• Partnered with a privately funded regional medical research group and a major state university-sponsored medical school.
FCH has become aware of the VeriSM™ approach and is applying the concepts to support its digital transformation efforts. As part of the governance activities, FCH has defined its mission (purpose and reason for being). The mission is to improve the health of the communities they serve. Additionally, the vision (what we aspire to be) is to be a national leader for health by 2025. The strategic enablers (the capabilities that facilitate strategic execution to meet the vision) and values include:
• Strategic enablers:
✓ People;
✓ Critical thinking;
✓ Innovation;
✓ Agility;
✓ Information Technology;
✓ Finance.
• Values:
✓ Excellence;
✓ Integrity;
✓ Compassion;
✓ Teamwork;
✓ Respect.
Note: the values listed will help to define the Service Management Principles.
This complex, sophisticated and vital health system is accredited through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). However, one of FCH’s hospitals is in jeopardy of losing the accreditation and is to be audited within the next 30 days. Additionally, FCH (the non-profit portion) maintains an Aa3 credit-rating from Moody’s Investors Service and an AA rating from Standard & Poor’s (S&P). Health premiums for medical insurance from the health plan rank in the lowest quartile when benchmarked against regional competition.
The strategic direction of the organization, in order to fulfill the health care system’s vision, is to ensure that all services (for example hospital functionality, insurance programs) are streamlined, secure and take full advantage of technology enablers. There are currently several system-wide strategic initiatives, including:
• Continue to meet the criteria for Accountable Care Organizations as defined by the Patient Protection and Affordable Care Act of 2010 (the 2017 repeal efforts are not highlighted in this case).
• Continue to grow – the success of FCH has created ever-increasing use of the clinics and hospitals as well as the health insurance program. As such, there is an opportunity to merge 1-3 new hospitals into the current organization.
• Expand proactive health programming to the communities through partnership with various public and private sector businesses (for example after school programs for all grades, prison healthcare, Senior and Assisted Living programming).
• Upgrade their Electronic Medical Record (EMR) system to comply with Meaningful Use Stages 1 and 2 requirements stemming from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
• Upgrade their inpatient revenue systems to comply with the Department of Health and Human Services’ (DHHS) latest round of Electronic Data Interchange (EDI) standards (“ICD-10”) stemming from the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
• Create an Enterprise Compliance Office headed by a Chief Compliance Officer (CCO) responsible for ensuring compliance with U.S. Federal regulations, JCAHO requirements, and corporate policies (for example HIPPA, EMR, patient information security, and enterprise information security).
FCH is structured as follows:
Office of Strategic Development (OSD)
The OSD ensures that the corporate strategy is reflected in a corporate plan and in departmental planning. This office conducts market research and competitive analysis to ensure FCH remains on target for achieving national recognition as a health leader by 2025. The OSD is responsible for the development of annual goals and objectives and assesses their progress on a quarterly basis. This office works closely with the CEO and shareholders ensuring their vision and values are reflected appropriately. This office oversees all strategic initiatives.
Organizational Capabilities
Human Resources (HR)
The Human Resource departments are key areas within FCH. Separate HR departments support the medical and the insurance areas. Each group utilizes a different software platform to provide the necessary knowledge, tools, training (for example onboarding, new skills), administrative services (for example tracking vacations/time off, shift management, performance measures), coaching, legal and management advice, and talent management oversight (for example recruiting, promotions, benefits). As each capability functions independently, they do not share any functionality or recordkeeping. The only cross-over between the HR capabilities is during the onboarding process when the two divisions present a unified view of FCH.
The capabilities’ main function is to manage the scheduling of FCH’s approximately 22,500 staff members and volunteers as well as ensure each staff member and volunteer has the appropriate training and skills. There is a robust training and refresh program to ensure compliance with various regulatory and accreditation requirements. Additionally, on the medical side, there is a critical training initiative for the upgrades to the EMR system. Ongoing training occurs for all volunteers to ensure the FCH’s values and processes are fully embedded within all volunteers.
Finance
Within FCH, there are two separate financial departments supporting the medical and insurance divisions. The Chief Financial Officer (CFO) sits within the medical division and, with the financial team, is accountable for the performance of both divisions. Planning and auditing (internal and external) are performed by the CFO and the financial team. Day-today financial activities, including monthly consolidation is performed within each division. The CFO and team in the medical financial division are responsible for producing FCH’s consolidated financial statements as well as the strategic forecasting activities. The medical division’s financial functions are further broken into sub-departments: accounts payable, accounts receivable, procurement, collections and reimbursements. The insurance division has a similar financial structure but also manages premium payments and awards claims against policies. A centralized corporate payroll group sits in the medical division.
Payroll works closely with the HR departments in both divisions to calculate accurately staff work hours, set salary or hourly rates, manage vacation and sick leave time, ensure adherence to the appropriate tax laws, and dispersal of paychecks. As both divisions are heavily regulated, there is a strict internal and external auditing program to ensure compliance.
Currently, the medical Information Technology (IT) department reports to the CFO. There is growing internal support to restructure and hire a CIO to send a message to the entire organization that IT is responsible for innovation and developing solutions to fit today’s digital environment.
Marketing
FCH’s Marketing department is very active and quite successful in its internal and external campaigns. This group was critical in the initial success of the insurance programs as well as the success of online capabilities supporting patients and the insurance clients. Continued growth of FCH is clearly dependent on the creative planning and delivery of critical information. There is an initiative to expand the current insurance offerings catalog with specialty plans to supplement current offerings.
Marketing also depends on the IT teams to provide the necessary technologies to deliver their developed communications. FCH is depending on Marketing to put together a campaign to communicate