Questions and Answers 2/24/14

Question: 

On the Consolidated Statements of Activities under Expenses, can you please give an explanation of “Health Services purchased: professional, hospitalization, pharmacy.”  I do not have an understanding of the specific activities that cause this type of expense?  Were they contracting pharmacy services?

Answer: 

As identified, these are health services purchased by WestPlan, separate from services provided by WestPlan's current salaried employees. If you believe this is important information for providing recommendations, then as part of your research, you should explore health service options by talking with administrators in the field to ascertain what one might expect for an organization of this size and scope, and make informed assumptions that you can defend if needed.

Question: 

The state of Oregon has a Patient-Centered Primary Care Home Program that encourages clinics to comply with this model. The case doesn't mention recognition of WestPlan by this program. May we assume that WestPlan clinics are not yet recognized?

Answer:

Remember that this is a fictionalized case. You should assume that WestPlan clinics are recognized.

Question: 

Can you share more detail about the demographics of the city of Dunnelly, Oregon?

Answer: More detail is not readily available. You should assume that the level of detail in the case is sufficient to make reasonable assumptions related to demographics.

Question: 

Out of the approximately 1800 patients with heart failure seen by WestPlan, how many are members? And how many non-members are participating in the Disease and Case Management Program?

Answer: 

Based on the information provided in the case, you should make reasonable assumptions about the number of members and non-members participating in the Disease and Case Management Program.

Questions and Answers 2/18/14

1. Harlan Reeves medications, dosages, strengths and frequencies.

Assume that Harlan received appropriately prescribed medications.

2.Which if any home health resources were being utilized by Reeves family?

Review the case more closely to find the answer to this question.

3. what were his labs after his first heart attack at home? bnp? ef? cr? hga1c? lft?

Harlan's health state is reflected by his CHF status. If you find this necessary information you should research CHF status

4. What is the hospitals current protocol for first time admission patients with heart complications?

Most hospitals have protocols and guidelines. If you feel this information is important to arrive at your recommendation investigate these protocols as part of your research.   

5. What is the city demographics as far as distance from each of the clinics from the hospital? From the center of the city?

Harlan made choices about his health care provider and system. If you feel this is relevant for your recommendations, you can make reasonable assumptions about distances in a comparable location.

6. what are the questions on the patient satisfaction survey? And what is the return rate of the survey?

If you feel this is important for your recommendations, then as part of your research you should explore patient satisfaction surveys.

7. What is the cost brake down for the ER, radiology, same day surgery, ect for the outpatient services.

If you feel this is important  for your recommendations, then as part of your research you should explore cost breakdowns for comparable outpatient services.

9. what is the criteria for pt to be admitted here in this clinic central hospital heart failure?

Decision to admit is based on health status and guidelines

10. what is the current discharge protocol for the hospital and other clinics?

You can assume the hospital and clinics follow a standard protocol, if you feel you need more detail, then as part of your research you should explore discharge protocols.

11. for the home care and hospice: only house calls? What’s the criteria for this?, how often do they come, what is the teaching techniques?

 You can assume a standard practice, if you feel you need more detail, then as part of your research you should explore these options.

12. For the disease and case management team: who does this intervention? what is it? what is the monitoring process?

You can assume a standard practice, if you feel you need more detail, then as part of your research you should explore these options.

13. For the identification and prediction model: what lab values are other data are going in to the prediction model. how are the statics run for identification?

Refer to classifications of heart failure.

14. For the DME vendor and monitors: how long does this process take ot get in the home and how does the education process work?

24 - 48 hours, usually, but some same day.  You could explore this independently as part of your research.

15: The case manager, who has guidelines to determine if contact to either the patient or the patient’s provider is warranted: what are the guidelines?

You can assume a standard practice for case managers. You could explore this independently as part of your research.

16: Dunnelly use the same EMR and utilize its capabilities to share some clinical information across their health systems: why is only some info only being shared?

Not all systems share or directly link data. You may want to explore EHR use.

17: Can we receive the spate financial sheets/information for each entity? Central Heart Hospital, homehealth, and the disease management?

Review the data provided with the case, if you need more detail, then as part of your research you can explore financial sheets with comparable organizations. 

18: Good afternoon, What are the average salaries for occupational therapy, family counselors/ Psychologists, dieticians, pharmacologist in dunnelly.

You can assume the average salaries for the above mentioned professions are comparable to others in the region. If you need more specifics and you think this information is important in arriving at your recommendations, then do some research into what one might expect to see for average salaries.

19: It states that he does not have Westplan insurance coverage or supplemental coverage. What types of insurance does he have?

Review the case again thoroughly to find the answer to this question

20: What is the average salary in Dunnelly compared to the rest of the state?

You can assume the average salaries are comparable to others in the region. If you need more specifics and you think this information is important in arriving at your recommendations, then do some research into what one might expect to see for average salaries.

21: What type of congestive heart failure does Mr. Reeves have?

Review the case again thoroughly to find the answer to this question

23: We wanted to know if the hospital or it's entities has done anything in the past to try to decrease re-admissions? I'f so, what worked and stuck and what failed? Why did it fail?

Review the details of the case more thoroughly.  If you need more detail, then as part of your research you can explore readmission reduction programs.

Question and Answer 2/11/14

Question:

On page #14 of the case, in the section titled "Personal History", a sentence reads: "Since he was on Medicare but not in an ACO, the Reeves' medical bills started to increase precipitously."  Did the case writers mean HMO instead of ACO?  I'm not sure how an ACO would affect a patient's bills.

Answer:

The Case writers meant ACO (Accountable Care Organization), If you believe this is important information for providing recommendations, then as part of your research, you should explore Medicare payment options as they relate to ACO's.

Question and Answer 2/6/14

Question:

Please clarify the rule: "Do not include any professional or university affiliations on the slides or other materials..." Does this mean we are not supposed to use people's names? Or does it mean we cannot mention specific Clinics or Universities anywhere on our materials?  

Answer:

That rule is about your own current profession and school.  You can reference a model clinic or facility that you are choosing to highlight for example, but you cannot list your actual college/university and professional program.  For example: Jane Doe, Pharmacy Student, University of Minnesota is not permitted. You might choose instead to role play and list your team names along with the titles from the case.  For example Jane Doe, Nurse Manager, Central Hospital is perfectly acceptable for your slides.

2014 CLARION Case Q&A

Greetings CLARION competition teams! Please send questions about the case to clarion@umn.edu we will then post those questions along with our responses on this blog. Please note: The deadline for submitting questions is Monday February 24th