Strategic Plan for the Montgomery Cares Program
Strategic Plan for the Montgomery Cares Program
Moon Choi
The George Washington University
The Health Care Enterprise NURS 6241Professor: Dr. Nicholas J. Scalzo
Chapter I: Overview and General Description of the Montgomery Cares Program
Montgomery Cares was established in 1993 as a private, non-profitable organization dedicated to providing access to low-income and non-insured residents of Montgomery County. Based on that, the group provides medical check-ups by a nurse or doctor, medications, sick visits by a nurse or doctor, lab tests, flu shots, X-rays, access to a specialist, access to oral health care, access to behavioral health care, and other health programs. In addition, there are twelve different agencies of health care in over twenty-five locations all through the county of Montgomery (United States, 2009). Additionally, the Montgomery Cares Program majorly offers basic health care services and services of community clinics to the medically uninsured and low-income adults who reside in Montgomery County, aged between eighteen and sixty-five years (Grsenz et al., 2009). The clinics that are funded by Montgomery Cares provide primary medical care services at low costs or at no costs at all to the people who qualify. Moreover, this program is partly funded by Montgomery County to aid in supporting networks of nonprofit, independent clinics. This study is crucial in the development of a community-based health system and makes a significant contribution in the decision-making process in the strategic planning of the healthcare enterprise. Some of this may fit better in you explanation of services offered.
Organizational History
LWVMCI first time use in a chapter – spell it out (2006) observe that for the nearly 60,000 residents of Montgomery County that are not eligible for state of federal health coverage or any subsidized plan of health insurance under the Affordable Care Act, groups of local foundations in Montgomery County worked this out and created a streamlined system of enrollment for the health care access program of the county that is dubbed Montgomery Cares. Montgomery Cares was established in 2005 and were a private-public partnership between the Health and Human Services department of Montgomery County, the five county hospitals, 12 health care clinics, and the Primary Care Coalition, which offers health care to the low-income uninsured residents of the county (Montgomery & Donovan, 2012).
While each of the clinics that participate has enrolled and screened the participants in the Montgomery Cares program since it was established, there has not been a consistent, centralized enrollment process (US & MCMS, 2009). Moreover, the Primary Care Coalition (PCC), which is a non-profit, and charitable group founded in 1993 with a vision of aiding in the provision of healthy lives for all the county residents, helps the Montgomery Cares through the provision of quality and basic medical care to the community.
Environment
The Montgomery Cares program provides medical care to the uninsured adults that live in Montgomery County. The program is offered to the various community clinics subscribed to the program and found across the whole county.
Figure 1: Location of Montgomery Cares Clinics
Illustration by Braddy & Braddy (2010)
Overview of the Services
The health care services that are under the Montgomery Cares program are offered through Community HealthLink, which is a network of nonprofit, independent clinic organizations within Montgomery County. Based on that, the main services that are offered by the Montgomery Cares Program are community clinics. In addition, consumer-based, non-profit, and community-controlled outpatient facilities that offer basic health care that includes immunizations, physical examinations, family planning, nutrition diagnosis and assistance, and treatment of the common diseases for the low-income individuals, the people that are homeless or underinsured/uninsured, or the other medically underserved people that are economically, culturally, and geographically challenged. Moreover, the services are generally offered on the basis of ability-to-pay. Lindon et al. (2009) observes that community clinics form part of the Federally Qualified Health Centers’ network, and numerous of them are referred to as “free clinics.” Overall I like this chapter
Chapter II: Mission, Vision, and Purpose
Montgomery Cares is a Maryland-funded, Montgomery County program that is designed to offer basic medical care to the low-income, adult and uninsured residents of Montgomery County via financial support to the community clinics. Moreover, the major services that are offered via Montgomery Cares are prescription drugs and basic/primary health care, although the program also supports oral pilot health programs and behavioral health programs, and access to improved specialty care via Project Access, which is a network of private health professionals majorly physicians who offer low-cost specialty health care services, plus the Archdiocesan Health Care Network (AHCN), which is a similar network that is regional based and is maintained by the Catholic church charities.
Mission Statement
Our mission is grounded on the development and coordination of a community-based healthcare system that strives for universal access and health equity for low-income community members. So what is your mission statement? Put it in quotations.
Vision
Our vision is to make Montgomery County the healthiest community in the nation. So what is your vision statement? Both statements should be in quotations.
Purpose
The purpose of Montgomery Cares Program is to offer basic and primary health care to the low-income, adult, and uninsured residents of Montgomery County through the community clinics located in different areas throughout the county. You need to elaborate on this. You also need to provide an explanation o f the mission and vision.
Values
The Montgomery Cares Program seeks to accomplish its mission and realize its vision by upholding the values that represent the partnership. Based on that, the program places the welfare of its patients, donors, and clinics offering the program, above all else, by ensuring the purity, safety, and potency of the services that are offered in the program. In addition, the program remains flexible and adapts to the different changing needs of its stakeholders as well as the diverse economic and environmental factors. Communication is effectively conducted with the different member clinics across Montgomery County to ensure that the services of the Montgomery Cares Program are readily available when need arises. Consequently, the program is efficiently carried out to make sure that the services offered are cost effective for standard use by the target population. In addition, an environment of advancing how to deliver the program’s services is cultivated through vigilance and education. Additionally, the Montgomery Cares Program recognizes the efforts that are put forth by the staff, donors, and the different clinics subscribed to the system throughout Montgomery County that cooperatively work for a healthier future of all the county residents.
The Montgomery Cares Program is founded on the following values:
Collaboration
Integrity
Innovation
Excellence
Community engagement
Health Equity
Goals
The goals of Montgomery Cares Program are aligned to realize the mission of the program while at the same time aspiring for self-improvement in order to achieve the program’s vision.
To create and develop a streamlined system of enrollment for the health care access program of Montgomery County, Montgomery Cares.
To appropriately cater for the basic medical and health needs of the approximately 60,000 Montgomery County’s residents that are not eligible for state or federal coverage of health care or a subsidized health care insurance plan under the Affordable Care Act.
Develop a centralized system of enrolment that will provide a means of reaching out to more residents of Montgomery County through which it will evaluate whether any other residents may be eligible for other medical services such as Medicaid.
To make sure that there is a uniformly high-quality medical and health care throughout Montgomery County, whether the residents receive care via a community health clinic or whether they are sign up in a private-pay Cadillac-quality plan.
Patients Base
Montgomery Cares Program’s patients are mostly female. More than half the received patients fall between 40-64 years of age. Approximately two-thirds of the patients in the cares program identify themselves as Hispanic. The majority of the patients received are foreign-born; of which half have been in the U.S for a period longer than five years (53%). About half of the patients in the Montgomery Cares Program currently report working for pay, and the majority of them report having family incomes from work and work-related activities of less than $25,000 annually. ok
Research indicate that the county captures disproportionally more females (57% of the total people that are uninsured in Montgomery County are estimated to be females, a difference of about 9 points) and disproportionally contains more numbers as compared to the uninsured ages of between 40 years and 64 years (as compared to those of between 18 years and 39 years of age). Additionally, a great proportion of the patients of the Montgomery Cares Program are male (in 2008 as compared to 2006), this population constitutes of immigrants, the homeless, or people living in supported housing or emergency shelters. Nonetheless, a greater proportion of the patients fall between the 40-49 years of age (with lesser proportions of the patients in all the other age groups, though these changes are not significant statistically).ok
Alignment of Care Program
The objectives, aims and chief purpose of the Montgomery care program are aligned with the vision, goals, and values that ensure the provision of quality healthcare service to the uninsured members of Montgomery. You need to explain this more – I’m not sure I understand what you mean.
This chapter needs more work – you need to provide a discussion of your mission, and vision and what they mean. You also need to provide a discussion of how your values drive the accomplishment of your mission and vision, as well as one on how your mission, vision, and values are aligned with direction, focus, and time in your enterprise. You need to identify your other stakeholders.
Chapter III: The Current Montgomery Cares Program Organizational Structure and Plan
The Current State of Montgomery Cares Program
The Montgomery Cares Program is a well-established organization. The organization consists of a group of health clinics that are community-based in operation. The clinic has established a reputable history of providing efficient and high-quality services to its target population of uninsured residents within the county. The clinic provides healthcare including specialty and primary services for approximately 28,000 patients and receives approximately 33,000 visits in a year (United States, 2009). Additionally, the Montgomery Cares works hand-n-hand with other partners such as affiliated hospitals and clinics other stakeholders to provide a variety of supportive initiatives and programs in an attempt to enhance and maximize the impact of the program on the community.
Eligibility to Accessibility to the Services
The program is provided to the Montgomery County’s residents that are medically uninsured and at least 19 years of age but not yet 65 years old, and who are US citizens that are not eligible for Maryland Medicaid, or any other form of health public assistance. Additionally, People with household income that falls below 200% Federal Poverty Level (FPL) are also eligible to receive the program’s services as illustrated below:
Table 1: Income Eligibility Guidelines
Gross Monthly Income, Family Size
1 2 3 4
200% FPL $1,7935 $2,3965 $3,015 $3,698
Illustration by Braddy & Braddy (2010)
Moreover, once a person is eligible for the Montgomery Care Program, health care benefits get administered through the designated basic care providers located in different areas of Montgomery County. I’m not sure you need to have this section in this chapter – don’t delete it though – as your plan takes shape we may want to move it to another chapter. Maybe the 1st chapter.
Major Business Processes and Flows
Significant Business Environment Events that have impacted the Organization Historically
Samuels and Samuels (2012) observe that the key findings on the infrastructure of the Montgomery Cares Clinics include:
More clinics were opened up in the region from the period of initiation, and several clinics have since then added new sites. Additionally, most of the clinics improved their existing physical space and added more exam space.
The growth of Montgomery Cares has shown a plateau in growth between 2010 and 2012 with a growth rate of 5% as compared to a 21% growth rate during the previous years.
The total operating hours have significantly increased across all the clinics in the county, with an increase in both evening and day time hours. This has resulted in a 25% increase in the number of patients seen and a 12% increase in the number of patient visit in Montgomery Clinics by 2012.
Reports suggested an increase in the population of bilingual staff at Montgomery Cares clinics between 2010 and 2012. However, access of interpreter services was scarce leading to a barrier in the accessibility of clinic services, especially for Spanish speakers.
By the year 2012, there was a significant increase in the population of equivalent full-time employees per clinic. In addition, the number courtesy and active medical staff also rose to an average of 40 per Montgomery clinic.
Moreover, most if not all of the clinics offering the program in the whole county currently employs a mix of volunteer and paid staff. In addition, one of the clinics reported to be using solely paid staff. However, Pieh-Holder et al. (2012) state that both recruiting and maintaining both paid and volunteer staff in these hospitals has proven to be a challenge over time. Additionally, relatively low pay that is combined with a demanding load of patients significantly contributes to high turnover rates in most sites. This isn’t a description of the major processes and workflows for your enterprise – what are the major functions and work that is done? You need to redo this section.
The Payment for Access to Montgomery Care Program Services
There are no annual premiums for the people that are enrolled in the Montgomery Care Program. Nonetheless, the program requires co-pays for some of the prescription drugs and services that are offered. In addition, the program contains a total individual annual benefits limit of $30,000.
Table 2: Montgomery Care Co-Pay Amounts
Office Visit $6
Specialty Care $11
X-Ray $6
Prescription Drugs $6
$2,500 annual pharmacy benefits limit
Illustration by Braddy & Braddy (2010)
Montgomery Care Program’s Covered Services
The program provides primary care office visits at the different community health clinics and other designated basic health care providers. Moreover, it also provides office visits of specialty care with a referral from the patients’ primary care providers. Other services include basic lab outpatient services through the primary care providers to patients and prescription drugs that have a basis on a generic, limited formulary and a certain diabetic and insulin supplies and other selected asthma medications. The program also provides; X-ray services, case management, Nurse Advice line that operates for 24 hours, disease management for some of the chronic conditions such as asthma and diabetes, colonoscopies with referrals from the patients’ primary care providers. Not sure why you are discussing this here. Is this your Assets and debt discussion – if so you need to refocus it on what your enterprise assets are and major debt.
Human Resources
The PCC provides the basis of operation of the Montenegro Cares program. A board of directors governs the PCC. It is made of 18 members who have volunteered to apply their expertise in community, as well as administrative and health policy matters. The board of directors is closely followed by the research director, the chief information officer and a group managing activities of the organization including the president, HR, Finance, External Affairs and development. The core competencies and need of the PCC with regard to the Montgomery Cares program are managed by five centers including the centers for Medical Access, Health Care Access, Community-Based Health Informatics, Health Improvement, and Children’s Health.
Figure 2: Organization Structure
Other than the well-formed organization structure, the Montgomery Cares program relies on the skills, knowledge and certificates of professional and other staff members for effective operation. For continued effectiveness, the Board of Directors requires experience in management of employees, as well as management of key components of an organization. Therefore, the board of directors should have the required knowledge and certificates in aspects such as human resource management and business management. This aspect is covered in the organization as most of the members of the board of directors, as well as other members of the management team are experienced professionals who have gained experience through working with different organizations before volunteering for the Montgomery Cares Program. In addition, most of the volunteer doctors, nurses and other medical staff are experience in their field of operation having acquired the necessary knowledge form accredited schools, as well as experience in working for different organizations. However, staff members still need to enroll to many workshops to perfect their skills in management, service and other areas of operation. This section needs to also address the knowledge, skills, and competencies required for key staff .
Technology: Health Information Technologies (HIT)
In Keating et al. (2013) state that one of the biggest challenges of a healthcare system is to allow the patients to move around the facilities without losing information, while at the same time evading duplication (excessive consumption, costs, risks for the patients). Therefore, in developing a high-quality healthcare system, an electronic medical case records’ mechanism that is easily accessible within the network of the operational clinics is essential. In addition, an electronic system also helps in advancing the sharing of information with the different specialist consultants since it allows for consultation requests to be electronically made, which reduces the number of reports (no waiting and no losses). Ohio (2009) observes that the PCC has for several years now acknowledged the importance of medical electronic documents, particularly in order to reconcile the data that comes from the emergency units and the data that comes from the general health practitioners in the clinics (emergency department discharged summary, data integration), and also to make more efficient and facilitate complementary examinations (eReferals) and consultation requests.
In addition, the increased need for the program to cater for emergency services has driven the need to first begin with the reduction in the numbers of emergency consultations that could have instead taken place under normal care conditions since they were initially not urgent in nature (“inappropriate” consultations). Gresenz et al. (2011) point out that the two most advanced Health Information Technology projects are MeDHIX and CHLCare that the Montgomery Cares Program aims to establish appropriately in the county. CHLCare is a web-based electronic program that shares medical records that are electronic in nature. Moreover, the program has a uniqueness of being developed as an open source particularly to connect the safety-net clinics in an integrated care system; no low functional cost product had existed in the medical market that is meant to meet the needs of the voluntary clinics in the county (MCHC et al., 2012. For example, as at 2010, only 35 clinics in the county were using CHLCare. In addition, they had at their disposal a database that contained more than 500,000 records of visits that relate to more than 100,000 patients (Gresenz et al., 2011). As such, the current technological capabilities in the clinics that use these software platforms allow for the inclusion of:; encounter data that includes diagnostic codes, patient demographics, patient’s scheduling of appointments, specialty referrals, visit planners, picture ID cards, clinical management reports and extensive patient clinical reports, electronic laboratory result interface, and clinical quality assurance data such as optional clinical data that is added by individual clinics like allergies and diabetes quality measures. What other technology does the staff have available to perform their functions.
Assets and Debts
Most of the assets of the program consist of the clinics distributed throughout Montgomery County, as well as the wide array of voluntary professionals working for the program. However, the Montgomery Cares Program incurs debts in its operations at times due to its non-profitable method of operation. This is where the Montgomery Council comes in offering grants, debt services and other funds to maintain the operation of the program. The councils support the program by increasing over $960, 000 to continue the dispatch of services offered by the clinic. In addition, the Council offers about half a million dollars for outpatient services and mobile crisis response activities for both children and adults.
The Affordable Care Act (ACC) is positioned to alleviate the influx of the population of the uninsured citizens of the US by increasing access to health insurance and healthcare. This program will relieve the pressure currently experienced by the Montgomery Cares Clinics due to the large number of uninsured patients. Success in the strategies employed by the ACC will lead to an increase in the provision of quality services due to a reduction in the number of patients. Even though the Affordable Care Act and other strategies aim at increasing the access to health care, as well as access to insurance by the majority of the people, the vision and mission of the Montgomery Cares program will not change considering that there will always be the disadvantaged members of the society who deserve care. However, considering that the Montgomery Cares is a non-profitable program, which relies on the contributions of the community, well-wishers and other volunteer organizations, the program encounters challenges in balancing its assets and debts. So what are the significant debts it has?
Stakeholders
Montgomery Cares Program is run and coordinated by various stakeholders who contribute differently to the program to ensure its mission, vision, and aims are realized throughout Montgomery County. As such, some of the key services that are provided through the program such as prescription drugs are offered by a network of private health professionals or physicians who offer low-cost specialty services to the eligible county members (MCHDM et al., 2009). In addition, health care services that fall within Montgomery Cares Program are offered through Community HealthLink, which is a network of non-profit, independent clinic organizations located in Montgomery County. Additionally, the Montgomery County’s Primary Care Coalition (PCC) helps by administering Montgomery Cares, coordinating the work of and offering appropriate infrastructure to the Montgomery’s County HealthLink clinics. Subsequently, PCC oversees a program that offers clinic patients with free medicine and low-cost generic medicines from the patient assistance program that is run by the pharmaceutical industry. Consequently, PCC manages a network of private practice physicians that offer specialty care to the various clinics across the County and also coordinates a multi-clinic diabetes patients’ management initiative (Braddy & Braddy, 2010).
The Community Clinic Inc. (CCI, which received support via the Montgomery Cares funds in 2008 financial year) operates clinics that support this program in three locations (Takoma Park, Silver Spring, and Gaithersburg). On the other hand, Mobile Medical Care Inc. (Mobile Medical, which also received support via the Montgomery Cares funds in 2008 financial year) operates at several locations in the County, and in some cases, it works in partnership with other different organizations (e.g., L’Accueil-Marie-de-L’Incarnation-L’AMI in activities such as operating an African/French clinic) to ensure efficacy in the delivery of these services. In addition, two other clinics that opened in the 2008 financial year, Mary’s Centre, that works in partnership with the Washington Adventist Hospital (since June 208) and the other, Under One Roof that is co-located with the Outpatient Addiction Services specializes in serving people with substance abuse or mental health disorders (opened in August 2007). In addition, the other clinics and hospital facilities that are indicated in Figure 1 above are major stakeholders in the Montgomery Cares Program because they serve the different patients that are subscribed to this program at a personal level. What other stakeholders are there?
Sustainability
The sustainability of the program is directly connected with its technological capabilities as it uses the Metro DC Health Information Exchange (MeDHIX) technology that is majorly meant for regional integration (PHCCCC and Pennsylvania, 2008). As such, the program allows the various health care providers such as the clinics, laboratories, and hospitals that have different individual programs to be able to share their data in regard to the patients (data integration), hence providing updated and quality medical services to patients. In addition, the program is based on humanitarian value that is provided by its ‘non-profit organization’ status to provide high-quality services to patients who lack medical insurance.
Figure 3: Electronic Information Bridge
Illustration by Braddy & Braddy (2010)
The PCC has played an important role towards ensuring the sustainability of the program. Sustainability is achieved through the development of partnerships with health care professionals and hospitals to provide pro-bono services. In addition, the PCC has been able to obtain the support of the county, private foundations and private donations.
SWOT Analysis of the Montgomery Cares Program
SWOT analysis is an essential aspect of all organization (Samuels & Samuels, 2012). The Montgomery Cares Program has its fair share of opportunities and threats. However, it also has strength and opportunities that enable it to remain sustainable.
Strength
The Montgomery Cares is equipped with skilled support staff and highly experience doctors that provide quality services to patients. In addition, the program is equipped with up-to-date technologies that facilitate organizational processes and knowledge management that ensures the creation, acquisition, and utilization of information in a manner that provides informed medical advice and up-to-date services.
Weaknesses
The Montgomery Cares is faced with the challenge of high workforce turnover and inadequate employees given that it depends on voluntary labor, and both governmental and non-governmental aids to run its operations.
Threats
The organization faces a threat of inadequate resources to support the large population of patients that depend on its services. Additionally, the organization faces a threat of not being able to comfortably accommodate the medical needs of the constant increase of eligible patients, given the possibility of having illegible patients cheating in order to get free medical services.
Opportunities
The main opportunity of the Montgomery Cares is the federal interest in ensuring that d the organization is provided sufficient financial aid to cater for the needs of all its patients. The rise in the population of medical graduates who are yet to get permanently employed, hence a constant supply of voluntary human resource to the organization.
SWOT Analysis Diagram
Table 3: SWOT Analysis
Strengths
Skilled support staff and highly experience doctors
Up-to-date technologies that facilitate organizational processes Weaknesses
High workforce turnover
Inadequate number of employees
Threats
Inadequate resources to support the large population of patients that depend on its services
Inability to comfortably accommodate the medical needs of the constant increase of eligible patients Opportunities
The federal interest in ensuring that d the organization is provided with sufficient financial aid
The increase in number of medical graduates who are willing to provide voluntary service
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Braddy, L. R., & Braddy, O. W. (2010). Montgomery County. Charleston, S.C: Arcadia Publishing.
Gresenz, C. R., Blanchard, J. C., Lurie, N., RAND Health., & Rand Corporation. (2011).Serving the underserved: An evaluation of the first years of Montgomery Cares. Santa Monica, CA: RAND.
In Keating, M., In McDermott, A., & In Montgomery, K. (2013). Patient-centered health care: Achieving co-ordination, communication and innovation.
League of Women Voters of Montgomery County, Indiana (LWVMCI). (2006). Montgomery County health and social services directory. Crawfordsville, Ind.: League of Women Voters of Montgomery County.
Lindon, M. E., & Montgomery Museum and Lewis Miller Regional Art Center. (2009).Virginia’s Montgomery County. Christiansburg, VA: Montgomery Museum and Lewis Miller Regional Art Center.
Montgomery Community Health Council (MCHC)., Wales., Powys Health Care NHS Trust., & Powys (Wales). (2012). Health directory: Montgomeryshire. Newtown: Montgomery Community Health Council.
Montgomery County Health Department, Montgomery County Department of Public Safety., & Video Gold Productions. (MCHDM, MCDPS,& VGP) (2009). Montgomery County Pennsylvania presents…pandemic readiness, medical healthcare professionals. Richboro, PA: Video Gold Productions.
.
Montgomery, H., & Donovan, W. (2012). Ranger medic handbook. Greer, S.C: North American Rescue.
Ohio. (2009). Montgomery County profile minority he
