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Implementation Plan for Proposed Initiative
The new initiative proposed for implementation at Memorial Hermann Health System (MHHS) community is to improve community healthcare through broader use of telehealth services in the Greater Houston area. MHHS community efforts in this area are extensively focused on serving the needs of diverse and underserved populations, which were reported as being times more vulnerable in terms of death during the first year of life compared to affluent neighborhoods (Kever, 2018). Since time to travel remains costly for neighborhood residents and time-consuming for service providers, the use of a mobile application that allows fast remote connection is a feasible solution for both parties. To justify the choice of the initiative, further considerations related to the 5-year budget, implementation plan, organizational impact analysis, and the effects on environmental change are discussed.
Budget Planning
The budget for the proposed telehealth initiative shows projected revenues and expenses for HMMS from a five-year perspective. It is assumed that the project will be initiated at the beginning of 2021 following the arrangements required for equipment purchasing and additional staff recruitment. The main assumptions for the budget planning are further outlined based on the initial proposal feedback and additional research, while the complete budget breakdown is provided in Appendix. Overall, it is considered that the initiative will be successful upon its completion in 2025.
The annual revenue from patient service receipts has been estimated by multiplying the number of patients receiving telehealth consultancy by the cost per visit. According to Rehm (2016), telehealth services are estimated at a cost per visit, which varies from $40 to $50 across the country, which is much lower than the country average of $176 per in-person care. Furthermore, it is assumed that, during the first year, the number of telehealth conferences will be limited to 15 patients per nurse and 8 patients per physician daily, while this figure will progressively increase after the first year and will require additional adjustments of the staff schedule. As the program will keep rolling out inviting new participants for remote healthcare, as well as the price of services will continuously increase, it is expected that annual revenues from services will increase 1.6 times annually (Rehm, 2016; ReportLinker, 2020). Hence, it is expected that, during the first year, the initiative will bring approximately $804,000 of revenues from operating receipts.
The operating costs for the initiative include staffing costs, costs for equipment and supplies, insurance costs, and other costs assumed as reserve funding. Staffing costs are based on recruiting 3 nursing practitioners, 2 physicians, and 1 medical assistant. The annual salaries considered for the staff are $119,920 for the nursing practitioner, $230,060 for a physician, and $39,190 for a medical assistant (U.S. Bureau of Labor Statistics, 2019). It is assumed that these roles will be fixed for the whole period of the initial rollout, while, since year 2, some internal staff will be reassigned to telehealth roles given that the number of in-house visits will decrease, and the number of teleconferences will increase. Salary estimations are made based on the assumption that the growth target for nominal wages will be annually increasing by 3.5-4% (Economic Policy Institute, 2020). Hence, staffing costs will incur the major part of operating costs for the initiative.
For equipment and services, such as web services costs, software and network updates, as well as equipment repairs, the fixed cost of $60,000 for the first year and an annual increase of 5% is assumed, while the cost of insurance is expected to remain stable during the first three years with a gradual increase by $5,000 annually since year 4 (U.S. Bureau of Labor Statistics, 2019). Based on the amortized loan principle, for the loan term of $100,000 during 5 years at an interest rate of 7% compounded annually, the yearly payment will be equal to approximately $24,400. Based on the above estimations, it is assumed that the initiative will bring losses during the first two years, while the overall cash surplus during the five years is estimated at $3,624,082.14, which confirms the financial feasibility of telehealth project implementation in HMMS.
Implementation Plan
The first step of the implementation plan is to begin preparatory activities for the initiative before it goes live in public healthcare. It is assumed that the main activities within this stage are developing a project proposal for HMMS management team, approving the project, recruiting team members, approving bank loans, and purchasing equipment and software required for providing high-quality telehealth services. The second step of the implementation plan is to actively promote the initiative among both internal and external stakeholders to receive their support and engagement with the telehealth services. Internally, it assumes training and communication with HMMS staff regarding the importance and benefits of telehealth as a cost-efficient solution for delivering remote quality care to a diverse population. Externally, it assumes partnership with volunteers, community support, and sheltering organizations in a Greater Houston area that can assist with matching patients to services, specifically, underserved populations or low-income individuals. The external partnership will require considering ethical and cultural restrictions in communicating program purposes, particularly referring to possible racial prejudices. Hence, all partners will be supplied with ethical checklists and asked to report on community recruiting progress every week.
Organizational Impact
Once implemented, it is expected that the initiative might have both positive and negative impacts on other organizational aspects. The positive impact manifests in the ability to provide healthcare services to broader communities with fewer costs and efforts incurred, which expects to increase the popularity of MHHS in the Greater Houston area and attract more patients annually. Furthermore, telehealth is advantageous in terms of familiarizing internal staff with new technologies for providing remote healthcare, which allows transforming the perception of how to deliver quality care for vulnerable populations. However, the main negative aspect is that the initial stages of the initial deployment might be associated with increased working hours required for functionality testing, as well as close communication with service providers to ensure that patients can seamlessly communicate with nurses and physicians. Moreover, some of the staff members might consider that the focus on telemedicine assumes a future staff shortage since the number of in-house visits is expected to be reduced where possible. It could be mitigated through personal interviews that explain the importance of separating telehealth services and in-house care for special cases which could not be resolved otherwise.
Mitigation Strategies and Environment
The main environmental risks identified for the proposed initiative are the lack of community awareness about telehealth services and internal resistance to participating in the project rollout. For the first case, the initiative remains viable since it brings the advantage of accessing healthcare services immediately and at a lower cost as an alternative to spending time booking time, travel, and registration. For the second case, it is a matter of organizational dynamics and internal communication, which is expected to be comprehended after the first year of initiative deployment. Hence, the strategies required to keep the program viability are proactive community education and communication, which shows the progress of the initiative in terms of patients successfully participating in the initiative, as well as feedback collection that shows the dynamics of patient growth. However, strong stakeholder engagement remains critical to ensure that strategies meet the overall program objectives.
Relevance and Significance of Research Evidence
The proposed implementation plan is based on economic, financial, and scholarly evidence, such as industry reports, employment, and wages analytics, as well as financial forecasting. The evidence is relevant for the chosen organization because of its strategic focus on providing support to diverse populations through remote care, as well as feasible for the proposed initiative to estimate required operational costs based on the labor trends. Furthermore, as summarized by Rehm (2016), the evidence shows past trends and forecasts for the market dynamics change in telehealth services based on reports, which allows comparing the past stance of the telehealth market against current perceptions of patients. Hence, it provides an opportunity to make future projections regarding job and scope of service changes to ensure that stakeholder needs are perfectly met.
Conclusion
Overall, the budget estimations confirm that the telehealth initiative in MHHS is feasible from a 5-year perspective. However, it requires the active engagement of stakeholders to ensure a dynamically increasing number of patients interested in remote healthcare services to cover elevating operational costs. The initiative also bears several organizational and external risks of non-acceptance, which requires significant efforts in education and training, as well as sensing patients regarding the quality of received services. Hence, it is important to ensure patient-centric delivery of telehealth services, as well as proactive communication, to ensure the initiatives success.
References
Economic Policy Institute. (2020). Nominal wage tracker.
Kever, J. (2018). Health disparities. University of Houston. Web.
Rehm, J. (2016). Telemedicine: The cost-effective future of healthcare. AJMC.
ReportLinker. (2020). The telehealth market by revenue is expected to grow at a CAGR of over 28% during the period 2019-2025. GlobeNewswire.
U.S. Bureau of Labor Statistics (2019). Occupational employment statistics.
Appendix
A 5-Year Budget for Proposed Initiative
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