Admin and Management EXAM 1

Accountable care organizations (ACOs):

groups of providers associated with a defined population of clients that are accountable for the quality and cost of care delivered to that population.

Alternative payment models (APMs):

payment systems that incentivize value-based care by focusing on reduced costs and high-quality care.

Bundled payment program:

form of insurance payment to healthcare providers that encompasses all costs associated with an episode of care.

Common examples are Medicare's Bundled Payment for Care Improvement and Comprehensive Joint Replacement programs.

Commercial/private insurance:

Privately owned companies that provide indemnity insurance, HMOs, or PPOs.

Copayment:

out-of-pocket payment that the insured is responsible for paying, typically at time of service delivery, and is not covered under an insurance plan

Deductible:

a specified amount that the insured must pay for covered services each year before the insurance plan will pay.

Dualism:

term used to reflect the involvement of both government (at the national, state, and local levels) and private industry in the healthcare system.

Episode payment model:

uses a single payment for all services related to a specific treatment or condition (e.g., a stroke), possibly spanning multiple providers in multiple settings.

Often referred to as "bundling." A single episode of care might include initial hospitalization; rehospitalization; post-acute care; and physician and other services, such as occupational therapy.

Free-market system:

a type of economic system characterized by the principles of supply and demand, competition, and free choice based on information.

Health maintenance organization (HMO):

company that uses a managed care approach to limit unnecessary use of health care by requiring the insured person to choose from a selected panel of physicians, and to get approval from the primary care provider for desired specialty services, including therapy.

High-deductible health plan:

an insurance plan with low insurance premiums but higher-than-typical deductible that requires increased up-front out-of-pocket payment for healthcare services.

Managed care:

method of controlling utilization of health care by requiring approval of hospitalizations and specialty services, as well as by negotiating reduced fees with providers and promoting efficient healthcare delivery.

Medicaid

- state-run program funded by the state and federal governments for people who have limited income or high medical expenses. Also covers nursing home residents who have spent down their assets and cannot afford to pay with their own funds. Eligibility for the limited-income cohort is based on the family income and size in relation to the national poverty level, although states can expand eligibility.

- A state-run program for people who have limited income or high medical expenses. Eligibility for the limited-income cohort is based on the family income and size in relation to the national poverty level, although states can expand eligibility. State-run programs waivers for provision of services under state Medicaid funding for individuals to receive services and supports in the home and community (rather than residing in an institutional setting) are called Home & Community-Based Services Waivers (under § 1915(c).

Medicare:

- federal program for people over 65 years of age who have worked for at least 10 years, and some individuals with disabilities that have lasted for 2 years or more.

- A federal program for people over 65 years and some individuals with long-term disabilities.

Mixed economy:

the type of economic system found in the United States (and elsewhere), where there is both individual ownership and individual freedom but also government control of a significant component or portion of the economy.

Out-of-pocket payment

the direct payment made by individuals to healthcare providers at the time of receiving services.

Patient-centered medical homes (PCMHs):

primary care model based on client-centered, coordinated, team-driven care and supported by strong health information technology (HIT).

Population health:

cumulative health/status data derived by the tracking of outcomes for a group of people as designated by geographic region, medical condition, insurer, or other common characteristics

Preferred provider organization (PPO):

manner of organizing the payment for health services by placing limits on where an insured person can obtain health care and controlling costs by negotiating discounts with providers

Prospective payment:

a method of payment based on a predetermined fixed amount for services provided using a classification system (e.g., diagnosis).

Quadruple aim of health care:

the aim toward improved health care, improved client and provider experience, and reduced costs.

Quality payment program:

payment program that incentivizes providers to meet quality measures by the potential of earning a bonus or incurring a penalty reduction in future payments.

Rehabilitation Services Administration:

A federal agency that funds state vocational rehabilitation and independent living support services, including therapy.

Retrospective payment:

payment to healthcare provider after services have been delivered.

Social determinants of health (SDoH):

nonmedical factors that influence health, such as housing, socioeconomic status, education, access to health care, employment, and social support networks.

Workers' compensation:

A state-administered program for workers injured on the job that provides temporary and permanent disability income as well as coverage of medical and rehabilitation expenses.

Value-based payment:

system in which purchasers of health care hold providers accountable for delivering a high-quality level of care in a cost-effective manner.

Veterans Administration:

Provides inpatient and outpatient care for qualified veterans, and funds care outside of the VA system when the wait for services exceeds the established criterion.

The ACA established a set of healthcare service categories that must be covered by certain plans that came into existence in 2014.

1) ambulatory patient services

2) emergency services

3) hospitalization

4) pregnancy, maternity, and newborn care

5) mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

6) prescription drugs

7) rehabilitative and habilitative services and devices

8) laboratory services

9) preventive and wellness services and chronic disease management

10) pediatric services, including oral and vision care. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace.

Policy statement:

A brief statement of the guiding principle to be communicated

Purpose statement:

A brief statement outlining the reason for inclusion of the policy and procedure

 Scope:

Lists the employee groups to which the policy and procedure apply (e.g., all occupational therapy department staff members)

Materials:

Any materials needed to carry out the procedures outlined

Procedures:

Statements outlining the specific actions to be taken by the identified employee groups and criteria for determining adherence to the policy

References:

Any related policies and procedures that should also be reviewed

Approvals:

Names the and persons responsible for oversight of the policy procedure (e.g., all occupational therapy team leaders)

Implementation date and review date:

Lists the date of the last review and update of the policy and procedure (typically policies and procedures are reviewed on an annual basis)

Formal authority (also legitimate power):

the right to issue orders or direct action by virtue of one's formal position.

Personal power:

power that is separate from the formal authority associated with an organizational position; power that comes from knowledge, personal attractiveness, or demonstration of effort.

Power:

the ability to force compliance to one's wishes through coercion despite resistance

Service competency:

the process of teaching, training, and evaluating through which the OT determines that the OTA or other occupational therapy personnel performs tasks in the same way that the OT would and achieves the same outcome.

Span of control:

the number of immediate subordinates who report to any one supervisor.

Supervision:

the control and direction of the work of one or more employees in a manner that promotes improved performance and a higher-quality outcome.

Factors to Consider in Selecting Rewards and Recognitions

• Investigate and consider whether to reward or recognize an individual or a team or department.

• Don't assume that all persons equally value the same types of rewards and recognition.

• Associate the reward or recognition with specific accomplishments rather than general performance.

• Individualize rewards and recognition whenever possible, such as writing individual thank-you notes or choosing rewards related to an employee's personal interests.

• Consider recognition that demonstrates your personal awareness of the employee's contribution to the organization.

• Provide reward and recognition in a timely manner close to the time of achievement.

Authoritative style of supervision:

one in which the supervisor has absolute say, and the supervisee is expected to comply without question or contribution

Collaborative form of leadership:

prioritizes interpersonal experience and mentorship

Continuum of care:

the delivery of health care over a period of time, such as from diagnosis to end of life

Demonstration:

the process of showing how something is to be done

Direct supervision:

method of supervision in which face-to-face interaction is the key component; may include observation, modeling, co-treatment, discussions, teaching, instruction, and video teleconferencing

Direct observation:

• Observing performance without making real-time changes to the actions being observed

• Observing performance without making real-time changes

• A requirement based on some state laws

• Typically completed on an individual basis, but can occur for groups

EX:

• An OT observes an OTA complete a treatment session in which an interruption would be more distracting to a patient.

• A newly hired OTA is observed completing a portion of an assessment to ensure compliance with previously instructed procedures.

Indirect supervision:

method of supervision in which face-to-face interaction is not a component; may include phone conversations, written correspondence, electronic exchanges, and other methods using secure telecommunication technology (AOTA State Affairs Group, 2021)

Intraprofessional collaboration:

• Collaboration which occurs among members of a team who identify as the same profession

• Prioritizes interpersonal experience and mentorship

• Values a clinician's unique perspectives, clinical experience, personal factors, and problem-solving strategies to accomplish the work

EX:

• An OT and OTA work together on a difficult discharge.

• An OTA with clinical experience with physical agent modalities (PAMs) works with an OT on a TENs protocol.

• An OTA and OT have a sit-down meeting to discuss strategies for a patient who is not progressing with therapy.

Modeling/demonstration:

• Copying the performance of another person

• Modeling can be defined as copying the performance of another person,

• Demonstration can be defined as showing how something is to be done.

• These methods are especially useful when a novel skill is being learned.

EX:

• An OT instructs an OTA on a complex long-arm splint.

• An OTA demonstrates to the OT how to utilize the new Hoyer equipment.

• An occupational therapy practitioner demonstrates a new neuro handling technique he learned at a conference.

Authoritative

• A style in which the supervisee is expected to comply without question or contribution

• Indicated in situations where concrete supervision is indicated, such as outlining required productivity or expectations of performance

EX:

• An OTA is tasked with data collection and must follow strict procedures for validity.

• A supervising OT addresses an OTA.

Occupational Therapist

• Complete screenings

• Complete evaluations

• Administer and interpret standardized assessments

• Develop occupational therapy plan of care

• Develop short-term and long-term goals

• Complete documentation

• Perform reassessments

• Complete treatment planning and execution

• Complete family training

• Participate in interdisciplinary communication

• Complete discharge assessments

• Perform screenings

• Conduct evaluations

• Administer and interpret standardized assessments

• Development of occupational therapy plan of care

• Plan and execute treatment

• Develop short- and long-term goals

• Document treatment

• Perform re-assessment

• Perform discharge assessment

• Conduct family training

• Participate in interdisciplinary communication

Occupational Therapy Assistant

• Treatment planning and execution

• Administering portions of standardized assessments

• Contributing to assessments

• Complete documentation

• Review goals outlined in the plan of care and communicate with the supervising OT when goals are no longer appropriate

• Develop interventions that follow the occupational therapy plan of care

• Complete family training

• Participate in interdisciplinary communication

• Administer portions of standardized assessments

• Develop interventions that follow occupational therapy plan of care

• Plan and execute treatment

• Review goals outlined in the plan of care and communicate with the supervising OT when goals are no longer appropriate

• Document treatment

• Conduct family training

• Participate in interdisciplinary communication

Needs Assessment (RECAP)

- Can be performed in a variety of ways

- Literature, experiences, interviews, focus

groups

- All partners should be included in the

assessment

What is an Environmental Scan?

A tool that can be used to collect data to design health programs tailored to the needs of communities.

An environmental scan can and should be done as part of the needs assessment process.

Mainly used to investigate external factors that are seen as keys to success of a program

Examines social, economic, environmental,technological, & political contexts in regard to the project (Ex: STEEP Analysis)

Mission Statement

1. Why an organization exists or the

function of the organization

2. Who the organization serves or who

it's customers are

3. How it achieves its purpose

Vision Statement

An aspirational message that states what the organization would like to become as it fulfills its mission

Strategic plan Step 1: Outline expectations

Clearly define the organization and business context upfront for all stakeholders to prevent managers and executives from misunderstanding one another and derailing the process.

Outline for your function the responsibilities, process timelines and expected outcomes for each participant, especially in cases where the planning and budgeting processes cross functions

Strategic plan Step 2: Verify the Business Context

Confirm the mission and vision:

Organization mission, which defines your organization's

reason for being and the goals it will continually pursue.

Example: An electric-car maker's mission "to accelerate the world's transition to sustainable energy" reflects its absolute commitment to moving toward sustainable practices and reminds employees of the company's broader purpose.

Organization vision, which embodies the organization's

abstract but realistic aspirations, including underlying values, principles and beliefs that support its decision-making processes.

Strategic plan Step 3: Set Goals and Objectives

Organization strategy translates business aspirations into:

Goals: Individual or combined undertakings that, when achieved, drive differentiated value in the longer term.

Example: Become the largest provider of pediatric

occupational therapy services in Arkansas.

Objectives: Discrete and measurable steps that describe how you will achieve a specific goal (see step 4 for the actions required for this)

Strategic plan Step 4: Assess your capabilities

Identify key functional capabilities required to execute on your action plan. Ask business partners to assess how they perceive your function's strengths and weaknesses. Your assessment and that of your business partners should broadly align. Regardless, generate a prioritized list of functional capabilities to bolster or gaps to fill as a result of your findings

Strategic plan Step 5: Develop an Action Plan

This is the stage at which you take your general assessment of goals and objectives and translate them into detailed action steps with assigned responsibilities. This functional action plan should be a formal document that summarizes the sequence of steps or initiatives required to attain an objective. This is the primary source of information for how you will execute, monitor, control and close out objectives.

Action plans are subject to change once surprise events occur, so be prepared to respond with an adaptive strategy to respond to change as and when you can handle it

Strategic plan Step 6: Set Measures and Metrics

The terms measure and metric are often used interchangeably, but they are different.

A measure is an observable business outcome (for example, employee engagement). Measures allow you to evaluate the efficacy of your action plans. Agree on them in advance to avoid reporting biases.

A metric describes the actual data collected to quantify the measure (say, the percentage of "satisfied" employees according to an annual survey).

Make sure measures and metrics are complete enough to account for a range of variables. For example, don't only use customer satisfaction to measure engagement. Also track critical factors, such as discretionary effort and intent to stay

Strategic plan Step 6: Key Performance Indicators (KPIs)

Key performance indicators focus on how well a business is doing. Without KPIs, it would be difficult for an organization's leaders to evaluate that in a meaningful way and then make operational changes to address performance issues.

Keeping employees focused on business initiatives and tasks that are central to organizational success would be challenging without designated KPIs to reinforce the importance and value of those activities.

In addition to highlighting business successes or issues based on measurements of current and historical performance, KPIs can point to future outcomes, giving

executives early warnings of possible business problems or advance guidance on opportunities to maximize return on investment. Armed with such information, leaders can manage business operations more proactively, with the potential to gain competitive advantages over rivals.

The KPIs different people in the same organization closely follow can also vary depending on their roles. For example, a CEO might consider profitability to be the best KPI for the company, while the vice president of sales might consider the ratio of a sales team's wins vs. losses as the highest-priority KPI.

Different business units and departments are also typically measured against their own KPIs, resulting in a mix of performance indicators throughout an organization - some at the corporate level and others geared toward specific operation

Types of KPIs

Lagging indicators. KPIs that measure the results of business activities, such as quarterly profit and revenue growth, are referred to as lagging KPIs because they

track things that have already occurred.

Leading indicators. By comparison, leading KPIs are those that herald upcoming business developments -- for example, sales bookings that generate revenue in future quarters.

Quantitative indicators. Indicators such as revenue or website traffic can be measured numerically. They're easy to assess and compare over time and are frequently used to monitor progress toward specified numerical targets.

Quantitative indicators provide accurate, data-based insight into how well a company or organization is performing.

Qualitative indicators. Qualitative indicators are more abstract and open to interpretation, such as customer/patient experience with a product or service

Strategic plan Step 7: Put your strategy on one page

Simply and clearly state the key elements of your strategic plan: where the functional organization is, where it is going and how it will get to the future state.

Capture an overview on a single page that communicates how you are adding value today and demonstrates how you plan to impact the business over the next year. Include a statement of strategy, a before-and-after description of the state of your function, one or two critical assumptions underpinning the strategy, and five to seven initiatives required to meet the functional objectives established to support business goal

Strategic plan Step 8: Drive the plan home

Do this by evangelizing the objectives and strategy across your function and company. The one-page strategy template is a helpful tool, as it makes the plan easy for others to consume, but you'll still need a deliberate process for communicating the plan — and ensuring that key constituencies understand and agree with it.

You must develop a clear and consistent message that drives buy-in and commitment among functional leadership and engagement and motivation among the workforce, with all stakeholders clear on how your priorities are changing and why

Strategic plan Step 9: Prepare to respond to change

Once the strategic plan is adopted and shared, it's critical to measure progress against the objectives, revisit and monitor the plan to ensure it remains valid, and adapt the strategy as business conditions change. To do this:

Monitor triggers to track the effectiveness of the strategic plan. Cancel underperforming projects quickly. Track and validate assumptions periodically.

Lastly, make sure you have an agreed-upon action plan for specific steps to take or decisions to make to increase the chances of success when

monitoring triggers an alarm

What is a STEEP Analysis?

A STEEP Analysis is the analysis of external environments of an organization.

● Cost Effective

● Provide a deeper understanding of business

● Alerts to threats

● Exploits opportunities

STEEP Analysis, S

S: Socio-cultural

○ Social forces; create our behavior and what we purchase

○ Influences opinions, behaviors, interests, opinions

○ Here we mention:

■ Structure of the population

■ Competition

■ Increase of global population

■ Traditions

■ Cultural diversity/demographics

STEEP Analysis, T

T: Technological

○ Tech advancements = expectation for instant results

○ Faster information exchange = quicker reactions to

change

○ Here we mention:

■ New technologies

■ Absorptive capacity for innovation

■ Globalization

STEEP Analysis, E

E: Economic

○ National interest rates and fiscal policy is set around

economic conditions

○ Associated with consumers' buying position

○ Here we mention:

■ GDP

■ Price changes

■ Revenues and savings

■ Level of employment

■ Taxes

STEEP Analysis, E pt 2

E: Environment

○ Ecosystem factors

○ Here we mention:

■ Water

■ Power

■ Attitudes towards ecology in society

■ Energy saving technologies

■ Environmental Regulations

STEEP Analysis, P

P: Political/Legal

○ Can create opportunities and advantages

○ Be aware of upcoming shift of power

○ Here we mention:

■ Political situations/stability

■ Regulations and legislations

■ Jurisdictions

■ Trade agreements/Tariffs

What is Marketing?

The process of identifying and communicating to consumers through a set of strategies and techniques intended to attract, persuade and maintain them as purchasers of services and products

First Step: Identify Your Target Market

• Target market is a particular group of consumers at which a product or service is aimed.

• In OT that consists of

- Clients and Potential Clients

- Referral Sources (DR)

- Payers

Second Step: Determine the Marketing Mix

• Marketing mix a combination of factors that

can be controlled by a company to influence

consumers to purchase its products.

• The marketing mix is represented by the "5 P's".

- Product/Service

- Price

- Place

- People

- Promotion

Market analysis

is the use of assessment techniques to understand customers, markets, and marketing effectiveness.

• Internal: SWOT Analysis

• External: Environmental Analysis

Internal: SWOT Analysis

- Strengths: promote and emphasize

- Weaknesses: neutralize and minimize

- Opportunities: convert to strengths

- Threats: anticipate and avoid

External: Environmental Analysis

- Sociocultural Trends

- Demographics

- Economic

- Political and Regulatory Issues