III - *11 iiiiiiii@ilit 114111111 litill DIVISION OF COMPREHENSIVE HEALTH PLANNING TECHNICAL ASSISTANCE STRATEGY AND PROGRAM Revised Septerhber, 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 . . . . . . . . I I I ' 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 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. 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 @iill be disseminated to CHP agencies. I. AVAILABLE REC)OURCES 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 Review and 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 facilities 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 @ency 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. 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 Philadelphia, 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, December 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 1, 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 oovernmental 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 American Medical Association, Joint Council 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 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) TA Memo #13 - Division of Comprehensive Health Planning Technical Assistance Strategy and Program 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-Tem 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. 8 TA Memo #16 - Computerized Axial Tomography Scanners DCHP Staff The memo provides 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 acquis ition of CAT scanners are also discussed. TA Memo #17 - Community Health Profiles: Pertinent Concepts, Content and Output 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" 6y 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" als-o 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 Stati,stics System This memorandum contained information on the Cooperative Health Statistics System (CHSS) of the Na'tional 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 Descriptions This memorandum described two publications of the Census Bureau: The Small-Area Data tlotes (SAD) and the Data Access Descriptions. SAD Notes contains up-to-date information concerning publications, 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 which readers have found in their area. The Data Access Description is sent to the subscribers of SAD Notes as it is issued. 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. 10 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. It is divided into five chapters: 1) Structure of Planning Decisions and Plan Development; 2) Measuring 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, ste-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-term) of the health system within the area." Other Available Resources Some documents 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 discus,-;.es 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 policy issues the review should address. For further information contact Allan Blackman, University of Washington, Department of Health Services, Seattle, Washington 98195. 2. Health Facilities Planning Guide for Reviewing Financial Feasibility of Proposed Capital Expenditure Projects University of Delaware, College of Business and Economics The guide is divided into the following sections: 1) the basic issues and problems involved in a review of financial feasibility; 2) the general elements of long-term financial planning for capital improvement projects; 3) Sources of capital, types of debt, debt provisions and methods for detei,,,lli,,ling debt capacity-, and 4) the general framework for conducting a financial feasibility review, including the use of various types of analytical techniques, A selected bibliography and glossary of terms are appended to the document. Guidebook for Facili Review 3. @-Y George Washington University, Department of Health Care Administration The guidebook discusses several aspects of a C@IP agency's review and coii,.ir.,3nt activities. The three main areas are: 1) recordkeeping including suggested forms and agency procedures; 2) assessing the cost to the aqency of conducting review activities which includes a means by which cost may be calculated by the aoency and a matrix to show the cost of projects in certain cat(-,.cloric,s: an(] 3) legal aspects dsicussed with the context of general principles of administrative law. 1 2 4. @qir,)rehensive Health Planning Series: Professional Standards Review iizations 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 tile characteristics and functions of must PSRO'S. There is a chapter detailing several political issues, including the designation of areas. Another chapter describes PSRO's and Public Health as well as PSRO implications for CI-IP. 5. Model Fund Accounting System for Areawide CHP (b) tgencies Health Planning Council of the Midlands, Oiiaha, Nebraska through a DIIE@,', Region Vil Purchase order The model fund aCCOLIlting system has instructions designed to aid a CHP agency in establishing a system of financial reporting. It describes basic concepts in fund accounting and tile 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 for a State-Assisted Areawide Planning Aqehcy 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. 0rganizational and Administrative Techniques University of Viashington, Department of Health Services (Project Director, Allan Blackman) The document provides CIJP 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 ralwsing. The bibliography is divided into three sections: a recoriinended bibliography, a supplementary bibliographic and a listing of the addresses Of publishing companies. 1 3 8., A Model Cost-Bencfit Analysis Scheme 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 tind(-,-rstin(ling of the costs (what is given up) and effects (what is accomplished) of various courses of action. The model cost-benefit analysis scheme provides a cognitive Piap--a fraiiio of reference for considering alterti,itives--consisting of a series of payoff matrices reflecting the merits of an individual proposal on the total health care system. Tile mod(-,I includes monetary and non-monetary-values and aides selection between independent projects as well as mutually exclusive projects. 9. stics 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 ahealth 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 Memorandum. The Constiirier Support Group: An Experimental Innovation in Community Planning Aiiaiida 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 soiiie consumer members of their Council. The design of the program was to proii,,ote formation of a group of interested consumer members which could attaclr-I problems 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 30458. II. ONGOING ACTIVITIES 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. Health Planning Materials Under Deve ent Resources under development 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 Developed by November, 1974 As these resources are completed and if their quality warrants it, they will be distributed as Technical Assistance Memoranda. HEALTH PLAN DEVELOPMENT AND IMPLEMENTATION 1. Plan Devel ent Resources Document Anerican Association of Comprehensive Aealth 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 companion document to the Project Review Resource Document (iten, 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 development but also -the form and format such a plan might take. 2 Need Assessment Manual for h@eawide Health- Planning Agencies Govci@iiiiient Studies and Systems The docuii-.eiit is a guide to C',]P agencies in acquiring and analyzing data on need. The proje-t calls for the design of a need assessment mcthodo- logy applicable to areawide CHP functions, its description in clear operational terms in a procedure manual, the field trial of the manual in two operating settings as the basis for any necessary revision, and the preparation of accompanying documents presenting concepts and iiietilods.for its functional integration into the processes of Health [Ilan Development and Project Review. While primarily oriented to area- v,,i(le agencies, statc agencies can also find it useful. 1 7 3. P-1@nning for Plan Document Development Aiierican Public Health Association TI)is is a guide for designing processes and organizational structures for hc,,iltli plan development. The purpose of the Guide is to assist CA)Iiii))-clionsive 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 Needs 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 planned for Staff and Council. STUDIES 1. 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 commit to the study. A general process for the conduct of studies will also be described. 18 PROJECT REVIEW 1. Project Review Resource Document American Association of Comprehensive Health Planning under contract with the Health Resources Development Institute, Inc. in cooperation with the Kentucky State Comprehensive Health Planning Ati,:2,icy Practical reference guide for the establishment and iinDlementation of the Capital Expenditure Review Process. This is desioned to be a companion document cf the Plan DeveloDment Resource Docuin,--nt being prepared by AACHP. It is desione(i as a guide for staff and working council in conducting 1122 review. 2. Guide to Reviewing the Financial Feasibility of Proposed Capital 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. Kork Program Development Guide Arthur Young and Companv The guide describes a process for the development of a OJ14(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- lineates what a work program should contain; how it should be prepared; and what use can be inade of it. Program budgeting is also explained. 2. Administrative Policies for CHP Agencies Linton, Mields and Coston, Inc. This guide contains a suggested set 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. 19 3. Arthur Youiq and Coi)ip'atiy- 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 [HEW and is simple in book-keeping 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 of transactions and the presentation of reports through the complete accounting cycle. COMMUNITY PARTICIPATION AND EDUCATION 1. Guide for a Public Information Program Linton, Mields & 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 representatives are discussed. Emphasis is placed upon tailoring the information to the audience for which it is intended. 2. Public Accountability Package Prthur-Younq & Company This package is to guide a CHP agency in achieving proper geographic and socioeconomic representation on its Board or Council. It discusses the 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 Hea s 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 di.vided 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 PLARINING cnoRDINATION Models in Interagenqy Relationships Linton, Mields & Coston, 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 CIIP activities are some of the factors considered. The gui de wi 1 1 i ticl ude such programs as ARC , RMP , OEO and Model Ci ti es. DATA MANAGEMENT Data File Maintenance Linton, Mields and Cost@.on, Inc. The report presents 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 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 Associatin, Western Branch (Project Officer, Jeffrey Tirengel) 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 agencies 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 i'lost 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. Development 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 to Determining and Pto,jecting the 'Need and Services Arthur Younq and Company The purpose of this contract is to ascertain and evaluate planning approaches 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 inpatient services, emergency medical services, home health care services and long-term care services. 3. Guide for Evaluating 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 Health Tanning George Washington University This project will (1) identify currently available health system models whic!) 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 applied sense) of current and future health system models, and (4) survey the state of the art of health system modeling and make recommendations for actions to increase this technique's usefulness in health planning 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 qo 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 tl.C potential of a university serving as a technical assistance center to coiii- munity groups and health planning agencies in the development of rural primary care centers. 6. A Study of Implementation Strategies in Comprehensive Health Planning Boston College 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 of their plans. Approximately 40 case studies of attempts to implement plans, results of these attempts, nature of plan and environ- nient influencing 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. Inipleinetitat ion Strategies in Comprehensive Health Planning George Washington 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 interdisciplinary review of the implementation process, structured around a "working" model of the CHP implementation process. 24 wide Health Plans 3. 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 Pdvisory Committee will develop criteria for selection of plans; provide input in development of implementation strategies and provide feed-back during the course of the Project. A monograph based on. these experiences will be developed. 9. Reviev,, Of l@',etho,,Iological [@;)Pt-oaches used to Determine Health Manpower Supply and !,,@i(,,iiireiients This project is to develop a monograph to serve as an interpretive aid to health planners regarding the wide range of methodologies used in assessing, health manpower supply and requirements and as a the practical planning level guide on "hoei-to-do-it'@ at various ilictilo(lol The iiiOt)Ogr I)II will critically review the ogles, explain the advantages and disadvantages of a given approach, and review it) a practical way al desired objectives. ternative niethods'to achieve 10. Organizational and Political Dynamics of Health Manpower Planning The monograph is to provide health planners with a guide in ways to plan vantage in developing and iniplementating effective health manpower plans. for and use oy,.qz)nizational and jurisdictional relationships to their ad- It will stress ways to identify in advance where patterns of organization 4 commonalities and differences may exist and how to plan accord al and jurisdictions in the resolution Of issues and attainment of compl .nluiiications between organizations stress methods to bring about improved cOIT, itigly, and objectives. ete 11. Structural and Functional Barriers to Health Manpower Planning 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 recommendations will be developed to serve as a guide to Planners in their day-to-day planning activities. 25 PROJECT REVIEW kqv i-,aLt_f Criteria and Standc-.rds for Health Services. University of I,,itshington 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 plannin(I 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 developtfleiit of criteria and standai-(],, include health maintenance organizations, radiation therapy services, renal disease'services, ambulatory stiroical centers, and long- term care services. 2- Legal Aspects of C@rehensive Health Planniing Joint Project by.Boston University and Tulane University This project will develop two manuals on the legal aspects of comprehensive health planning. Tile first manual will be directed toviard agency staff and Council and will describe actions an aqency needs to take to be le(lallv operating. The second manual will be for lawyers who rrilht 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 MANAGB4ENT Dimensions of Technical Assistance to Su corporation Pmerican Technical Assistance C 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 planning responsibilities but which is not readily available in their respective Plan- ning organization. First, the document will assist the planner in definin@. the technical problem area(s) and indicate the types of assistance required to approach a specific problem or issue. Second, the monograph will revievi alternative approaches in identifying and procuring the technical know-lio-.,i 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 ltlUtIlTY PARTICIPATIOti At!D EDUCATION Evaluition and Development of Orientation Materials fbr Health Planning COLinci 1 Meiiibers 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.1 take into account the 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 access; and a descriptive analysis of what these data systems can fulfill. The handbook will show in detail how local and ceiiSL]s data can be utilized in planning, programming and evaluation functions. 2., Critical Issues Concerning Information and Data Needs To Support Health Manpower niii Applied.Manaqement 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 and 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 information user types, the activities carried out by the users, and the basic types of information required to support planning responsibilities. 27 3 Evaluation of the Excliang.e of Health Manpower Information Auerbach Associates This Study will evaluate the status of and anal ze problems r6lated to the y compilation, storage, docuniantation, dissemination, exchange and access for retrieval of information on health manpower, to include plans and recominenda- tions for dealing with these problems. 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 Sets for Use 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 components--primarily 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 (or other pertinent information) follows the summary street 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 glossary is to provide a common 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 teri-ninology--health related activities, manpower related activities, and the planning 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 healtli planning. 28 6. Standard Occup t@io@l Classificati.on Code Health Manpower Planning Branch, DCHP This project calls for staff activity to assemble information, and promote collaboration among Federal, State, and local agencies responsible for collection and analysis of health manpower data, in regard to standardization of definitions and classification of health occupations. MISCELLANEOUS 1. Evaluation Scheme for Assessing Health Manpov@,er Planning Program 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 through 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 working. Evaluation of the State Role in Supporting Health Professional Education kbt Associates, Inc. e of State governments in supporting health This project evaluated the rol professions education, focusing on 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. Inventory of State and Local Programs that Support Health Manpower Training Applied Management Services, 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 govcriiii@orit 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 foniiats for tabulation. On completion of Phr-ise I, the next phase of the study will eiistic 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 1973. 29 Regional Office Technical Assistance Programs Approximately $1.2 million (over one half of the to tal TA budget) has been allocated to the Regional Offices for the support of their technical assistance programs. The Regional Offices are programming these resources in tvio 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 can 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, Responsibility 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 Programs. 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. Regional Office II Participation in a Tri-Regional Technical Assistance contract. 30 Health Plan Development and Implementation 1. Support for the completion and documentation of a State healtK plan development process. This project includes the. development of a data base 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 !I health plan. 3. Expansion of seminar series and resource material on economic and political implications of cost containment in the health planninn process. 4. Provision for long-range technical assistance to the CHP planning agencies by the production of an inventory of technical assistance resources in Region 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.add 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 organizatio ns 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 II. This model is to be developed from a project which will be linking a State's long range master plan for health manpower education to areawide agency planning efforts. The project will include exploration of i.-.,ays to improve the identification of health manpo@,!er np-eds, resources and problems of maldistribution. 7. Support for demonstration projects in two States of Reoion 11 for the purpose of adopting and integrating the experience, methodology and content of State health plans to areawide level plan development. 31 Stiidi es 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 II 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 trainin ,g 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) trai.ning 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 final report will map out a strategy which describes the data sets required by areawide and state health planning agencies. 32 ,Zeqional Office III Health Planning Research'Services, Inc. is a corporation of the health planning agencies in Region Ill. 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 management 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 flodel Health 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 system. 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-making regarding resource allocation. The methodology will at least address the following concerns: establishment of measurable goals and objectives, identification of health prob-lems, 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 indicators and health service require- nients, 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 III Review and Comment System Sue Ginsberg The study has a t%,.,o-fold purpose: 1) to improve the Review and Comment procediii-es of the R-,,-giorial Office; and 2) to cooridiiate Regiondl review so that CliP agency input will be 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 coiiiiiients by CliP agencies and the impact of the comments. It is e>:pected that the evaluation will result in recommendations to the Regional Health Administrator for changes to the current Review and Comment system. 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. @ional Office IV 1. 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. 3. Workshops on PD, PR, AM, CP&E, DM in each state in Renion IV. Don Davis Associates, Inc. will develop these 2-day workshops b'etween 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 Methodolorl,@l, 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 Review" to be studied by thp North Carolina Association of CHP Directors. This project will anal@,ze personal and agenc@, liabilities of the staff, Board members and task forc; members for their role in the Project Review process. 34 Renional Office V oi's 314(a) agency to assist them in 1. Consultation to the Illin 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) Agencies of CHP Agencies Project Review, Agency Management for Indiana Association St,ite 314(a) and 314(b) Agencies for Health Planning Fiti,,incial Feasibility, Capital Financing Indiana Association for State 314(a) and 314(b) Agencies for Health Planning Plan Development, Agency Management, Michigan Association Project Review for Region V 314(a) of CHP Agencies and 314(b) Agencies Support Region V Seminar workshops with Avsociation Michigan presentations, of Facilities Planning, of CHP Agencies Community lt,,%.@olveii,,ent, and Planning Coordination for State 314(a) and Hospitals .Ieilcit!s and lan Deve opinent f r State Minnesota ency 314(b) Agencies Cost Containment, Financial Minnesota 314(a) Agency Feasibility for State 314(b) Agencies Evaluation for State 314(a) and Ohio Association of CHP 314(b) Agencies Agencies Plan Development, Agency Ohio Association of CHP @lanac,,eTT,.ent for State 314(a) Agencies and 314(b) Agencies Cost Containment for State Wisconsin 314(a) Agency 314(t)) Agencies Regional Office VI 35 I. Tulane University 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 the 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 Texas 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 of 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 decision- 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-benefit 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. Regional Office 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 attaining program in Program Evaluation Techniques and Critical Path Method Techniques as they relate to the ADP and CHP agency work programs. 3. Model Account System for Ser esource 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 Cate 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 Planning 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. Th6 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 Reqional Office IX i. Participation in a Tri-Regional Technical Assistance contract 2. Develoi)tnent of a Methodoloqy to Review and Ai@@l-lealth Sdrvice Costs. aiiif i lie -ri-n-an-c-,ia-l--Fe-a-'sibility of a Pro4ect Lester Gorsline Associates This contract will address the subjects of rate review, financial information ancial forecasting analysis, budgeting and capital financing, long-range fin and the economic considerations and impact of C[IP 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 Project Review Manual Educational Resources Associates, Seattle, Washington This contract is to develop a manual with a suggested set of criteria for project review and suggested model procedures for the agencies in Region X. To reduce duplication of effort by the Regional office and the CIIP agency, ontent of the review by the Regional Office the manual will also specify the c . 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 Aqreements in Reqion X Arthur Young and Company, Portland, 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 DIlEt4 and Region X DPA's and the operations procedures agreed upon between Region X DPA's and 314(b) agencies to determine if the requirements of Section 1122 have been met. 5. Baseline Set of Data for Health Plan Components State of Alaska, Department of Health & Social Services, Office of Comprehensive Health Planning This data set is primarily for rural areas and will include the following items: 1) Demographic description of areas of Alaska; 2) inventory of health facilities; 3) statement of health needs and 4) list of problems in priority order relating to health facilities. 39 Projects Planned to Advance the State of the Art ment current efforts in developing Projects in this category are to aug the state of the art of health planning with major emphasis on the development of criteria for expensive facilities and services such as radiation therapy and open heart surgery. 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 wi.th@ithe field. Planning_ and Criteria for Health ZS)eerrvvilces a. Planning Approaches, Cr SDeciali @ervices 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. These criteria and standards for planning and project review, as opposed to standards for licensure and accreditation, relate primarily to economic feasibility, cost containment, o erational capability' accessibility and availability p of services. Specifically, the contractor shall develop planning approaches, criteria and standards for each specialized services. In addition, he will design evaluation criteria for the developed approac es, criteria and standards will be field tested in various health planning agencies in accordance with with the plan develop- ment 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, cardiac services, cancer services, stroke services, and intensive care 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- zatiohs 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 proqrams will be visited to develop case studies of how these arrangements evolved and their impact on the institutions involved and the ouality 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 organization,s.for sharing services. 2) An evaluation of these arrangements. 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 Heal th Planning 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 costsi 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 infbr- 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 prbblem-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 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 development and project review, particularly those necessary for the review of facilities and expensive specialized services. The National Center for Health Statistics and the Bur6au 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 primary, secondary and tertiary levels of care, and the impact of each alternative on other delivery components in the s stem, and y b) tools and methodologies to analyze the impact of introducing a new delivery component or changing existing-bnes in the community. For example, if a health planning agency hat determined that its pla nning area needs primary care, it has various alternatives to deliver that care such as hospital outpatient clinics, healt 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 an 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 ret6urces and costs. Fourthly, the contractor will develop a. descriptive model for delivering he alth 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 doveloped--one for health planning agenc staff and y 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 System The f this contract is to establish organized programs .,purpose o 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 needodt assestment 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 1. 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 Development. b. Sources Planninn Lnfo ation The Center for Health Resources Planning Information (CHRPT) 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 exte'nsive literature related to health planning. The Center will carry out the following fundamental operations: 1) Collection., 'processing and analysis operation will include such activities at: (a) acquiring documentary materials; (b) quality screening, indexing and abstract ing 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 ihe full text of publications and reports through hard copy or microfiche.