# Presentation: 011907

## Demonstrating Benefits to Your Network's Members

**GSU - Rural Health Network Development Technical Assistance Program Conference Call****October, 2003**
**Gregory Bonk, President**
**HMS Associates**
**Getzville, NY**

## Adapted from the 
Real-World Benefits of Collaboration Session*
at the
Health Resources and Services AdministrationOffice Of Rural Health PolicyAnnual Grantees Meeting Washington, DC
August 22, 2003

*One of the highest rated sessions at the conference

**Real-World Benefits of Collaboration Session***
**at the**
**Health Resources and Services Administration****Office Of Rural Health Policy****Annual Grantees Meeting**** Washington, DC**
**August 22, 2003**
***One of the highest rated sessions at the conference**

## Potential participants

- Rural Health Networks - learn how to focus your energies and identify and deliver benefits to your members
- State Offices of Rural Health - learn how to encourage collaboration as a basis for meaningful change
- Critical Access Hospitals - learn about potential new beneficial relationships between you and your support hospital

- HMS Associates

## Preparation for discussion

- Think about the benefits your network is expected to deliver to the community and each member
- Identify your biggest obstacles
- Review this presentation
- During the Q+A, ask about ways to identify benefits, fast-track your objectives, and sustain needed programs

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## Presentation phases and topics

- Phase I. Key concepts for developing networks, collaboratives and partnerships (Slides 6 - 19)
- Phase II. Tools: Mapping current member interest and benefits, identifying new benefits, and fast-tracking program development (Slides 20 - 41)
- Phase III. Network management concepts and tips (Slides 42 - 57)
- Each phase is 25 to 30 minutes - 20 minutes for presentation followed by 5 to 10 minutes for Q+A.

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## Phase I. Key concepts

- Collaboration as a means for change
- Principles of collaborative action
- Lessons learned

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## Collaboration as a means for change

- Nature of collaboration and networks:
- No single agency can accomplish the goal
- Collaboration occurs between similar types (horizontal) of health care providers, i.e., hospitals; different types (vertical) of health care providers, i.e., CHCs and Substance Abuse Clinics; and different “pillars of the community”, i.e., healthcare and faith-based
- Agencies collaborate to the extent to which they, and the communities they serve, benefit from participation

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## Collaboration within the pillar

- Substance Abuse Services
- Public Health
- Hospitals
- Community Health Centers
- Physicians

- Horizontal

- Vertical

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- Collaboration between pillars

- Pillars of the Community

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## Collaboration

- Participation of independent agencies or different pillars of the community is not only desirable but MANDATORY for success
- Participants have unique roles that only they can perform

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## Principles of collaborative action

- I. The critical nature of benefits
- II. Understanding your network’s dynamics
- III. How networks work

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## Goals, objectives and benefits

- Goal: The over-riding shared vision
- Objectives: How you get there — attain the vision
- Benefits: The importance of the objective to each member of the network or collaborative

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## Benefits

- Agencies participate to the extent to which they, and the communities they serve, directly benefit:
- Quality of Care
- Financial Viability
- Market Share
- Stability — Mission critical
- Community Image
- Spirituality or Wellness
- Success (benefits) generates sustainability

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## Benefits

- The benefits that each member expects to receive must be recognized by all
- The quality of care benefit in one sense is a given
- How the network will improve quality must be stated
- Although less altruistic and “PC”, other benefits, specifically, financial, market share, and stability, should not be under-valued.
- Why not? Maslow’s Hierarchy of Benefits

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## Maslow’s Hierarchy of Benefits

- Level 1 – Physiological needs: Financial, market share
- Level 2 – Safety needs: Stability
- Level 3 – Love and belongingness needs: Community image, wellness
- Can not reach Level 3 unless 1 and 2 are reached. Financial, market share and stability benefits should not be under-valued.

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## Needs/benefits Hierarchy

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## Lessons Learned

- Never too early to identify benefits.
- Emphasis on process management, i.e., listening, empathizing, and relationship building, can be counterproductive. How many members of your collaborative will provide financial support because you are a good listener who understands their concerns?
- By their nature, collaboratives have high process requirements but they are a means to an end. How much energy do you place on managing relationships versus delivering benefits?
- As you provide benefits you build relationships rather than vice versus.

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## Critical balance: Process and benefit

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## Critical balance: Monitoring progress and benefits 

- Formally report on workplan each quarter
- Formally assess progress toward expected benefits
- Formally re-assess member interests and potential new member benefits - semi-annually - See Universe Checklist Tool

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## Phase II. Tools

- Mapping current member interest and benefits
- Identifying new benefits
- Fast-tracking development

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## Mapping member interests and benefits

- Identify or reaffirm core participants
- Compelling needs
- Identify and share expectations
- Benefits
- Mapping tools

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## Member interests by program

- Program Type

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## Member benefits by type

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## Benefits beyond getting the grant

- Some members thought that getting the grant was the benefit for the community
- Assess each members own priorities
- Show them how their own priorities relate to the grant’s objectives: a network health care benefits counseling program brings approximately $4,000 to service providers per year for each new covered individual.
- If the relationship is in fact minimal, recognize that and focus on members whose priorities are similar to grant objectives or adjust priorities

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## Interest and benefit maps

- Interest map shows who’s most likely to be involved, perceives objective as compelling and must act - core resource
- Benefit map shows type of motivation - is a preliminary self-sustainability check in that member attaining better financial results are most likely to be the core for a hard money -  dues/fees structure
- Track financial benefits

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## Interest and benefits mapping:Interest, compelling needs

**See Excel Shareware: HMS Benefits Map.xls**

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## Mapping: High priority (interest) equals locally compelling

**See Excel Shareware: HMS Benefits Map.xls**

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## Mapping and documenting: benefits and roles

**See Excel Shareware: HMS Benefits Map.xls**

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## Adjusting objectives

- Health care market place is ever-changing
- Objectives must be relevant
- If interests is waning in general, re-assess member and community needs
- Have you ever thought about:

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## Universe of collaborative potential

- “Within the box”

- See Universe Checklist Tool

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## Fast-tracking program development and self-sustainability

- Capacity assessment
- Best practice assessment
- Timely action plans
- 3 to 5 months to complete

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## Fast-track Model

**3 to 5 months**

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## Capacity assessment - members as resources

- What does each member bring to table
- Staff
- Programs
- Facilities
- Technology
- Access to special populations

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## Best practice assessment

- Program specific
- Talk with other collaboratives/networks but be sure that their programs and experiences relate to your community: A centralized access point to a closed system is very different from one to an open system.
- Literature review
- Federal technical assistance programs

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## Relevancy

- Rural
- Type of members - horizontal/vertical
- Cultural sensitivity
- Resource requirements
- Development and operational issues
- Self-sustainability
- Lessons learned

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## Selection of model

- Use the most relevant as a model
- Shape to local conditions
- Design/build only when circumstances warrant
- Time
- Money

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## Tools:  Fast-track questionnaire

- Internet based: Inexpensive, best response rate
- 1. What are your organization's major priorities for 2003/2004?
- 2. Do any of these priorities pertain specifically to (special population) or (community)? If so, which one(s)?

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## Questionnaire

- 3. The collaborative is working on five major objectives with financial support from the federal government. Please rank from 1 to 5 with 1 being the most important to your organization and 5 being the least important.
- Inappropriate ER use
- Access to primary care
- Condition of neighborhood
- Substance abuse services
- Community wellness
- 4. What tools or resources may your organization bring to the table to help address these objectives?

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## Complex collaborative results - objectives - overall interest

- High ranks/bars are high interest

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## Complex collaborative results - objectives by type of agency

- High ranks/bars are high interest

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## Action plan

- Meet with interested members
- Discuss best practice model
- Discuss their potential role
- Revise or adjust as needed
- Act

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## Phase III. Network management concepts and tips

- Guiding concepts
- Principles of network development
- Compelling needs
- Incrementalism
- Management tips
- Interest in network approach
- Asking members for financial support
- Competition between members
- Cooperation of network agency staff
- Inertia
- Power brokers
- Self-sustainability

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## Principles of network development

- Organizations participate in networks to the extent to which they benefit: strategically, financially, mission critical programs
- Participation will vary by member
- Membership will contract and expand over time
- Membership needs and expectations should be assessed annually and network program emphasis should be adjusted accordingly
- Both centralized and decentralized capacities are useful
- Objectives requiring changes in the internal operations of network members are labor and time intensive

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## Compelling needs: Must be locally determined

- Eminent closure of hospital
- Entry of urban providers or plans in community
- Extremely high infant mortality rates
- Extremely fragmented care: similar immunizations in 1 month
- Extremely high rates of diabetes
- Need to maintain obstetrical capacity to keep local employers
- Extremely high insurance premiums
- Extremely high levels of people with no insurance
- Eminent loss of physicians
- Extremely high levels of accounts receivable/rejected claims

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## Incremental growth - small stepsNortheast Alliance

- Initial reason for the network (1990)
- Severe lack of primary care
- Eminent closure of public hospital
- Service Area
- Primary 22,000 people
- Migrant workers
- Hill tops and valleys - many radio “dead spots”
- High poverty + unemployment
- Lead Agencies
- Two hospitals, county public health

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- Incremental benefits

**Self-sustainability**

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## Collaborative Management: Answers to FAQs

- Interest in network approach
- Asking members for financial support
- Competition between members
- Cooperation of network agency staff
- Inertia
- Power brokers

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## How can I get agencies to be more interested in the collaborative?

- Describe how the collaborative’s programs correspond to the needs of their agency and the community it serves
- Ask them about their top five priorities
- Relate their priorities to these programs
- Recognize that all may not be interested but may become more interested as the network provides benefits to its members
- Do not try and convert everyone to the need for a collaborative. If essential agencies will not participate, develop work-arounds or place a lower priority on the program

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## We are in our third year and I have a difficulty asking my members for financial support.

- Start discussing benefits and self-sustainability in the first six months of the grant period
- Horizontal networks should have dues and fees as an integral part of their business plans.
- Focus immediately on objectives which:
-  Have potential financial benefits to your members
-  Address realistic outsourcing needs of network members

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## Some network members are competing in some ways with other network members. How can I deal with that?

- Collaborative programs can always be contaminated by outside unavoidable competition between members
- Consider competition to be an issue only if it negatively effects your program
- Competing parties start to use network as a battleground and automatically disagree with each others action
- Competitors want to withdraw from programs unless one drops out
- If unavoidable, suspend action plans and examine options

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## How can I get the staff of network member organizations to cooperate?

- CEOs should be unwavering in their support of collaborative programs when these programs impact the internal operations of their organizations. If the CEO is not committed, do not expect staff to be
- CEOs should not be expected to provide details on day-to-day operations of their agencies
- Involve all types and levels of staff in the planning and implementation process, for example, clerical, administrative, and clinical staff
- Be prepared to adjust activities to conform to the terminology and procedural requirements of the participating agency
- Examine the issues staff raise regarding plans and adjust plans as needed

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## We do not seem to be accomplishing much and commitment is weakening. What steps can be taken to revitalize the network?

- Action plans should contain both short term - one year - and long term - three year - objectives
- Celebrate the small successes - development of MOUs, completion of surveys/assessments, meetings with key parties, development of deliverables in workplans
- Examine the source of inertia - bad plans, members are not doing what they said they would, lost funding, staff, or objectives are no longer important or feasible
- Change is incremental
- Recognize that if the collaborative cannot provide benefits that it may not be needed in its current form

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## I’m being torn apart by the two power brokers on the board.

- Re-examine the collaborative vision: mandatory participation
- Obtain input from other board members
- Consider multiple approaches to consensus: Other interested parties, previously unidentified benefits

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## Self-sustainability

- Successful programs are the basis for self-sustainability
- Many programs will not be self-sustainable
- Programs which provide significant financial benefits to their members are the most likely candidates for hard money support: dues or fees
- Community health status improvement programs are the most difficult to find hard money support for. Soft money, grants, is more likely
- Complimentary worksheets and network development consultative services are available from Greg Bonk at
- 	(716) 688 - 8448 _[consulthms@aol.com](mailto:consulthms@aol.com)__ _
- Visit us at www.askhms.com

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