Environmental Assessment

Environment assessment is a process used to scan, identify, forecast, and assess the impact of external forces in a health care organization’s environment. An EA is a planning tool that may be used for development purposes, contract negotiations for reimbursements, or revenue enhancement.

Influence on Capital Needs Environmental Changes Socio-Political
Technology Competition Mission
Regulatory Economic Resources

Development

Staffing needs analysis is a critical component of planning and an environmental scan may provide a view of organizational strengths and threats in a particular service area. Other considerations are deployment of technology, capital needs, and organizational design.

While in the Southwest, Roberta Winter worked with a consortium of community health clinics to assess penetration of indigent care services based on select disease groups. At risk patients were identified and encouraged to access sponsored disease management programs in order to improve health outcomes and reduce unpaid and under reimbursed charges.

Contract negotiations with providers

Reimbursement contracts must account for all types of reimbursement in order to accurately project population data and forecast revenues and expenses. For most providers this means estimating the number of uninsured and indigent served in addition to other contract reimbursements. This is especially true for primary care organizations that serve large numbers of Medicaid patients. It is vital that under reimbursement be properly accounted when estimating charges for negotiated reimbursements with insurers.

Roberta Winter has substantial experience examining insurance company and third party reimbursement contracts for private employers in the following states: Washington, Oregon, California, Hawaii, Virginia, Massachusetts, and Texas. She has also worked for a large hospital network examining reimbursement levels for value creation proposals at the executive level.

Revenue enhancement

An environmental scan may reveal the adequacy of Federal government reimbursement for rural or indigent health care populations is less in the Pacific Northwest than for other service areas. There are thirty-four programs for DHHS that reimburse for these characteristics . Additionally, there are grant programs specifically for service development in high poverty counties under the Consolidated Health Center Program. Four million dollars will be awarded by September 1, 2007 for this program, with an average grant of $80,000 . This grant would help an organization finance a planning role for one year or hire a consultant to help a nonprofit group with program development. There is an additional twenty-four million to be granted, with an average grant of $600,000 for organizations who develop new health care services in high poverty communities. Approximately twenty percent of the U.S.A. population is represented by this measure.

The Health and Human Services Administration provides planning grants for organizations that are providing health care in high poverty areas. Impacts may include shortages of primary care providers, migrant worker population, proportion of community served without insurance, and unreimbursed care.

Pulling it all together

An outside consultant can help your organization objectively identify areas of opportunity, weaknesses, and threats. Market research, sizing of impacts and creation of a work plan are services available for environmental assessments.

Roberta Winter has experience as a project manager who has conducted market and regulatory research for health care organizations. These skills provide a consolidated source point for a client who wishes to perform preliminary research for policy, capital projects, or other contracting needs. In addition to research and project management skills she is trained in measuring potential outcomes, especially in qualitative areas.

Included with this synopsis is a list of recent projects Roberta Winter has worked on for health care organizations, along with references.