@iiw@lk@lli DIVISION OF COMPREHENSIVE HEALTH PLANNING TECHNICAL ASSISTANCE STRATEGY AND PROGRAM Revised September, 1974 Department of Health, Education and Welfare Health Resources Administration Bureau of Health Resources Development Division of Comprehensive Health Planning Technical Assistance Branch TABLE OF CONTENTS Paqe Technical Assistance Strategy . . . . . . . . . . . . . . . . 1 I. Available Resources . . . . . . . . . . . . . . . . . . . . . 3 Technical Assistance Memoranda Series . . . . . . . . . . . 3 Other Available Resources . . . . . . . . . . . . . . . . . 11 II. Ongoing Activities . . . . . . . . . . . . . . . . . . . . . 15 A. Mechanism for Communication and Coordination . . . . . . 15 B. Health Planning Materials Under Development . . . . . . . 16 Resources to be Developed by November, 1974 . . . . . . 16 Resources Under Longer Term Development . . . . . . . . 22 Regional Office Technical Assistance Programs . . . . . 29 Regional Office I. . . . . . . . . . . . . . . . . . 29 Regional Office II . . . . . . . . . . . . . . . . . 29 Regional Office III . . . . . . . . . . . . . . . . . 32 Regional Office IV . . . . . . . . . . . . . . . . . 33 Regional Office V. . . . . . . . . . . . . . . . . . 34 Regional Office VI . . . . . . . . . . . . . . . . . 35 Regional Office VII . . . . . . . . . . . . . . . . . 35 Regional Office VIII . . . . . . . . . . . . . . . . 36 Regional Office IX . . . . . . . . . . . . . . . . . 37 Regional Office X. . . . . . . . . . . . . . . . . . 37 III. Projects Planned to Advance the State of the Art . . . . . . 39 DIVISION OF COMPREHENSIVE HEALTH PLANNING TECHNICAL ASSISTANCE STRATEGY The purpose of this paper is to describe the major elements of the Technical Assistance resources which are or will be available to state and areawide CHP agencies through the Division of Comprehensive Health Planning (DCHP). In addition to the activities of the Central Office of DCHP, the DHEW Regional Offices have received funds to support technical assistance. Major elements of the Central Office program and some of the Regional Office activities are reflected in this document. It should also be recognized that many technical assistance resources are being developed on the state and local levels either by CHP agencies or through CHP agreements with other organizations. We are currently attempting to develop mechanisms to exchange such information. For this effort to be successful , health planning agencies must provide DCHP with information on their accomplishments and copies of products that will be of use to others. Activities in DCHP's program were selected based upon results from the assessment program and a preliminary management study conducted by the Regional Offices in July, 1973. These indicated that priority areas for technical assistance are: plan development and implementation, project review (including Section 1122), agency management, community participation and education, and data management. These five areas are the major focus of the DCHP Technical Assistance Program. In the design of the Technical Assistance Program the following principles were considered: 1. The Technical Assistance Program should build upon current resources in the field. 2. Technical Assistance should be geared at capacity or capability building rather than the direct provision of manpower for specific tasks. 3. The Technical Assistance Program should attempt to build multiple centers of expertise to guarantee the capacity for long range provision of technical assistance. 4. Technical assistance should be provided in ways which have high cost/effectiveness ratios. 2 The Technical Assistance Program, based upon these principles and priorities, .encompasses a variety of forms: generic written material, training through workshops and seminars, and in a few cases one-on-one technical assistance Resources in this paper are divided into three sections: I. Available Resources II. Ongoing Activities III. Projects Planned to Advance the State of the Art As more information concerning these resources is developed it will be disseminated. 3 T. AVAILABLE RESOURCES Technical Assistance Memoranda Series This direct communication between DCHP and the (a) and (b) agencies and (c) programs disseminates information and methodologies of potential interest and use to agencies. The following items* have already been distributed. The series will continue and is expected to expand with the further development of health planning,materials. TA Memo #1 - Manual for Rev-iew iiid Comment Region II Task Force on Review and Comment This manual is a guide to CHP agencies involved in review and comment of new or expanded health faciliti'es or services. It describes a review process, discusses the involvement of various agencies in that process, and lists the Federal programs which require review. TA Memo #2 - Summary of Facility Planning Methodology at Local Agency Level Division of Comprehensive Health Planning, Health Resources Administration This summary describes a framework for facility planning focusing on health services. Suggestions on sources of data and a description of a general methodology for information analysis are included. The summary considers manpower needs and suggests references and items for consideration in financial review. TA Memo #3 - Hospital Audit Guide American Institute of Certified Public Accountants, Committee on Health Care Institutions The guide defines some basic accounting terms and discusses various procedures used in auditing hospital financial statements. It presents several accounting procedures and provides examples of common financial statements. A brief discussion of depreciation is included. Request from: American Institute of Certified Public Accountants, Inc. 606 Fifth Avenue New York, New York 10019 *DCHP's supplies of some of these documents are exhausted. Where this is the case, the source of the item is listed and additional copies should be requested from them. 4 TA Memo #4 - Debt Financing Alternatives for Hospital Construction Hospital Survey Committee The report analyzes the impact of debt financing on hospital construction. It documents the increased use of debt financing, makes cost comparisons of major types of financing, and reviews alternatives to current financing methods. Request from: Hospital Survey Committee Seven Benjamin Franklin Parkway Philadelphiai Pennsylvania 19103 TA Memo #5 - The Practice of Planning in Health Care Institutions American Hospital Association This document provides an overview of the planning process in health care institutions--who should be involved and how. It describes a minimal set of institutional service statistics and recommends that an institution needs demographic, health status, and health service resource data about the community in order to plan effectively. Copies are available for $4.50 from: American Hospital Association 840 North Lake Shore Drive Chicago, Illinois 60611 TA Memo #6 - Optimal Criteria for End-Stage Kidney Disease Care American Medical Association, Kidney Advisory Committee. Published in the Journal of the American Medical Association, October 1, 1973, Volume 22b. The report describes the optimal criteria for the classification of hospitals according to their capability of providing specified level of stratified care. It presents some general guidelines formulated by the Committee, and definitions and optimal criteria for four classes of facilities: 1) chronic dialysis units, 2) satellite dialysis units, 3) dialysis centers, and 4) kidney transplant and dialysis centers. The criteria are grouped into specific categories and designated as musts or shoulds, as appropriate. Request from: Joint Commission on Accreditation of Hospitals 875 North Michigan Avenue Chicago, Illinois 60611 5 TA Memo #7 - A Bylaws Model for Areawide Comprehensive Health Planning Councils Robert C. Bills, for Region IX, CHP The document presents sections for an agency's bylaws with a discussion of the purpose of each section and possible alternatives to the model where standardization is not feasible. Sections cover corporate purposes. Agency membership, the Board of Directors, officers, committees, elections, conflicts of interest, general provisions and amendments. It was written by a California attorney familiar with the Non-Profit Corporation Law of his own state and may need some modification for use outside of California. TA Memo #8 - The Effective Use of Consultant Services in Comprehensive Health Planning Donald B. Ardell and Maryann Holohean, Published in Health Services Report, Dece4nber 1973 The article guides a CHP agency in the selection and management of consultant services. It specifies several potential sources of outside expertise and outlines the key steps to a productive consultant experience. TA Memo #9 - Survey of Hospital Charges as of January , 1973 American Hospital Association The publication contains the results of the 1973 American Hospital Association survey of fees patients are charged for basic, routine services provided by hospitals. Sections describe the charge characteristics for non-governmental hospitals and non-federal governmental hospitals. Charqes for some special service beds and basic ancillary services are specified in addition to daily service charges. Copies are available for $5.50 from: American Hospital Association 840 North Lake Shore Drive Chicago, Illinois 60611 TA Memo #10 - Optimal Criteria for Care of Patients with Stroke, Heart Disease and Cancer Joint Commission on Accreditation of Hospitals. All were published in the Journal of the American-Medical Association as follows- Patients with Stroke - October 8, 1973, Vol 226 Heart Disease Patients - December 10, 1973, Vol 226 Patients with Cancer - January 7, 1974, Vol 227 1 6 These reports recommend criteria for optimal care of patients with selected diseases. These criteria were developed for the purpose of identification of hospitals capable of providing the most advanced techniques and methods for the diagnosis and treatment of these diseases. This information should be used in conjunction with the aqency's established criteria for reviewing applications. Request from: Joint Commission on Accreditation of Hospitals 875 North Michigan Avenue Chicago, Illinois 60611 TA Memo #11 - Health Planning and the Environment - A Preventive Focus American Society of Planning Officials (Project Director, Michael Meshenberg) The document defines the conceptual framework of environmental health planning (EHP) and the relationship of EHP to agency functions. Perspectives of prevention and of focusing upon the health-related effects of the environment are presented. Specific parts discuss the conceptual framework, the areawide health plan, project review in EHP, planning coordination EH data for CHP agencies, and internal organization and management for EHP. A bibliography is appended to the document. TA Memo #12 - The Size and Shape of the Medical Care Dollar Social Security Administration, Office of Research and Statistics, DHEW Publication No. (SSA) 73-11910 This booklet provides an overview of the medical care expenditures in 1972 and the growth in some aspects of health costs since 1950. Some charts focus on the effect of the Economic Stabilization Program in reducing the rate of increase in these costs. Other charts specify figures on the amount and characteristics of several federally-funded health programs. Copies are available for $.35 from: Superintendent of Documents United States Government Printing Office Washington, D.C. 20402 (Control #1770-00222) 7 TA Memo #13 - Division of Comprehensive Health Planning_ Technical Assistance Strategy and rogram This paper lists the major TA resources that are or will be available to CHP agencies through DCHP and describes the basis for the design of the TA program. The report is divided into three main sections: Available Resources, Ongoing Activities, and Resources to be Developed During FY 1975. Each entry specifies the title and description of the resource. Request additional copies from: Technical Assistance Branch Division of Comprehensive Health Planning 5600 Fishers Lane, Room 11-11 Rockville, Maryland 20852 TA Memo #14 - Workbook for Short-Term Planning Robert W. Birchfield and Henry F. Keaton Chicago Hospital Council This workbook was developed to assist hospitals in a) assembling and forecasting activity data upon which plans are based; b) evaluating the feasibility of such plans and budgets; and c) documenting the institution's planning process in the form of a written plan. Completion of the workbook is designed to help hospitals in meeting some of their responsibilities under Section 234 of PL 92-603. The process in the workbook contains thirteen steps with instructions and a worksheet for each step. Copies are available for $6.75 from: Chicago Hospital Council 840 North Lake Shore Drive Chicago, Illinois 60611 TA Memo #15 - Reference Manual for Project Review Standards and Criteria Tulane University, School of Public Health and Tropical Medicine (Project Director, Vernon Seifert) in conjunction with Region VI The manual is designed as a basic reference guide to be used with the Review and Comment Manual developed in Region II. This document specifies a model set of standards and criteria which can serve as a basis for Project Review. A suggested procedure for project review delineates activities of the staff, review committee and agency in using the manual. It also includes a set of recommendations on how to incorporate the appropriate standards into a health plan. Copies are available for $2.50 from: Tulane University School of Public Wealth & Tropical Medicine 1430 Tulane Avenue New Orleans, Louisiana 70112 8 TA Memo #16 - Computerized Axial Tomo_qraphy Scanners DCHP Staff The memo provi des some information on computerized axial tomography (CAT) scanners. Some characteristics of the EMI Scanner and the Automated Computerized Transverse Axial Scanner (ACTA) are described. Some areas which a CHP agency needs to consider in dealing with requests for acquisition of CAT scanners are also discussed. TA Memo #17 - Community Health Profiles: Pertinent Concepts, Content and u@tput Formats of Community Health Profiles Community Profile Center Community Health Services, Health Services Administration The document describes community health profiles in terms of the capabilities, data content and applications in health planning. It is divided into four main sections: 1) pertinent definitions and an overview of the issues surrounding the use of the profiles; 2) an identification of primary and secondary data sets, possible sources and reasons for collection; 3) the analysis, interpretation and presentation of data derived from community profiles; and 4) a short discussion of the general utility of these profiles in health planning. TA Memo #18 - Reading Materials on HMOs Two documents were included with this memorandum: "HMOs and the Law" .by Steven Epstein and "HMO Feasibility Study Guide." The article by Epstein discusses the different types of state statutes which can affect the development of HMOs and illustrates the several basic types of organizational structures and how they relate to these statutes. The "HMO Feasibility Study Guide" also discusses legal barriers and organizational structures. In addition, it discusses the feasibility of developing an HMO in terms of marketing, provider relationships, and financing. The guide stipulates techniques and requirements for conducting a feasibility study and discusses the data needed to determine whether or not an HMO should be developed in a community. TA Memo #19 - The Cooperative Health Statistics System This memorandum contained information on the Cooperative Health Statistics System (CHSS) of the National Center for Health Statistics .(NCHS). The CHSS represents an effort to organize a coalition of Federal, State and local parties to establish uniformity and comparability in the collection and processing of health statistics. The system provides for collecting data one time only from each source but for using that data for multiple purposes and sharing it with other levels of government. A Data Use and Analysis Laboratory has been established within the Cooperative System to provide assistance in investigating problems related to the effective application of health statistics in health and program planning and evaluation. 9 Four documents were sent with this memorandum: 1) a general article entitled "The Cooperative Health Statistics System" by Edward B. Perrin, Ph.D., Director of NCHS; 2) a paper containing a brief description of the seven components of the CHSS and two issues of the newsletter titled "News of the Cooperative Health Statistics System." TA Memo #20 Information Concerning Small-Area Data Notes and Data Access This memorandum described two publications of the Census Bureau: The Small-Area Data Notes (SAD) and the Data Access Descriptions. SAD Notes contains up-to-date information concernii ions, computer tapes, and services which are available or being planned for various geographic areas as well as information regarding other activities of the Census Bureau. A section of each SAD Notes issue is devoted to presentations of applications for census data whic readers have found in their area. The Duata AAccess Desc ription is sent to the subscribers of SAD Notes as it is iss ued. The 4-6 issues of this publication released eac year provide very detailed information on Census Bureau products, activities and services, with each issue addressing a different topic in depth. TA Memo #21 - A Guide to Comprehensive Health Planning Arthur Young and Company This guide discusses the role of the agency and the council in relation to the Areawide Health Planning Agency Performance Standards. It provides a description of-agency responsibilities focusing on plan development and implementation. The guide is designed for use in orienting new staff and council members to the agency's role and function. While primarily oriented to areawide agencies, State agencies can also find it useful. TA Memo #22 - Compilation of Plans, Standards and Criteria DCHP with input from 314(a) and 314(b) agencies and 314(c) grantees This document is an update of the compilation published in February, 1974. It contains both the original material (Which CHP agencies sent to DCHP in response to a request for plans, standards and criteria) and publications that DCHP has received since February. The material is arranged by types of services with each entry specifying the source of the document and a brief summary of the contents.' 1 0 TA Memo #23 - Comprehensive Health Planning: Analytic Concepts Blue Cross Association This handbook was designed to aid participation of Blue Cross Plan board and staff members in their communities' health planning process and is of value.to a variety of planning participants. Tt is divided into five chapters: 1) Structure of'Planning Decisions and Plan Development; 2) Measurinn Community Health Problems; 3) Forecasting: General Concepts and Patient Predictions; 4) Judging Facility Requirements from Patient Predictions; and 5) Plan and Project Review. The uses and limitations of particular planning methodologies and the implicit values and assumptions involved in certain types of judgement are discussed throughout the handbook. TA Memo #24 - Manpower Realities and Health Care Costs American Association for Comprehensive Health Planning This article provides an agency-oriented, step-by-step program to incorporate manpower review into the review agency's functions by requiring of the applicant not only a.response to the "adequate staff" or manpower availability question, but also a response to cost containment through manpower consider- Ations. The review agency can then implement a manpower plan when it ties " . . . the production of health personnel, first to the needs of the individual projects, then to the overall needs (at least short-tem) of the health system within the area." Other Available Resources Some document5 have been developed which might be useful to health planning agencies but are not a part of the TA Memorandum Series. The following is a partial list of such documents. 1. Health Services and Facilities Financial Feasibility Review Packet The packet contains three papers: 1) Capital Expenditure Review: A Financial Feasibility Manual; 2) How to Effectively Use the Financial Feasibility Review Manual; and 3) How Financial Feasibility Fits into the Planning Process. The first paper is the basic manual and discusses the review processes for utilization information, financial information, change rate, and reimbursement. All of these are considered from the perspective of what important questions and pol,icy issues the review should address. For further information contact Allan Blackman, University of Washington, Department of Health Services, Seattle, Washington 98195. 2. Heilth Facilities Planninq Guide for-Reviewinq Financial Feasibility of Proposed C enditur@Pr ject@ University of Delaware, College of Business and Economics The (-@ijide is divided into the following sections: 1) the basic issues and @rot)l-f@is involved in a review of financial feasibility; 2) the ge.,i(,t-(Il e"ei-i(l,f.s o@ long-term financial planning for capital improvement pro,jects; 3) of capital . types of debt, debt provisions' and ni,-thods for debt capacity; and 4) the general fra.,:ip-@@iork for conducting a @--,isit)ility reviek-j, including the use of various types of tc,c A selected bibliography and glossary of terms are appended to the document. G idot)ook fo@Fa l@ltty@e l@L- 3. -. -U w George Washington University, Department of Health Car(, Administratioti The guidebook discusses several aspects of a CVIP agency's review and coii@irLnt activities. The three main areas are: 1) recordkeepinq including suggested forms and agency procedures; 2) assessing the cost to the agency of conducting review activities which includes a means by which cost may be calculated by the aqency and a matrix to show the cost of projects in certain categories,. and 3) legal aspects dsicussed with the context of general principles of administrative law. 1 2 4. Compre-hensive Health Planning Series: Professional Standards Review Organizations Institute for Urban Studies and Department of Political Science University of Houston, under a subcontract from the University of Texas, School of Public Health at Houston This report examines PSRO's as a federal regulatory program for health care cost containment and quality assurance. The background arid legisla- tion of PSRO's is described as well as the charact(@i-istics and functions of most PSRO'S. There is a chapter detailing sevei-,al political issues, including the designation of areas. Mother chapter describes PSRO's and Public Health as well as PSRO implications for C14P. 5. Model Fund kcou inD S --n t Is@eiii for Preawide CHP s Health Planning Council of the Midlands, aiaha, Nebraska through a DIIEW, Region Vil Purchase order The model fund accounting slvstc-in has instructions designed to aid a CJIP agency in estal)'Iisnitig a sy,,terTi of financial reporting. It describes basic concepts in fund accounting and the books of record and chart of accounts considered necessary for a CIIP agency. It presents a traditional financial accounting system which provides for functional breakdown of expenditures and has a sound cost allocation method. The use of the system does require the services of a bookkeeper. It can then be maintained manually or can be automated. 6. Model Agreement or a State-Assisted Areawide Planninq Aaency University of Colorado Medical Center, School of Medicine (Project Director, Leland Kaiser) This paper was developed for the Colorado State Department of Health and is a useful reference document for any State considering using this mechanism to acomplish Comprehensive Health Planning. It specifies model provisions of such an agreement with a discussion of the rationale for each provision. Accountability for the expenditure of funds and the delegation of specific functions are included. 7. Organizational and Administrative Techniques University of Washington, Department of Health Services (Project Director, Allan Blackman) The document provides CIIP staff with an annotated list of readily available materials for training Board members- Topics listed include community organization for change and action, board and committee skills, group dis- cussion and dynamics, public relations, and fund raising. The bibliography is divided into three sections: a recommended bibliography, a supplementary bibliography and a listing of the addresses of publishing companies. 1 3 A Model Cost-Benefit Analy is Schem@ University of Delaware, College of Business and Economics (Principal Investigators, Robert L. Paretta and Donald J. Puglisi) The study developed a framework to improve allocation decision by providing a better understanding of the costs (%,that is given up) and effects (what is accomplished) of various courses of action. The model cost-benefit analysis scheme provides a cognitive Piap--a frame of reference for considering alterriatives--consisting of a series of payoff matrices reflecting the merits of an individual proposal on the total health care system. The model includes monetary and non-monetary-values and afdes selection between independent projects as well as mutually exclusive projects. 9. Statistics for Comprehensive Health Planning Public Health Service, DHEW (IISM 73-1217) (Editors, Jerome Lubin, Junior Knee, Royal Crystal, Valeda Slade) The document contains chapters on the role of statistics in CHP and the integration of data in information systems for planning. Subsequent chapters present some uses and sources of data concerning health status, demographic and socioeconomic profiles, health manpower, health facilities, health services and environmental health. CHP agencies were sent copies of this early last year. Request additional copies from: Office of Information National Center for Health Statistics Room 8-20 5600 Fishers Lane Rockville, Mai--yland 20852 10. Area Resources File Health Manpower Planning Branch, DCHP This file has base data aggregated at the county level. Included are demographic, health facility and manpower data. Explorations are underway to add financial data. The file provides the capability to print out selected data for each county and to aggregate it for a health planning agency's area. This enables comparison between area of a range of planning statistics. Plans are underway to produce a set of data for each health planning agency. This will be described in a future Technical Assistancd Mewrandum. 1 4 11. The Consumer Support Group: M Ex erimental Innovati.on in Comunity Planninq Ananda A. Beck and Peter C. Bishop This research report describes and evaluates the Consumer Support Group concept which was one 314(b) agency's way of increasing the active partici- pation of some consumer members of their Council. The design of the prograi;l was to promote formation of a group of interested consumer members which could attack problen@s of consumer participation. The group would start with staff support then gradually become an autonomous force. This report concludes with some observations and general recommendations for increasing consumer participation. For further information contact Dr. Peter Bishop, Georgia Southern College, School of.Arts and Sciences, Statesboro, Georgia 30453. 1 5 ONGOING ACTIVITI@ES A. Mechanisms for Communication and Coordination 1. DCHP Central Office and the Regional Offices currently support many activities which should provide technical assistance when completed. Coordination in this effort is required to avoid unnecessary duplication and to build nationally on successful regional technical assistance programs. However, some duplication of effort is desirable since for most health planning functions more than one approach is possible. However, close coordination will be maintained to insure that resources developed in one office are available for use in similar activities of the other offices. One vehicle to accomplish this is the Technical Assistance Sourcebook. This Sourcebook describes all the central and regional technical assistance activities. It has been issued in November and December, 1973, and July 1974 and will be updated periodically. Activities listed in the TA Sourcebook which are available to all agencies are included in this paper. As additional generic materials are developed in the field (local and state level as well as Regional and Central) they will be added to the Technical Assistance Sourcebook. Copies of generic materials produced by areawide and state agencies can be sent to the Technical Assistance Branch, DCHP. Questions about the Sourcebook can be directed to the Regional Offices. 2. Good communication is essential both between and within the federal government and the health planning field. A number of Federal programs carry out and support activities which can influence CHP. These include the Census Bureau, National Center for Health Statistics, Bureau of Health Services Research, Bureau of Health Resource Development, and the Bureau of Quality Assurance. DCHP is in the process of determining which of the activities of these other organizations can be of benefit to the health planning field and are working to coordinate activities more closely with health planning needs. 3. The Technical Assistance Memorandum series will continue with its frequency dependent upon the development of useful health planning materials. 1 6 B. Health Planning Materials Under Development Resources under developrnpnt fall into three broad categories: 1) Resources to be developed by November, 1974; 2) Resources under longer term development-, and 3) Regional Office technical assistance programs. In the development of these tools, some,CHP agencies have been or will be contacted to provide their experiences and to review or field test the documents. This is an important part of tailoring the documents to actual agency needs. The materials listed below are classified by health planning agency functions for quick reference. This work program will be modified by passage of any new legislation that affects health planning agencies and by the analysis of all the agency assessment reports. To date as much flexibility as possible has been built into planned efforts to ensure that when the products are available they will be responsive to future legislative directions. Resources to be Develo Noovveemmbbeerr,, 1974 As these resources are completed and if their quality warrants it, they will be distributed at Technical Assistance Memoranda. HEALTH PLAN DEVELOPMENT AND I ION 1. Plan Development Resources Document Aiierican Association of Comprehensive Health Planning Under contract with Government Studies and Systems This is designed as a practical reference guide for the establishment and implementation of the Plan Development process. This was developed as a conipanion document to the Project Review Resource Document (itei-ii 8 in Project Review section). It can be used as a guide for staff and working committees. The manual addresses not only the methodology for plan developm,2nt but also -the form and foriiiat such a plan might take. 2, Need AssessiTient Mintial for Areawide Health Llann encie@ Govr:i,riiiient Studies and Systems '!he dOCL,'Ill('Ilt is a giiide to CliP agencies in acquiring and analyzing data on need. The project calls for the design of a need assessment incthodo- logy applicable to areaviide C[iP functions, its description in clear operational terms in a procedure manual, the field trial of the ni,,itILId I in two operating settings as the basis for any necessary revision, arid the preparation of accompanying documents presenting concepts and i;,,ethods-for its functional integration into the processes of Health Plan Development and Project Review. While primarily oriented to area- wide agencies, state agencies can also find it useful. 1 7 3. @lanning for Plan Document Development Aiierican Public Health Association ,rt,is is a guide for designing processes and organizational structures for- health plan development. The purpose of the Guide is to assist (@)iiip@-eliensive Health Planning agencies primarily to prepare a strategy of, and, to a lesser extent carry out, a sequence of activities which will produce a comprehensive health plan document. It is anticipated that the readers of the Guide will include agency Board Committee members and staff. 4. Determining Health Ne6ds by -Zoning Analysis Arthur Young & Company This technical paper presents the design, development and application of health service zones in determining areawide health needs. The concept of zonal analysis and its potential use in developing a health plan are discussed. 5. Educational Package for Plan Development American Association of Comprehensive Health Planning Under contract with Government Studies and Systems This package is designed for use in training staff and council members in Plan Development. It will build on the DCHP Agency Assessment simulation package and two resource documents being developed by AACHP. A pilot institute using the package will be held for Regions I and II beginning in April. -Separate curricula are plannpd for Staff and Council. STUDIES I. Guide to an Agency Policy on Studies Linton, Rields & Coston, Inc. This document will guide an agency in deciding which studies to perform and what level of agency resources to commtt to the study. A general process for the conduct of studies will also be described. 18 PROJECT REVIEW 1. Eroi c@t Review Resource Document American Association of Comprehensive Health Planninq under contract with the Health Resources Development Institute, Inc. in cooperation with the Kentucky State Comprehensive Health Planning A(leficy Practical reference guide for the establishment and iMDlementation of the Capital Expenditure Review Process. This is designed to he a companion I y document of the Plan Development Resource Docuin!-nt being prepared b AACHP. It -is desioned as 0 guide for staff and working council in conducting 1122 review. 2. Guide to Revi.ewing the Financial Feasibility of Proposed Capi'tal Expenditure Projects Arthur Young & 'Company The guide provides basic instructional background to staff members on the nature of capital financing and the factors that should be considered both in performing and analyzing a financial feasibility study. It will help the agency to review the validity of studies submitted to them as a part of the capital expenditure review. It can also be used to review an agency's own guidelines for determining the financial feasibility of a project. AGENCY MANAGEMENT 1. Work-Program Developi@nt Guide Arthur Young and Company The guide describes a process for the development of a '-)014(b) agency's work program. It is based upon the eight agency functions and indicates how the work program should be developed as a management tool. It de- lineatus what a work program should contain; how it should be prepared; and what use can be made of it. Program budgeting is also explained. 2. The Policy Development Process Linton, Mields & Coston, Inc. This guide contains a suggested procedure for the development of administrative policies for CHP agencies. They include policies for the elements in the performance standards and designate which person is responsible for administering the various segments of the policies. The set of policies is simply coded with emphasis upon the format being flexible and easily amendable. 1 9 3. Agency Management Accounting System Arthur Young and Company The manual describes an accounting system which will provide management with financial data in a form useful for decision making. It is capable of meeting the reporting requirements of DHEW and is simple in bookkeeping techniques. The system has sound rules for allocating costs and accounts for agency activities by function. The emphasis is upon generating reports which will provide useful management data. The manual for this system traces the recording ofItransactions and the presentation of reports through the complete accounting cycle. COMMUNITY PARTICIPATION AND EDUCATION 1. Guide for a Public Information Program Linton, Rields & Coston, Inc. This is a guide to CHP agencies in establishing and maintaining relations with the communications media. It discusses varying levels of agency activity in both internal and external communications. Identification of newsworthy materials, presentation and timing of releases and liaison with press renresehtatives are discussed. Emphasis 'ring the information to the audience is placed upon tailo for which it is intended. 2. PL!blic kcountability Package Arthur-Younq & Company This package is to guide a CHP agency in achieving proper geographic and socioeconomic representation on its Board or Council. It discusses tile development of a community profile to determine what representation is desired and then discusses how to match existing agency membership against the desired profile. 3. Guide for Conducting Public Hearings Technical Assistance and Continuing Education Program School of Public Health, University of Texas at Houston This document will provide guidance on conducting public hearings. It is divided into two parts: why public hearings are important to an agency's Program and how to conduct them. For further information contact Post Office Box 20186, Astrodome Station, Houston, Texas 77025. 20 PLANNING COORDINATION Modc@.Is in Interagency Relationships Linton, Mields & Costori, Inc. This document presents some models on how to relate with agencies of other Federally-furided programs. The activities of each program as well as their possible relationship to CHP activities are some of the factors considered. The guide will include such programs as ARC, RMP, OEO and Model Cities. DATA MANAGEMENT 1. Data File Maintenance Linton, Mields and Coston, Inc. The report present@ a system for the basic organization of CHP data files. It describes a centralized data bank for medium-sized to smaller agencies with the focus upon simple storage and useful retrieval. It includes an index of categories under which to organize and maintain the files. MISCELLANEOUS I. Provision of Training to Health Planning Participants Regions I, II, III Boston University Regions IV, VI University of Texas Regions V, VII University of Michigan Regions VII, IX, X American Public Health Association Branch Available October', 1974 - June, 1975 Each contract will provide eleven training seminars to the staff and Council of health planning agencies within the Regions covered by the contract. In general the content areas of the seminars will be based upon the functions in the performance standards for health planning aaencies. The specific content will be chosen in accordance with input from all CHP aqencies and after considering the other training and technical assistance activities in the Regions. While being managed centrally, each contract will also have an Advisory Committee of local, state and regional health planning representatives. 21 2. Development of a Simulated Health Planning Agency Training Package Don Davis Associates, Inc. This contract will modify the existing 314(b) agency simulation package into a training tool by updating the package and by developing.problem sets for each function based upon the package. An Instructor's Manual will be developed to provide the information necessary to use the simulation package to its fullest potential. The contractor will also conduct a training seminar to train up to 30 individuals in the use of the simulation training materials. 22 Resources Under Longer Term Development illost of these resources are not expected to be completed until the summer of 1975. A few will be later than this as they are two-year efforts. HEALTH PLAN DEVELOPMENT AND IMPLEMENTATION 1. @ 10 ment of a M(idel Health Plan Government Studies and Systems, Inc. The document will define the uses and format of a Comprehensive Health Plan. It will answer the questions of what the plan should contain and what it might look like. This effort will analyze the.decisions which planning councils must make using a health plan, it will analyze plan documents that have been produced and it will develop a model or models outlining plan format and content. 2. Development of approaches tQ Determining and Ptojecting the Need and be-ni@ri@-f-o-r- Iie a I t. ervi @s Arthur Younq and Company The purpose of this contract is to ascertain and evaluate planning approache which determine and project the need and demand for specific health services. In addition, the contractor will develop a model approach to planning for each of the specific health services based on the evaluation of the original approaches assessed. Suggested health services for development of planning approaches include, but are, not limited to, acute ambulatory services, acute hospital inpat-ic@nt services, emergency medical services, home health care services and long-term care services. 3. Guide for Evaluating Quantitative Approaches to Health Planning University of Michigan School of Public Health The grantee will develop a practical guide directed to health planners to increase their understanding of what operations research, and related models can and cannot do. The guide is intended to aid the health planner in resolving conflicting objectives inherent in health facilities and services planning problems. The guide will contain a literature review, an analysis of constraints impeding implementation, and an integration of useful modeling approaches within comprehensive planning. 23 Evaluation of Health System Modeling Efforts Useful in Comprehensive Healt@i annipa George Washington University This project will (1) identify currently available health system models whic!i can effectively be used by planning agencies, (2) develop a set of criteria for evaluating the technical adequacy of current and future health system models, (3) develop a set of criteria for assessing the utility (in an (il)l)lied sfiise) of ciAr,t-(,iit and future health systeiIii models, ind (4) survey t@i(@ state of the art of@ticalth systeiii iiiodelit,.o and iiiake re(:oiiinic@I)dat-iolis for actions to increase this toclinique's usefulness in health plaiiiiiii( agencies. 5. Planner's Manual on Developing Rural Primary Care Program Cornell University This project will develop a manual that will evaluate the elements that O(,) into success or failure of rural primary care programs; to assess the potential of health planning agencies to develop rural primary care centers as well as plan for them, to study the impact on the centers of alternative strategies that have been applied in the communities and to demonstrate t@,,c. potential of a Liniversity serving as a technical assistance center to coiti-- munity groups and health planning agencies in the development of rural primary care centers. 6. A Study of Implementation Strategies in Comprehensive Health Planninq Boston Colleqe The proposed study is to examine and analyze the experience of a selected number of health planning agencies in the United States with respect to implementation ofltheir plans. Approximately 40 case studies of attempts to implement plans, results of these attempts, nature of plan and environ- nient infILIC@IlCing each case will be presented. A statistical analysis re- lating these case studies to a general theory of decision making and community process under development by two of the principal investigators will be presented. A Policy Guide to strategies in comprehensive health plan implementation found to be most successful will be developed. 7. Inipleme ntation Strategies in Comprehensive Health Planning George Washinqton University, Department of Health Care Administration George Washington University will develop a monograph for health planners which will be useful in designing and evaluating implementation strategies, and an annotated bibliography. The monograph and bibliography will be based on an extensive inter-disciplinary review of the implementation process, structured around a "working" model of the CHP implementation process. 24 8. Strategies for the Inip (@ entation of keawide Health Plans ,_L University of Southern California An intensive study will be made of all health plans submitted by 314(b) agencies in California. From these, two will be selected (one rural and one urban) for development of strategies for plan implementation. An hivisory Coiiei)ittce will develop criteria for selection of plans; provide input in (](!vLIol)i;iLni, of implementation strategies and provide feed-back during the course of the Project. A monograph based on these experiences will be developed. 9- R(2V'it@'v,' Of f,',Ct,iololoqical l;)Pt,oaches i-ised to Determine Health Manpower -Suppl@d i This project is to develop a monograph to serve as an interpretive aid to health I)Iatine)-s r(,gai@din,,l the wide range of methodologies used in assessing lie,iltl,, iiiaiil)oiie), supply 'arid requirements (arid as a guide on "hovi-to-do-it" at tti,,, practical Pldtining level The "IO@)Ogt-aPli will critically i-evici-i the vc"-j()us exl)l@.iin the (idv(inta(("s (111(i disldvaritiqe,- Of a given ,I rL@vi(@w in a practical way alternative methods, to achieve (1p,)roiich, dn, (1@,,,ired ot)j(2cLiv(,s. 10- Organizational and Political Dynamics of Health Manpower Planning American Association .for Comprehensive Health Planninq Thc- monograph is to provide health planners with a guide in ways to plan for and use Organizational and jurisdictional relationships to their ad- vantage i-n developing arid iiiiplementating effective health manpower plans. It will stress ways to identify in advance where patterns of organizational d 4 con,iiiioiialiti(,s and differences may exist and how to plan accor lngly, and stress methods to bring about improved communications bet,,,/eeti organizations and jurisdictions in the resolution of issues and attainment of complete objectives. 11. 5_trur-tural and Ftinctir)nii L;arriers to Health Manpower Plinriitiq The Levine Group Incorporated This project will develop a monograph to clearly define planning barrier(s), background description of each type of barrier, and the impact of a barrier on a given planning activity. Alternatives to certain barriers will be considered with consideration of the following basic factors: economics; timeliness in reference to current demand; existing "state-of-the-art;" legislative constraints; consumer apathy. A set of rec onimendations will be developed to serve as a guide to planners in their day-to-day planning activities. 25 PROJECT REVIEW 1. Deve ment of Criteria and Standards for Health Services University of Washington This contract is to develop,suggested criteria and standards which can be applied to various health services or potential health services to promote efficient use of scarce resources in the project review function. These standards for planning and project review, as opposed to standards for licensure and accreditation, relate primarily to economic feasibility, cost containment, operational capability, accessibility and availability of services. Suggested health service areas for development of criteria and standards include health maintenance organizations, radiation therapy services, renal disease services, ambulatory surgical centers, and long- term care services. 2. 1 Aspects of Comprehensive Health Planning Joint Project by Boston University and Tulane University This project will develop two manuals on the legal aspects of comprehensive health planning. The first manual will be directed toward agency staff and Council and will describe actions an agency needs to take to be legally operating. The second manual will be for lawyers who might be representing a CHP agency. It will contain a discussion of the laws governing CHP agencies as well as existing court cases which have involved health planning agencies. AGENCY MANAGEMENT 1. Dimensions of Technical Assistance to Support Health Manpower Planning American Techn,ical Assistance Corporation This project is to develop a monograph which may serve as a day-to-day aid to health planners in identifying expertise which is required in their plannina resonsibilities but which is not readily available in their research plan- ning organization. First, the document will assist the planner in defining the technical problem area(s) and indicate the types of assistance required to approach a specific problem or issue. Second, the monograph will review alternative approaches to identifying and procuring the technical know-how for a planning activity and/or support a critical decision. The information will apply to any type of technical assistance as well as that to support health.manpower planning. 26 COI,ltl[JtIITY PARTICIPATIOti A[!D EDUCATION Evaluation and Develooment of Orientation Materials fbr Health PI (0-Lin-ci-f embers University of Virginia This contract is to develop materials that will orient health planning Council members to their responsibilities within their agency. The development of orientation materials will build upon existing orientation/training activities which will be evaluated in the first phase of the contract. Products under this contract include an orientation manual and seminar as well as a manual providing guidance to agency staff on how best to use the manual and seminar. These materials wil,l take into account tile current health planning legislation. DATA MANAGEMENT Data Handbook for Health Planners Bureau of The Census, Census Use Study This handbook will serve as a guide to local health planners in the use of census and local data. The handbook will serve both an inventory reference purpose and a "how-to" purpose. 'The reference aspect will encompass a thorough inventory of data sources, identifying executive data systems and content; a description of how to find and gain @ccess; and a descriptive analysis of what these data systems cin fulfill. The handbook will show in detail how local and Census data can be utilized in planning, programming and evaluation functions. 2. Critical-Issues Concerning Infoi@niation and Data Needs To Support M-a6-r)-c)'w-e-r'-P-la-nti-i-ii-q"-'- Applipd.Managemc,nt-Sciences This monograph is to assist'policy makers and administrators in making improved use of health manpower data and supporting information in planning for the required number of health personnel in the appropriate places, personnel with the appropriate training, and assurances of optimal utilization of all available health personnel. The document will summarize the major infomation@user types, the activities carried out by the users, and the basic types of information required to support planning responsibilities. 27 3, -va uatiol@ f the lealth Manpower Information Auerbach Associates This Study will evaluate the status of and analyze Problems related to the compilation, stor(ig(-,, docuiiiantition, dissemination, exchange and access for retrieval of information on health to include plans and recoiniiienda- tions for dealing w-.;tli thc-,se'probleiiis. Objectives of the study include: improvement in capabilities for acquiring and retrieving published and unpublished information on manpower; facilitating users' access to such information; developing network and other arrangements for pooling of information among Federal and other agencies; improving access and inter- change of information between central office and Regional Office BHRD components; and planning for optimum use of automated procedures in these functions. 4. Selected Data Ssets.ffoorr jUse by Health.Planners Health Manpower Planning Branch, DCHP This compilation describes 71 primary data sets, each of which has been assembled on a nationwide basis with data available in a variety of sub- national geographic and/or organizational coinponents--priinarily state/county/ zip code. The 71 data sets are divided into three sections: 1) those available as publications, 2) those available as computer tapes, atid 3) those in the developmental stage or forthcoming. Each data set is represented by a summary street which provides the title, the organizations) primarily responsible for development, basic description of data elements, and a contact point for further information. When possible, a copy of the survey instrument used for other pertinent information) follows the summary sfieet to aid the user in better understanding the scope and intent of the data collected. 5. Glossary of Health Manpower Planning Terms Health Manpower Planning Branch, DCHP The glos,-;ary.is to provide acommon reference and guide to health planners concerning precise terminology used in health manpower Planning, improved understanding of related concepts, and to clarify ambiguities between terms and concepts within the health and related fields. The scope of coverage in the glossary will encompass three primary fields of terminoloqv--health related activities, manpower related activities, and the plannin6-processes. The general approach to be used in developing precise terminology is to focus on definitions which convey the most appropriate usage of the term in health planning. 28 MISCELLANEOUS 1. Evaluation Scheme for Assessing Health ManPoOer Planninq Pvl ogram Impact The project will assess the impact of programs designed to strengthen capabilities of individuals who are functioning or trained in health manpower planning at the State and local levels. This impact assessment will be accomplished througfl an evaluation of the outputs of individuals and organizations. The methodology used in this project will utilize a cost/benefit type analysis of programs and the actual situations found in those areas where program "graduates" are living and work-ing. 2. Evaluation of the State Role in Supporting Health Professional Education bbt Associates, Inc. This project evaluatc-(i the rolp of State governments -in supporting health professions education, focusing oh investigating desirable methods for collecting and analyzing information related to the State role in financing') coordinating, and planning health professions education, and also providing substantive information derived from case studies and five selected states. 3. Invento wer Trainitig kl,)Iicd Manageiyient @@ervices, Inc. This project is a contract study in two phases. Phase I is currently under way. It consists of a feasibility or pilot study on methods of collecting State and local government data on their -programs and expenditures for health manpower education and training in FY 1972. It covers a small number of State and local areas, and investigates such questions as: use of secondary sources, and use of various sampling and interviewing techniques, and alternate fonlats for tabulation. On completion of Phase I, the next phase of tile study will ensue using FY 1974 and FY 1975 funds. It will make use of the findings of Phase I to design and carry out a survey of health manpower programs and expenditures of all 50 State governments and a representative sample of local governments in;FY 1972 and/or l@73. 29 Regional Office Technical Assistance Programs Approximately $1.2 million (over one half of the total TA budget) has been I allocated to the Regional Offices for the support of their techn4cal assistance programs. The Regional Offices are programming these resources in two major ways. The first involves joint regional efforts to secure a contractor who could provide a variety of technical assistance services to the Regional Office and its agencies. The second involves the Regional Offices developing and funding specific projects. The Regional Office Technical Assistance programs planned to date are listed below. More information cap be obtained from the respective Regional Offices. Regional Office I 1. A contract with Boston University to provide individualized TA to five CHP agencies in the area of Community Participation and Education 2. Participation in a Tri-Regional Technical Assistance contract 3. Agency Management Models Arthur Young & Company Up to 9 models relating to the following elements will be developed: by-laws, Pesponsibility delineation, Organization Chart, work program, .administrative manual, personnel policies, financial management policies, fund raising strategies, evaluation program. Six 2-day workshops and some individual consultation in the area of Agency Management will also be provided. The overall approach will be upon management by objective training. 4. Developing CHP Education Proqrams Boston University This project is to develop a manual of adult education techniques to increase CHP.agency effectiveness. They will also conduct four one-week seminars for persons with specific responsibility for education of Board, staff or community and will provide technical assistance in education program development. II Participation in a Tri-Regional Technical Assistance contract. 30 Health Plan DevelODment and Implementat' n 1. Support for the completion and documentation of a State health plan development process. This project includes- the.development of a data geared specifically to setting precise objectives and measuring progress in their attainment through the use of quantitative indicators, a directory of sources of data required to measure the current status and improvement in the health care delivery system, a manual of procedures for obtaining and using these data, and a set of formats especially adapted to the presentation of data for this purpose. 2. Establishment of a framework for the development of a Region II health plan in an effort concurrent with plan development by the State and areawide agencies. A written report will be produced documenting these efforts and describing a feasible framework for further activity to develop a Region 11 health plan. 1 3. Expansion of seminar series and resource material on economic and political implications of cost containment in the health planning process. 4. Provision for long-range technical assistance to the CHP planning agencies by the production of an inventory of technical assistance resources in r) !'.egion II. This inventory shall identify and evaluate the potential of these resources for linkages with the Region II Office of DCHP. This effort shall address all the functional areas and performance standards of the CHP agencies. The investigation to develop this inventory shall be based on current and anticipated problems for health planning agencies. These shall be identified through the review of assessment reports and the requirements of the new pending legislation. 5. Development and support of a panel in Region II to review planning technology development. The panel will include representatives of selected organizations and universities. A written report of their findings and recommendations for further activity will be produced. 6. Development of model for coordinating areawide and state manpower planning in Region 11. This model is to be developed from a project which will be linking a State's long ranqe master plan for health manpower education to areawide agency planning e?forts. The project will include exploration of says to improve the identification of health manpo,@ier needs, resources and problems of maldistribution. 7. Support for demonstration projects in two States of Renion IT for the purpose of adopting and integrating the experience, methodology and content of State health plans to areawide level plan development. 31 Studies Update of an areawide agency's methodology for developing bed utilization data as a means for determining health service needs and priorities. This model will be available as a guide for other areawide agencies. Project Review 1. An analysis will be made of the legal implication of regulatory and review responsibilities in New York State and New Jersey under their Certificate of Need laws and Section 1122 of the Social Security Act. The analysis shall be used as background for written materials and advice to the (a) and (b) agencies in seminars. 2. Further development of Project Review criteria in Region 11 include: a) identification of health scarcity areas in an urban setting; b) guidelines for criteria for domiciliary care facilities; and c) further development of health service criteria by Region II committee. Agency Management Development of a specially designed management training program for CHP agency staff. Program shall include an in-service institute and/or on-site training of agency directors and management staff. Community Participation and Education Development and conduct of program for in-service training of agency staff in consumer participation and education (based on model developed by Columbia University Continuing Education Program under 314(c) training grant.) Planning Coordination Demonstration project has been developed to explore the potential for integrating CHP and RMP agency functions. The initial emphasis will be in data management. A report will be produced identifying ways in which the components of CHP and RMP can be combined under new legislation. Data Management Region II coordinating council on health planning data. This council of (a) and (b) agencies will focus on strengthening the data management capacity of all health planning agencies through problem oriented workshops, the review of data resources and the development of cooperative data acquisition and management strategies. A ftnal report will map out a strategy which describes the data sets required by areawide and state health planning agencies. 32 Regional Office III Health Planning Research Services, Inc. is a corporation of the health planning agencies in Region III. Their basic purposes are: 1) to provide Technical Assistance to Reqion III CliP agencies; 2) to conduct research in health planning; and 3) to coordinate TA in Region III. The major activates for,the coming year are the following: 1) Board education in the areas of board responsibility for agency management, specific health system subject briefings, and information and techniques for making rational decisions regarding facility review. 2) Staff education in the areas of agency manaqeirent and management by objectives, defining planning methodologies, designing planning frameworks, and developing a state plan model. 3) Development of Health Status Resource Allocation System. This will further develop the Model li'c!alth Status Resource Allocation System, including the design of a regional data' system, continuation of the advisory council to oversee system development, and special training for staff members in the implementation of the systeiri. 4) Development of a plan for interagency linkage of health planning in the District of Columbia metropolitan area. 5) Development of methodologies to improve the process of decision-iii,iking reqardirin resource allocation. The methodology will at least address the following concerns: establishment ol measurable goals and objectives, identification of health prob-lepi,.;, ranking of priority concerns, identification and analysis of alternatives, identification of need/demand for services in. priority health areas, projection of current supply and demand levels for priority areas, examination of the relationships between health status indicator's and health service require- ments, examination of the relationship between the outputs of health service programs and the impact exerted on target populations. Criteria and standards to guide the process of allocative decision making will then be developed. Such criteria and standards will address the questions of accessibility, need, quality, adequacy, acceptability, and financial impact. 33 .Evaluation of the Region Ill. Review a d Con4iient System Sue Ginsberg The study has a tt@' o.--fold purpose: 1) to improve the Review and Comment pi-oce(Itit@es of the R@-giotial Office; and 2) to cooridi)ate Regional review so that CI-IP agency input will bc@ meaningful and simpler to provide. The contractor will analyze the current status of Regional reviews including what grants are reviewed and by whom, how many of each type are reviewed, the number of coji-,i,,ients by CI-11) agencies arid the impact of the comments. It is e>:pected that the evaluation will result in recommendations to the Regional Health Adiiiinistrator for changes to the current Review and Comment system. Procedures This is a model set of agency policies and procedures to assist agencies in the management and organization of health planning agencies. The set defines internal agency relationships, and develops operational guidelines to assure balanced relationships within_an agency. A model set of Personnel policies which identify the elements of sound personnel management in a health planning agency is also being developed. ffice IV I. Participation in a Tri-Regional Technical Assistance contract. 2. Workshop on grants management in each of the eight states in Region IV. This will be developed by the management support staff in the Region with George Williams, Region IV as Project Coordinator. Workshops on PD, PR, AM, CP&E, DM in each state in Region IV. Don Davis Associates, Inc.-Will develop these 2-day workshops between now and October, 1974. 4. "Bed Need Analysis and Projection for a Multi-County Area" to be studied by the Health Planning Council for Central North Carolina, Durham, North Carolina. This will focus on analyzing bed need for use in project review activities. 5. "Phased Studies for Determining Nursing Home Facilities Status and Methodolonte for Assessing Present and Projected Needs" to be conducted by the Central Mississippi Health Planning Council, Jackson, Mississippi. 6. "Internal institutional Planning for Health Service Administration" to be studied by the Comprehensive Health Planning Council of South Florida, Inc., Miami, Florida. 7. "Legal Aspects of Project @eview" to be studied by the. North Caro lina Association of CHP Directors. This roject will anal,,ze personal and aqenc,, liabilities of the staff, Board membeprs and task forc'e members for their role in the Project Review'process. 34 Renional Office V 1. Consultation to the Illinois 314(a) agency to assist them in developing evaluation methodologies for activities related to plan development, studies, project review, data base maintenance with major focus on cost containment. 2. The following section lists seminars to be developed and specifies the content areas.of the seminar and the responsible agent: Plan Development, Agency Management Illinois Association for State 314(a) and 314(b) A encies of CHP Agencies @g Project Review, Agency Management for Indiana Association ,@t(ite 314(a) and 314(b) Agencies for Health Planning Fin,iticial Feasibility. Capital Financing Indiana Association for State 314(a) a'nd 314(b) Agencies for Health Planning Plan Development, Agency Management, Michigan Association Project Review for Region V 314(a) of CHP Agencies and 114(b) Agencies Support Region V Sr@niiriar workshops with Michigan A5sociation presentations_ of facilities Planning, of CHP Agencies .Community and Planning coordination for Stite 314(a) and ti(i(,ticit!% and Ilospitals Pl-an-Dev-elopinent f-6- State Minnesota 314(a) Agency 314(b) Agencies Cost Containment ' Financial Minnesota 314(a) Agency Feasibility for State 314(b) A(j(, ncies Evaluation for State 314(a) and Ohio Association of CHP 314(b) Agencies Agencies Plan Development, Agency Ohio Association of CHP Management for State 314(a) Agencies and 314(b) Agencies Cost Containment for State Wisconsin 31,4(a) Agency 314(b) Agencies Regional Office VT 35 I. Tulane Universil-.-y will conduct the following activities: a) Develop technical reference manuals on - determination of health service and bed needs - agency management - planning coordination - legal aspects of Review and Comment b) Establish a Technical Assistance extension agency to funnel university resources to respond to tire TA needs of individual CHP agencies in Louisiana c) Develop and implement a university home study correspondence program d) Design and conduct at least three week-end seminars in "Institutional Program Planning and Review and Comment." This will address some of the problems and needs of project applicants who need CHP reviews as well as the problems of CHP agencies 2. The University of Texa!l will conduct the following activities: a) Establish a Technical Assistance extension agency to funnel university resources to respond to the TA needs of individual CHP agencies in Texas b) Develop a "Guide to the Use o@ Cost-Benefit Analysis in Health Planning." The Guide will describe the use and components of cost-benefit and cost-effectiveness analyses, it will relate these tools to the decisior, making processes of health planning agencies. Case studies will be the basis for part of the study. The last chapter will describe how to do a cost-bene!i@, analysis. 3. The Civil Service Commission will develop a mechanism to monitor and evaluate the progress made on implementation of the work program of the Agency Development Plan. egional Iffi e VII 1. Training seminars on Plan Development, Project Review (including capital expenditure review) and Agency Management. 2. Development of models to evaluate the elements in the functions of Plan Development, Studies, Project Review, Agency Management, and Planning Coordination. This multiple effort also includes a training proqram in Program Evaluation Techniques and Critical Path Method Techniques as they relate to the ADP and CHP agency work programs. 3. Model Account S stem for ervice/Resource Inventory and Need Analysis Mid-American Comprehensive Health Planning Agency, Kansas City, Missouri The model will assist in summarizing need, services and resources from the four perspectives of a) health status, b) quality, c) cost, and d) accessibility. 36 4. The Nebraska State Health Department will develop a "Guide to Lonq-Term Care Alternatives" which will include a cost-benefit analysis. 5. Ambulatory Care Plan Health Planning Council,of Central Iowa, Des Moines, Iowa The study will plan, develop and publish an Ambulatory Care Component of the health plan focusing on a review of unmet needs and services currently provided in Polk County, Iowa. 6. Model Personnel Policies & Procedures R.J. Gunter & Associates Don Davis Associates, Inc. Two contractors will approach this subject from slightly different angles. R.J. Gunter and Associates will develop a model plan for staffing and model personnel policies for areawide CHP agencies. The models are to be based on the legislative package for Regional Health Systems Agencies. Don Davis Associates, Inc. will develop a manual on personnel policies and procedures for the areawide agencies to include (sample or model) policies with the rationale for them. 7. Langston, Kitch and Associates, Inc. will develop a "Data Management Training Model.", Renional Office VIII 1. Participation in a Tri-Regional Technical Assistance contract 2. Planning Framework for.a Health Plan Region VIII staff of Comprehensive Health Plannino and Health Manpower Planning The staff will develop an outline of a health plan including three major components of facilities, manpower and services. They will concentrate on the facilities framework initially. The framework will include suggested standards and criteria for use by CHP agencies in Region VIII. 3. MBO Approach to a CHP Work Program Applied Management Systems A 2-1/2 day workshop will discuss how the Management by Objective approach can be used in a CHP work program. Goals, objectives, tasks, output measures and man-day equivalents will be presented. During the workshop the CHP agencies will reformat their work programs in accordance with a form developed by the Regional Office which integrates the ADP into the work program. 37 Renional Office IX 1 Participation in a Tri-Regional Technical Assistance cont ract 2. Oeveloi)ment of a Methodoloqy to Review and Analyze Health Service Costs -ana-- o Deter6l-iie-@e ri nancia I Feas ib--f i@iy- of P @C) i-@f Lester Gorsline Associates This contract will address the subjects of rate review, financial information analysis, budgeting and capital financing, long-range financial forecasting, and the economic considerations and impact of CHP agency decisions. The contractor will develop analytical frameworks for review of the cost and financial feasibility of both a health service project and a health facilities project and will specify in detail the data required to analyze the financial feasibility of a project. Two workshops will be held and a manual on financial feasibility review will be developed. Regional Office X 1. Participation in a Tri-Regional Technical Assistance contract 2. Health Facilities Planning ktivities Arthur Young & Company, Portland, Oregon The contractor will develop a state-of-the-art paper on health facilities planning and identify a minimum set of action steps that a CHP agency must perform to meet requirements for acceptable facilities planning. The contractor then will critique facility plans of agencies in Region X and will conduct a training program on facilities planning. 3. Development of a Proj@t Review Manual Educational Resources Associates, Seattle, Washington This contract is to develop a manual with a suggested set of criteria foi, project review and suggested model procedures for the agencies in Reqion X. To reduce duplication of effort by the Regional Office and the CIIP agency, w by the Regional Office the manual will also specify the content of the revie staff and suggest where CHP agency input is most appropriate. Reqional office staff-will help develop the standards and criteria for around fifteen health programs. 38 4. Evaluation of 1122 A reelmillents in Reqion X Arthur Young and Company, Portla-nds Oregon After studying the 1122 regulations, the contractor will develop a concise written report of authorities and responsibilities for each of the parties involved. They will then conduct an evaluticn of agreements between DHE14 and Region X DPA's and the operations procedures agreed upon between Region X DPA's and 31@,.(b) agencies to determine if the requirements of Section 1122 have been met. 39 111. Projects Planned to Advance the State of the Art Projects in this category are to augment current efforts in developing the state of the art of health planning with major emphasis on the development of criteria for expensive facilities and services. The projects described below build on many of the other efforts described in this paper. They have been designed as a result of information provided by the agency assessment program and consultation with the field. At this date the projects described below are being developed as part of a competitive Procurement process. 1. Developing Planning Approaches and Criteria for Health Services a. Planning Approaches, Criteria and Standards for Specialized fer'vi c es The purpose of this contract is to identify and define approaches useful for the planning of specialized services and to develop criteria and standards for these services which can be used in performance of the plan development and project review functions of health planning agencies. Thes,e criteria and standards for planning and project review, as opposed to standards for licensure and accreditation, relate primarily to economic feasibility, cost containment, operational capability, accessibility and availability of services. Specifically, the.contractor shall develop planning approaches, criteria@and standards for each specialized service. In addition, he will design evaluation criteria for the developed approaches, criteria and standards will be field tested in various health planning agencies in accordance with the plan developmnt and project review functions and modified to reflect any necessary changes. The specialized services to be addressed in this procurement include: preventive services, rehabilitation services, burn treatment services, trauma services. It is anticipated that as a result of this contract, health planning agencies will have a firm technological base from which to allocate scarce resources more efficiently and effectively. Working relationships with other Bureaus will be developed dependent upon the service area selected. Regional Medical Programs staff will continue to be involved in this project. 40 b. Development of Methodologies for the Health Planner to Evaluate Services Shared by Health Care Delivery Organizations The purpose of this contract is to develop the methodologies and analytical tools which will enable health planning agencies to identify and evaluate existing type of arrangements'among health care organi- zations for sharing services, to identify and evaluate the potential for implementing arrangements for sharing services, and to describe the techniques to initiate these arrangements. Up to sixteen sites, that are representative of sharing arrangements in the general categories of: (1) medical facilities and medical care, (2) manpower resources, (3) administrative and other support services, and (4) continuing education and/or inservice programs will be visited to develop case studies of how these arrangements evolved and their impact on the institutions involved and the quality of health care delivery to the respective communities. The final product will be two monographs. The first monograph will consist of: 1) A summary of the existing types of arrangements among health care organizations for sharing services. 2) An evaluation of these arrangements. 3) Case studies of the sixteen (16) programs visited. 4) An annotated bibliography of recent literature regarding shared services. The second monograph will present the methodologies and analytical tools necessary to identify and evaluate the current arrangements for sharing services, the potential for sharing services, and the techni- ques for initiating arrangements and programs for sharing services. The monographs will be field tested for usability in four (4) health planning agencies prior to the completion of this project. The work of the Bureau of Health Services Research will provide a foundation for this project. The Division of Facilities Utilization will also be involved. c. Relation of Technological Advance to Health Plannin_q This contract will develop and test a methodology for identifying new and spreading advances in health technology, and for rapidly determining their impacts and implications for health planning. Areas to be considered are manpower requests, capital costs, operating costs, or other aspects significant to health planning. The contractor will categorize the types of technological advances taking place in the health field and develop a methodology to determine resource requirements and costs of those advances. The contractor will present his findings in a form which will be useful as a tool to health planners in appraising the impact of technological advances. The Division of Health Care Technology, Bureau of Health Services Research, Regional Medical Programs and Division of Facilities Utiliza- tion staffs will be consulted on this project. 41 2. Developing Methods for, Data Analysis a. Development of a Data Collection and Analysis Handbook for Health Planners The purpose of this contract is to improve the health planning process through the development of a handbook on health system and health status data collection, analysis, interpretation, and use. The Contractor shall identify the data requirements mandated or implied in the proposed health resources planning legislation and the specific types of information and approaches to data collection, analysis, interpretation and use which a health planning agency should apply in the development of its health plan documents and in its reviews of proposed health projects. The Contractor shall specify the types of decisions to be made by agencies, the infor- mation necessary to make those decisions, the types of data re- quired to yield the information, the sources for these data, and the advantages and disadvantages of various approaches to the collection, analysis, interpretation and use of the data. The product of this activity will be a reference document useful to State and local health planners in the discharge of their data collection and analysis responsibilities. Health planning agencies representatives will be involved throughout the project. The contractor will identify the type of studies which have been conducted by a sample of CHP agencies, describe the purposes of those studies, the methodologies used, and the manner in which study results were used. The contractor will also identify addi- tional types of studies which can assist agencies in carrying out their responsibilities of plan development and project review. Techniques for data analysis will be presented in problem-specific manner. Examples of problems that a health planning agency might have to address will be presented; the analysis and interpretation processes will be explained as they relate to the resolution of the,problem. Descriptions of other types of planning problems for which similar types of analytic approaches would be useful will also be included. Specific attention will be paid to the types of analytical approaches necessary in health plan document develop- ment and project review, particularly those necessary for the review of facilities and expensive specialized services. The National Center for Health Statistics and the Bureau of Health Services Research will be involved in the monitoring of this project. 3. Developing Knowledge about the Health Care System a. Impact of Health Care System Component Interaction The purpose of this contract is to provide health planning agencies with a) knowledge on alternatives for delivering health services at 4 2 primary, secondary and tertiary levels of care,'and the impact of each alternative on other delivery components in the system, and b) tools and methodologies to analyze the impact of introducing a new delivery component or changing existing ones in the community. For example, if a health planning agency has determined that its planning area needs primary care, it has various alternatives to deliver that care such as hospital outpatient clinics, health maintenance organizations or office-based physicians. It is anti- cipated that this contract will furnish the health planning agencies with various options to providing health care and the impact, in terms of resources and costs, that each option is likely to have on its community health care system. Specifically, the contractor will identify the various components of the health care delivery system for primary, secondary and tertiary levels of care. Furthermore, he will analyze the rela- tionship (including interaction effects) between each component in the system in terms of resources and costs (including costs relating to utilization and efficiency). Thirdly, the contractor will develop and evaluate analytical tools and methodologies for planning agencies to analyze the impact of introducing or changing a delivery component of the system in the community in terms of resources and costs. Fourthly, the contractor will develop a descriptive model for delivering health care in a rural community setting and in an urban community setting based on its analysis of component interaction. Finally, two training programs will be designed and developed--one for health planning agency staff and one for health planning agency Board/Council members concerning health care system options and component impact in terms of meeting community goals and objectives. The Bureau of Health Services Research will be involved in the design of this effort. 4. Developing an Informed Planner a. Health Resources Planning Educational §Istem The purpose of this contract is to establish organized programs of study for the,,development of health resources planners and for increasing the competencies of current planners and to establish a mechanism for the dissemination of health resources planning information to those responsible for the education and training of health resources planners. The contract will be operational for two years. Phase 1, the first year's endeavors, will be directed to,assessment of the current and projected requirements for planners and the competencies needed, assessment of the current and projected educational and training programs, and the design and the development of programs of study indicated as most effective to develop or increase the capability of planners following an analysis of the two assessment efforts. 43 Phase II will require delivery of and evaluation of the effectiveness of the programs developed during Phase I. In addition, an educational resource center will be established to serve as a mechanism for the dissemination of health resources planning knowledge and techniques to the community of health resources planning educators. The project will be tied closely to related projects just started by the Bureau of Health Resources Deve opment. b. Center for Health-Resources Planning Information The Center for Health Resources Planning Information (CHRPI) is perceived as a focal point that will have the capacity to provide planning agencies with ready access to a comprehensive health planning related information base. The Center is best described as a technical resource center and clearinghouse designed to place at the disposal of planners an extensive literature related to health planning. The Center will carry out the following fundamental operations: 1) Collection, processing and analysis operation will include such activities as: (a) acquiring documentary materials; (b) quality screening, indexing and abstracting of documents; (c) preparation of bibliographies; and d) development of state-of-the-art-monographs. 2) Information dissemination and related services include: (a) announcement services; (b) distribution of full bibliographies; (c) literature reviews; (d) summaries of health resources planning projects currently underway; (e) the establishment of a computer based query response capability; and (f) development of a service to make available the full text of publications and reports through hard copy or microfiche.