DNP 840 Module 8 Integrated Strategic and Financial Plan Example

A Plan Leaders Can Fund and Families Can Count On: The Integrated Strategic and Financial Plan for a Dementia Care Service Line

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 840: Strategic Planning and Financial Management

Instructor Name

Month Day, Year

A Plan Leaders Can Fund and Families Can Count On: The Integrated Strategic and Financial Plan for a Dementia Care Service Line

A strategic plan and a financial plan answer different questions, what an organization intends to do and whether it can afford to do it, but leaders need both answered together. This paper brings together the analyses prepared over the course for the composite health system's dementia care proposal: its mission and the evidence behind it, the environment, the operating and capital budgets, break-even and ratio analyses, and midyear monitoring. It presents the integrated plan the steering group will submit for approval, including risks, measures and the decisions leaders will make along the way.

Strategic Summary

The program exists so that people with dementia can keep living at home safely and with dignity, and so that their families never face the disease without help. The case rests on rising need and on evidence that coordinated dementia care works. In a randomized trial, a centrally delivered care program improved quality of life for people with dementia, reduced their emergency department visits and lowered caregiver depression and burden (Possin et al., 2019). A comprehensive program led by nurse practitioner care managers meant fewer patients moved into nursing homes, and Medicare spending came out about even after the program's own costs were included (Jennings et al., 2019). Family caregivers carry most of the load: people with dementia make up about a tenth of older adults living in the community but receive about 41% of the hours of help that family and unpaid caregivers provide (Kasper et al., 2015).

The environmental assessment found no local organization offering coordinated care across the course of the disease, and the health system's shared record, home health agency and nurse advice line give it real advantages in filling that gap.

Service Model and Growth Plan

Registered nurse care managers, supported by bilingual care navigators, a social worker, a geriatrician and a nurse practitioner program director, will serve each enrolled family by phone, video and home visits, with a named care manager, a care plan, caregiver coaching, a 24-hour line and access to respite. Enrollment will start in the four practices with the most diagnosed patients and expand to all 42 practices by month 12, reaching about 400 families by the end of year one, 700 by the end of year two and 900 by the end of year three. A leased adult day site next to the busiest practice will open in year one with room for 14 participants a day.

Three-Year Financial Plan

The table summarizes the operating projection, with the adult day site shown separately because it is funded from capital.

Financial Commentary

The program loses money in year one while it hires ahead of enrollment, covers its direct costs in year two and produces a surplus in year three as fixed costs are spread over more families. After three years the cumulative position is still about $193,000 below zero, and on current projections the investment is recovered early in year four. The break-even analysis showed that the program needs about 503 average enrolled patients if shared savings arrive as expected and about 615 if they do not, so year-two results depend on those savings; by year three, enrollment is well above both thresholds.

The health system can afford this investment. It is a small fraction of annual operating revenue and well within cash reserves. The system's thin 1.0% operating margin, however, means the plan must show how the program adds new revenue and supports value-based contracts rather than drawing on reserves indefinitely.

Risks and Contingencies

Each major risk has a trigger that prompts a planned response. If average enrollment is more than 15% below budget for two consecutive quarters, the program will pause further care manager hiring and redirect existing staff to outreach, as it did after the first six months when a weekly schedule review and an electronic referral prompt were added. If the monthly navigation payment falls by more than 10%, the steering group will revise the staffing model and seek a larger share of savings in value-based contracts. If shared savings in the first settlement fall below half of the budgeted amount, the break-even target of 615 patients without savings becomes the working goal for year three. If care manager vacancies exceed one position for more than 60 days, the program will use a retention bonus rather than agency nurses, whose cost produced an unfavorable rate variance in the first half-year.

Measuring Performance

Performance will be reported quarterly on a scorecard with four perspectives, so that financial results are never reviewed apart from the results for families. The families perspective includes caregiver strain scores, emergency department visits per enrolled patient and the share of patients still living at home at 12 months. The care process perspective includes performance on national dementia care measures, with targets of 85% for advance care planning and safety counseling. The financial perspective includes enrollment against budget, revenue per patient, cost per patient and the net result. The workforce perspective includes care manager vacancy, turnover and caseload. Results will also be compared with peer programs through the regional dementia care network the program joined.

Governance and Decision Points

The chief nursing officer sponsors the program, and a steering group including two family caregivers reviews the scorecard each quarter. Two formal decisions are built into the plan. At month 12, leaders will decide whether to proceed with year-two hiring, based on enrollment, billing performance and early outcomes. At month 24, after the first shared-savings settlement, they will decide whether to expand the adult day capacity and whether to extend the program to the health system's rural clinics. Each decision will be made against the targets in this plan, which protects the program from being judged on impressions and protects the organization from continuing a service that is not working.

Conclusion

The integrated plan links the dementia care program's mission and evidence to a staged growth plan, a three-year financial projection, explicit risks with triggers, a balanced set of measures and scheduled decisions. It asks the health system for an investment it can afford, shows when that investment is expected to return, and gives leaders clear points at which to adjust course. Above all, it keeps in view the reason for the program: helping families live with dementia at home, with the support they need.

References

Jennings, L. A., Laffan, A. M., Schlissel, A. C., Colligan, E., Tan, Z., Wenger, N. S., & Reuben, D. B. (2019). Health care utilization and cost outcomes of a comprehensive dementia care program for Medicare beneficiaries. JAMA Internal Medicine, 179(2), 161-166. https://doi.org/10.1001/jamainternmed.2018.5579

Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642-1649. https://doi.org/10.1377/hlthaff.2015.0536

Possin, K. L., Merrilees, J. J., Dulaney, S., Bonasera, S. J., Chiong, W., Lee, K., Hooper, S. M., Allen, I. E., Braley, T., Bernstein, A., Rosa, T. D., Harrison, K., Begert-Hellings, H., Kornak, J., Kahn, J. G., Naasan, G., Lanata, S., Clark, A. M., Chodos, A., . . . Miller, B. L. (2019). Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: The Care Ecosystem randomized clinical trial. JAMA Internal Medicine, 179(12), 1658-1667. https://doi.org/10.1001/jamainternmed.2019.4101