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