Problem Statement
A public hospital wished to increase access to subsidized health insurance for children of immigrant parents.

Strategic Consulting
Focus groups were designed and implemented to determine the impediments to access. A discussion guide was developed to facilitate the group process. The cultural landscape was addressed by conducting the groups in 3 languages, using physicians who spoke the language as facilitators.

Results
Valuable information was collected and used to design interventions that increased access to health insurance for these youngsters.

Problem Statement
A managed care company wished to improve results with their at risk book of business.

Strategic Consulting
Analyses of network patterns of utilization and cost as well as the internal organization of utilization, disease and case management were conducted by a team of nurses and doctors. Comparisons of utilization against regional benchmarks were also conducted.

Results
Outliers were identified and strategies and a work plan were developed to target problem networks. Recommendations for modifications in staffing and organizational structure, based on national and regional staffing norms, were also made.

Problem Statement
A pharmaceutical company needed a strategy to position a new drug on managed care formularies.

Strategic Consulting
As part of a managed care strategic plan, surveys of managed markets decision makers are key. A survey questionnaire was developed. Phone and email surveys were conducted.

Results
The survey results were tabulated and incorporated into a strategic plan.

Problem Statement
A managed care company wished to implement a pay for performance program to recognize and reward health care professionals for management of their members with diabetes.

Strategic Consulting
The program was designed in consultation with the medical director and a plan project coordinator. Result criteria, data submission criteria and monetary rewards were established. The clinical tracking system was modified to accept the newly defined data. External and internal communication materials were developed. Interdepartmental staff trainings were developed and implemented.

Results
The program was implemented six weeks from the date of inception. Provider relations representatives delivered the information packets to the health care professionals and, in most cases, were well received.

Problem Statement
The same Medicaid health plan above was in the third year of the diabetes pay for performance program. The plan’s continued dedication to improving the quality of care provided to their members led them to enhance their pay for performance diabetes program to include rewards for outcomes in addition to process measures.

Strategic Consulting
National guidelines were used to develop the draft outcomes measures, which were presented to a advisory board of professionals for their feedback. Program design and implementation included development of the criteria and rewards, internal and external communications and training, development of programming steps to effect payment, modifications to the data collection system, chart abstraction and inter-rater reliability of data entry.

Results
Reporting outcomes of care and being rewarded accordingly is expected and accepted by the plan's practitioners. Ever increasing numbers of practitioners have participated since the inception of the program. A few large groups, given the potential increased revenue through this bonus program, have made it a priority to carefully manage the care of persons with diabetes. This pay for performance program is a model for health plans that wish to promote aggressive management of persons with diabetes.

Problem Statement
To build or not to build a behavioral health child and adolescent inpatient unit was the question posed by a hospital client.

Strategic Consulting
The community resented the fact that their youngsters had to receive behavioral health inpatient care a considerable distance from home. JRC Health Care Consultants, Inc. conducted a feasibility study to determine the financial, programmatic and regulatory ramifications to the hospital system of providing care locally. An assessment to establish need was also conducted. Both study results supported an inpatient service but with marginal financial feasibility. It was also determined that regulatory approval would be extremely difficult to obtain.

Results
Much to the delight of the community and the regulators, the hospital agreed to pursue a strategic partnership to develop a partial hospital program for children and adolescents.

Problem Statement
Upon the request of the local behavioral health commissioner, a hospital assumed the operation of a behavioral health outpatient clinic. The clinic was in financial distress and was located in a sub par physical plant.

Strategic Consulting
The clinic needed a complete overhaul—literally and figuratively. In this case, the overhaul entailed a rigorous regulatory CON approval process, marketing, relocation, name change, staff reorientation and financial viability tactics. A work plan was developed and implemented.

Results
Regulatory approval for the relocation and change of ownership was obtained. Relocation and a name change set the stage for aggressive marketing techniques. Staff orientation and participation in the "new and improved" service laid the groundwork for enhanced productivity and increased revenue.

Problem Statement
A community agency wished to develop a program to guide each of its services to identify and implement quality improvement activities.

Strategic Consulting
A review of the existing internal and board committee structure and policies and procedures was conducted. Interviews with management and line staff were also conducted.

Results
A quality improvement program was designed to meet the needs of the agency. The program included a committee structure with responsibilities for each committee. Where possible, the existing structure was used to minimize meeting time. Agenda, meeting and performance improvement templates were created for each service. Training of service managers in the development and tracking of performance indicators took place. Given the turnkey nature of the tools, the agency is well equipped to implement their quality improvement plan.

Problem Statement
A community agency experienced a death of a client and wished to have an outside evaluation of the circumstances surrounding that incident.

Strategic Consulting
A thorough investigation into the care and treatment of the client as well as the agency¹s ability to monitor quality internally was conducted.

Results
JRC Health Care Consultants, Inc. developed a comprehensive report with salient findings and recommendations. The findings were the basis for a root cause analysis and a corrective plan developed by internal staff with coaching by the consultant.

Problem Statement
A Medicaid health plan wished to improve the health of patients living with diabetes, increase health care provider awareness of the issues surrounding screenings, develop nurse case management strategies to assist health care providers in getting services to their patients, educate patients and health care providers about the plan¹s management services and to improve reported quality measures.

Strategic Consulting
The implementation plan included provider and member communication and phone follow up, visiting nurse services, and support to health centers in establishing diabetes screening and education sessions. In addition, monetary incentives were established for providers and a gift of a 100-minute phone card was given to patients to encourage participation.

Results
The screening rates for all four core diabetic measures improved significantly. 79% of patients were screened for A1C, 40% received eye exams, 68% LDL-C screenings and 48% were screened for nephropathy.

Problem Statement
A health plan wished to increase the quality of care for the chronically ill and build stronger community linkages between solo and private practitioners by implementing health tracking registries similar to the Bureau of Primary Health Care¹s Health Disparities Collaborative model.

Strategic Consulting
A master project plan was developed and implemented that included coordination of the activities required to successfully implement the health tracking registries. Other activities included clinical consultation to the IS professionals in the software selection, modification and implementation processes, development of a site-specific project plan, training practice staff in the principals of chronic care management and registry tracking, development of a chart extraction tool, work with evaluation professionals in the design of the evaluation tool, and development of practice report formats.

Results
Five very diverse practices implemented the care model and registry tracking tool. In varying degrees, the model of care shifted from a provider-centric model to a team/patient-centric approach, with improved health outcomes.