Master's Thesis- Developed by team at University of - Diabetes
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- 1. Diabetes Center of ExcellenceMid Atlantic Medical CenterTeam 7: Scott BankardAnita CullerLisa Delphias Rodney Dismukes2009UNC Chapel Hill HPM Capstone Business Plan12/1/2009
Mid Atlantic Medical Center
Diabetes Center of Excellence
In the United States 23.6 million people have diabetes.It is estimated that in 2007 diabetes cost $290 billion in direct and indirect costs. Diabetes was the 7th leading cause of death in 2006 and a person with diabetes is twice as likely to die as a person of similar age without diabetes.The problem of diabetes in Eastern North Carolina (ENC) is even more significant.Diabetes is the 5th leading cause of death.The prevalence rate is approximately 10.5%, as compared to 8.7% for the remaining North Carolina counties and 7.8% for the United States.Within the 10 county primary service area of Mid Atlantic Medical Center (MAMC), this equates to 77,075 patients with diabetes. In 2007, diabetes mortality for the ENC 29 county population was 38.6% greater than the rest of the state and there were significant disparities between the age-adjusted mortality rates of non-white males and females (57% and 53.2%), compared to the white male and female rates of 27.2% and 21.2%.
MAMC must carefully balance mission and margin considerations when deciding the direction that will best serve the people of Eastern North Carolina.The scope of the diabetes epidemic is such that inaction could lead to significant financial difficulties.It is difficult to quantify the full scope of the anticipated demand that this epidemic will place on the MAMC.However, a proactive approach to treating complex diabetes on an outpatient basis will lessen the costs due to hospitalization for these patients and shorten lengths of stay for those individuals who are admitted.Given that the payer mix of the primary service area is not favorable for costly care, strategic action to reduce the cost of diabetes care is required.In addition, a Diabetes Center of Excellence strategically positions MAMC to take better advantage of likely shifts to pay for performance or pay for outcome reimbursement models being proposed under healthcare reform legislation.
Creating a Diabetes Center of Excellence will offer comprehensive care of complex cases of diabetes and preventive management for patients with diabetes and pre-diabetic conditions in eastern North Carolina.The Center will offer services in endocrinology, nursing case management and education, and nutrition counseling. A collaborative effort will be developed to improve diabetes patient management with multi-specialty care such as physical/occupational therapy, prosthetic/orthotics, mental health, vascular surgery, wound care, optometry, and nephrology.
Central to this business plan is a build vs. buy analysis.A possible affiliation with the renowned Joslin Diabetes Center in Boston, Massachusetts, an affiliate of Harvard Medical School, was examined from a financial and strategic perspective.On a franchise model, the Joslin Center offers an affiliation program, which provides technical assistance and consultation for planning and implementing a Diabetes Center of Excellence that includes the use of the Joslin brand in marketing campaigns and access to Joslin-developed intellectual property, such as procedural guides, staff training, and data management.Alternatively, building the center in house with MAMC resources and expertise was evaluated.
The Diabetes Center of Excellence will target the primary service area which includes the ten counties in closest proximity to MAMC (Beaufort, Craven, Edgecombe, Greene, Lenoir, Martin, Nash, Pitt, Wayne, and Wilson Counties). The 10 primary service area counties account for 31% of the diabetes mortalities in Eastern North Carolina.The Center will also target non-white males and females, those with lower incomes, and less education to address the disparities for the disease in this area.This program will focus on the adult population with plans for future expansion into the pediatric market as well.
The following are considered MAMCs major competitors for diabetes care:
- Minnie P. Stackhouse Diabetes Center, Lenoir Memorial Hospital in Kinston
- 2. Wayne Area Diabetes and Education Center,Wayne Memorial Hospital in Goldsboro
3. Wake Medical Center in eastern Wake County 4. Duke Medical CenterBarriers to Entry:
The primary barrier to entry is financing a new center. Another potential barrier is in hiring an endocrinologist since there are only approximately 3,000 nationwide.However, the medical school affiliated with MAMC has an Endocrinology fellowship program and could be a potential source of these specialized physicians.Other barriers include needing physician referrals for reimbursement for diabetes education.
Keys Success Factors:
- Brand establishment of Diabetes Center of Excellence and/or Joslin Diabetes Center
5. Program development meeting the National Standards for Diabetes Self-Managementeducation 6. Effective chronic disease management focusing on prevention, early and on-going screening, education, and collaborative coordination with multi-specialty care 7. Establishment of primary care referral base and affiliations with local providers and organizations 8. Clinic facilities that are convenient and accessible to the target market 9. Meet key performance indicators established based on national and state standards, such as increased screenings, decreased inpatient services, and decreased mortality ratesMarketing strategy Togetherwe can manage
Offered services will be developed in two phases. The initial phase is to establish the primary endocrinology specialty and patient education components of diabetes care, as well as establish collaboration between secondary support services such as lab services, pharmacy, prosthetics/orthotics, podiatry, and behavioral health. The long term goals will be to create a larger, all inclusive multi- specialty center that will allow patients to obtain all their medical care in one clinic and to pursue multi-site expansion by replicating the model throughout hospitals in the greater 29 county service area.
Pricing will be dictated by current reimbursement rates. Outpatient clinical visits will be routinely billed and reimbursed.Diabetes care supplies will be set at market standard prices for self pay or insurance reimbursement.Medications through the hospital pharmacy will be charged at reimbursable prices plus co-pays.
The location of the Diabetes Center of Excellence will be on the MAMC campus with its own entrance, proper signage, and logo display. This is critical because the majority of all medical services provided in Pitt County are adjacent to the medical center.Having the center on campus will facilitate referrals to the other medical services.
A multi-faceted strategy with an annual budget of $20,000 will be used to promote the Diabetes Center of Excellence. The goals of the promotional strategy that will be the measurements of success are:
- Establish name recognition
10. Increase market to new patients 11. Increase market to minority population 12. Increase number of new physician referrals 13. Increase community awareness and involvement with diabetesGeneral marketing efforts already available at MAMC, such as the website and media outlets will be used to introduce the Center and build the brand.A more targeted campaign, including diabetes education information, will be used to reach patients with diabetes and specifically those African American and Latino patients that are considered high risk and for which there are demonstrated disparities in health outcomes.Finally, since there are an estimated 25% of people that unknowingly have diabetes and of those North Carolinians that have diabetes only54% of have taken a diabetes education class, there will be strategies to market to the community at large, through sponsoring diabetes fundraising events, screening events, and workplace partnerships.
Location: MAMC Physicians Pavilion at 1234 Wellness Blvd, Suite 5, Greenville, NC
Lease: 5 year term
Hours:Monday through Friday 8:00 until 17:00 (medical care and education classes)
Tuesday and Thursday evenings from 18:00 until 20:00 (education classes)
Saturday from 10:00 until 14:00 (education classes)
Staff:Endocrinologist, 1 FTE years 1-2; 2 FTEs beginning year 3
Nurse Practitioner, 1 FTE
Administrator, .5 FTE
Registered Dietician, .5 FTE years 1-2; 1 FTE beginning year 3
RN Educator, .5 FTE years 1-2; 1 FTE beginning year 3
Medical Assistant, .5 FTE year 1-2; 2 FTE year 3; 2.5 FTE beginning year 4
Clerical, 2 FTE
Initially, the space will include 3,000 square feet with a waiting room; a 600 square foot classroom; space for the receptionists; 6 exam rooms; and an administrative area for the office manager and billing office.An additional 2,000 square feet will be needed to upfit in year 3 to accommodate a second Endocrinologist.There will also be a small, CLIA waived, in-house laboratory that will provide convenient testing of critical lab values such as HbA1C, blood glucose, lipid panels and urinalysis.
The Center will utilize the same Epic/Healthspan electronic medical record and patient scheduling system as MAMC.Also, the Center will not need its own accounting, inventory control, human resource management, time clocks, or email software for this same reason.Plans will need to be made for the successful integration of the MAMC systems into the operations of the Diabetes Center of Excellence.
The Diabetes Center of