographics, for one. People are living longer, and the elderly are, by far, the primary users of home health care. STUDENT CHOICE 2 (INCORRECT) People in the suburbs are looking for options that are closer to home and less costly. Plus, less and less caregivers are able to leave the workforce to stay home and care for the sick. STUDENT CHOICE 3 (CORRECT) A rise in certain diseases and better technology to mee t the needs of people with these diseases in their homes. TANYA RESPONSE 1 That’s true. Make sure you have some exact numbers in your recommendation, though. And, don’t forget to address the other ages, too. I hear that young people with chronic illnesses are utilizing home health care more and more, because of the flexibility. Response 1 kicks the Student back to Branching 1 options. TANYA RESPONSE 2 Haven’t there been Paid Family Leave Laws put into place in several states? I think these were d esigned to help caregivers take more time off work to stay home with sick family or friends. Make sure you’re aware of policy changes like this that can also affect the market. Response 2 kicks the Student back to Branching 1 options. TANYA RESPONSE 3 Yes. You hear about Alzheimer’s being on the rise, as well as other diseases like diabetes in both young and old. Be sure to mention specifically which services and procedures can be performed at home, thanks to the advances made in technology. I personall y know about one, hemodialysis, because I have a friend who gets this done at home, and she said it’s changed her life. She can still work during the day and, then, at night, a nurse comes to her home and takes care of the dialysis. Examples like these can go a long way. Just remember, Alzheimer’s can only be handled in home in the early -to-middle stages of the disease. Response 3 kicks the Student back to Main Branching options. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 20 BRANCHING 2 TANYA RESPONSE B2 Can you give me some specific examples? These always help. STUDENT Social changes reflect less caregivers being able to stay at home and more people looking for ways to save time and money, while also avoiding sending an elderly parent to long term care. Let’s not forget children either. Home care for children with major illnesses has also expanded. TANYA And you think this will help ensure that people will utilize home health care? It sounds reasonable. Just make sure you have some numbers to back these statements up. Response kicks the Student back to Main Branching options. BRANCHING 3 TANYA RESPONSE B3 First, tell me if you think it will fix the readmission problem. Secondly, what about the risks involved? Are they too great? Student must select correct option to proceed. STUDENT CHOICE 1 (INCORRECT) Well, the CNO seems to think it will fix the problem. But the Chief of Medical Staff thinks the problem should be fixed at the hospital level. STUDENT CHOICE 2 (CORRECT) Dr. Halpert thinks the legal and financial risks are too great. But I talked with the CFO, and she feels the opposite. STUDENT CHOICE 3 (INCORRECT) I think it will help with the readmission problem, but it should not be the sole solution. Better training and patient education and outreach needs to be put in place, too. There are some financial and legal risks, but in the long run benefits should top the risks. TANYA RESPONSE 1 Sounds like they both want to keep the care of the patient in the hands of their own groups. Ken wants his nurses to play a bigger role, while Dr. Halpert wants her doctors in the loop more. You have to decide which one has the best case based on the evidence you’ve gathered. Response 1 kicks the Student back to Branching 3 options. TANYA RESPONSE 2 Here’s a case where the numbers ca n help you make a good, final decision. Some people have justified concerns, but if they’re not substantiated by facts, they shouldn’t be given as much weight. Yes, there are risks, but Bright Road isn’t the first hospital to go down this road (I think nea rly 25% of all home health Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 21 care is provided by hospital systems). I’m sure the numbers are lining up in favor of taking the risk more often than not. Response 2 allows the Student to proceed. TANYA RESPONSE 2 That sounds reasonable. But, as far as I know, the hospital contracts with outside home health agencies. It makes you wonder, what will change if Bright Road offers the service themselves? If the patients don’t take advantage of it, then we’ll still have the high readmission rates. So, yes, better training and better education of patients at discharge sounds necessary. And if Bright Road offers home health care themselves, they will be more likely to promote this option, especially since their own people will be involved and they can be more confident of the quality of service. Response 3 kicks the Student back to Branching 3 options. STUDENT These are great things to think about. Thanks, Tanya. I’ll have a recommendation to you by tomorrow afternoon for sure. TANYA And then I’ll pass i t on to the Board, once I go over it. I’m sure it will be great, you’ve done a very nice job on this! Scene 7: Assessment A 10 -question assessment is presented to the student. It’s time to check your knowledge. Answer the following 10 questions to show what you know about health care delivery. Good luck! The student answers the questions and then sees the assessment results. Assessment Results Here are your results. Click Save Results if you are satisfied with the outcome. Or you can click Try Again if you want to try and improve your score. NOTE: The student can retry the assessment by clicking the Try Again button, or can continue to final scene by clicking the Continue button. Health Care Delivery Navigate 2 Scenario: Expansion April 10, 2018 22 Scene 8: Making Your Recommendation In this scene, the Stud ent will write an email to their supervisor, Tanya Morales, with a recommendation on whether Bright Road should expand into home health care or not. The recommendation will include each aspect of the analysis, as gathered from the staff. Location Student’s Office Scene setup Student is sitting at their desk. On -screen characters None Off -screen characters None On -screen text: In the body of the email below, type your recommendation on whether Bright Road should expand or not into home health care. Don’t forget, you can use the notes you’ve taken throughout your interviews. Be sure to back up your recommendation with the analysis of the information gained from the staff. Your recommendation should be 250 -500 words. To: Tanya Morales Re: Bright Road expan sion into Home Health Care Body of Email: NOTE: Student will be able to fill in their recommendation here. NOTE: The student will be given an option to “Send” the email after writing the recommendation. After the student submits the email, the computer screen fades to the previous view of the student’s office. On -screen text: Congratulations! Your recommendation to Tanya has been sent! THE END