MMHA 6475 Week 11 Executive Program Proposal Example

Executive Proposal: A Gated Hospital at Home Pilot for Tamarack Health's Flagship Campus

Student Name

Walden University

MMHA 6475: Program Planning, Implementation, and Evaluation

Instructor Name

Month Day, Year

Executive Proposal: A Gated Hospital at Home Pilot for Tamarack Health's Flagship Campus

Executive Summary

Every winter, admitted medical patients at Tamarack Health's flagship campus spend hours on emergency department stretchers after the decision to admit, and the system's own four-hour standard is missed for a large share of them. Hospital-level care at home, developed at Johns Hopkins and tested in a randomized trial, treats selected acutely ill adults at home with twice-daily nurse visits, daily physician rounds by video and a 24-hour command center; studies have reported outcomes comparable to inpatient care at lower cost (Leff et al., 2005; Levine et al., 2020). This proposal requests approval of a pilot at the flagship campus for patients with five common conditions, followed by a staged expansion contingent on readiness gates and the first evaluation review.

The program would require about $650,000 in one-time start-up costs and about $1.97 million a year in fixed operating costs, with variable costs of about $1,150 per episode. At an illustrative revenue of $7,800 per episode, it breaks even at about 297 episodes a year, roughly 62% of planned capacity. Its success would be judged on seven objectives covering reach, adoption, delivery, safety and sustainability, with readmission, cost and boarding hours evaluated against Tamarack's sister campus. All figures are illustrative or slots for the system's own data.

Decision requested: approve the pilot at the flagship campus, the start-up budget and the build phase; authorize the steering group to proceed past each readiness gate when its checks are met; and schedule a leadership review of the 12-month evaluation before any expansion beyond the second hospitalist group.

Need

The needs case documented the gap with three records the system already keeps: monthly boarding hours, midnight medical occupancy and length of stay for the five pilot diagnoses. National data show that boarding rises steeply as occupancy approaches capacity (Janke et al., 2022), so modest reductions in occupancy during peak months can shorten waits substantially. Adding beds would take years and capital; an observation unit would help mainly short stays. Home care fits the gap's seasonal, condition-specific pattern.

Goal and Objectives

The program's goal is safe acute treatment at home for patients who qualify, which in turn opens medical beds when they are scarcest. Seven objectives, organized by the RE-AIM dimensions (Glasgow et al., 1999), make the goal measurable: offer the program to 60% of eligible patients and achieve 40% acceptance; have two of three hospitalist groups referring by month 9; complete 90% of scheduled nurse visits on time; keep escalation at or below 8%; keep readmissions no higher than for matched inpatients; and, by the eighteenth month, carry the program's running costs in the campus's regular budget. Targets will be confirmed after the baseline review.

Logic

Figure 1 in the full proposal shows the logic diagram: inputs such as nurses, paramedics, video rounding, the command center, kits, delivery contracts, health record build and a payer agreement lead to screening, home visits, rounds and escalation response, which produce completed episodes and then, arrow by numbered arrow, the outcomes the program is meant to change. The arrow most at risk runs from completed episodes to freed beds and shorter boarding. It depends on enrolling patients who would otherwise occupy beds at the busiest times, which the launch plan and evaluation are both designed to test (Chen, 2015).

Launch Plan

The build phase, months 1 to 5, creates the clinical protocol, health record tools, delivery routes, kits, staffing, command center and payer agreement. Gate 1 checks that each is complete and that staff report commitment to the change and confidence in carrying it out, the two elements of organizational readiness Weiner (2009) describes. The pilot, months 6 to 11, enrolls patients from one hospitalist group within 20 miles. Gate 2 checks safety, fidelity and the second group's readiness. Expansion follows in two stages through month 18. The sister campus stays out of scope as the comparison site.

Budget

Start-up costs total about $650,000, including health record build, kits, training, the command center and contract review. Recurring fixed costs of about $1.97 million cover nurses, command center staff, hospitalist time, a program manager, a pharmacist and the technology platform. Variable costs average $1,150 per episode. Break-even depends mostly on volume, which is why adoption by additional hospitalist groups is a launch priority. The value of freed beds is not counted in the break-even and is treated as a separate benefit.

Monitoring and Evaluation

Four core components, twice-daily nurse visits, daily video rounds, escalation response within the protocol window and first-dose delivery, are monitored weekly against thresholds, along with penetration, acceptability and cost per episode (Proctor et al., 2011). Outcomes are evaluated at 12 months: readmission and cost by difference-in-differences against the sister campus (Dimick & Ryan, 2014), and boarding hours by interrupted time series with a second analysis at 24 months. Fidelity results travel with the outcome results, so a weak finding can be read as either a problem with the model or a problem with how it was run.

Sustainability

Programs funded by launch money often end when it does. The maintenance objective requires that recurring costs move into the flagship campus operating budget by month 18. Three conditions must hold: volume near the break-even point, a payer mix that includes at least one commercial agreement besides Medicare, and a 12-month evaluation showing safety. If Medicare's authority to pay for hospital care at home changes, the steering group will bring a revised budget to leadership within one quarter. The proposal asks leadership to treat the program, if it succeeds, as part of the system's inpatient capacity rather than as a special project.

Appendices

Appendix A: full launch task table with owners, dates and dependencies. Appendix B: budget detail, start-up and recurring, with break-even sensitivity at 240, 297 and 360 episodes. Appendix C: alignment crosswalk linking each objective to the needs case, logic diagram, launch tasks, budget lines, fidelity measures and outcome indicators, with the revision log and glossary. Appendix D: the clinical protocol, including eligibility criteria, the visit schedule and escalation rules, approved by the medical director. The appendices are referenced by page throughout the body, so a reader can move from any claim in the summary to the evidence behind it.

References

Chen, H. T. (2015). Practical program evaluation: Theory-driven evaluation and the integrated evaluation perspective (2nd ed.). Sage.

Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401-2402. https://doi.org/10.1001/jama.2014.16153

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Janke, A. T., Melnick, E. R., & Venkatesh, A. K. (2022). Hospital occupancy and emergency department boarding during the COVID-19 pandemic. JAMA Network Open, 5(9), Article e2233964. https://doi.org/10.1001/jamanetworkopen.2022.33964

Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Inouye, S. K., Greenough, W. B., III, Guido, S., Langston, C., Frick, K. D., Steinwachs, D., & Burton, J. R. (2005). Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of Internal Medicine, 143(11), 798-808. https://doi.org/10.7326/0003-4819-143-11-200512060-00008

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67