Business Planning and MAPP

Business planning is indicated for public health organizations that are trying to

1. start new initiatives, that will...
   
2. collaborate with external partners, working together to...
   
3. generate revenue, and ultimately...
   
4. be sustainable (i.e., self-supporting) into the future (e.g., after the grant ends).

Maybe this goes without saying-- but the foundation of a strong business plan is a deep awareness of what the community (or market if you prefer) that you plan to serve actually needs and wants. That's the awareness that processes like MAPP are designed to create.

That's why we are so glad to be working with the Mobilizing for Action through Planning and Partnerships (MAPP) program-- a strategic planning process to help communities understand their community health needs, assets and opportunities, and then take meaningful action on them.

The public health business plan fits in at the "action" phase of MAPP, laying out the details of how a new initiative will work with the various partners, and connecting those details all the way back to specific needs, specific customers, and specific attributes of a community.

I mention all this now because the Management Academy for Public Health is offering scholarships to three MAPP communities this spring-- to come to Chapel Hill for training starting in August. Deadline for applying with your MAPP team is coming up fast, May 15, 2009. In addition to some great management training the team will have the opportunity to develop a business plan with the support of business plan coaches, UNC staff... and a room full of great colleagues from North Carolina and across the country!

Public Health and Health Care and the MAPH

I’ve been toying recently with writing another book or putting out a special issue about the conversation between public health and medicine today: how prevention and treatment are interdependent, what programs are currently under way that depend upon partnerships and collaboration between medical and public health researchers and professionals, and what are the policy implications for state and federal policy makers. The differences between the two fields have always been described as those between population-level issues (like STDs) and individual-level issues (like heart attacks). With the rise of chronic disease, and ever more convincing evidence of how prevention has an impact upon individual health outcomes, the lines are getting blurred.

Some of the recent Management Academy plans that Monecia Thomas described in her last post are great examples of how the two fields are coming together: the primary care clinic being set up by New Hanover County on the same campus as the emergency room; and the Making A Successful Teen (MAST) program dedicated to providing maternity care for pregnant teens, as well as ongoing contraceptive services, support and services for the young fathers, and dental care going forward. That team came to their issue through a desire to provide dental care, which has been linked with health outcomes, including the outcomes of pregnancy.

None of this is easy. There’s a reason many public health agencies are reluctant to provide primary care and dental care: it’s expensive in terms of space and personnel. It’s also difficult to draw in the paying customers who can balance the budget in ways that the poor and uninsured – even if they have Medicaid – can’t always do (particularly in the case of dental care). It is sometimes thought of as a stigma to get your health care at the public health department. In both cases described here, planners thought about this issue. In the case of the primary care clinic on the hospital grounds, users, even those who have a primary care doctor, may find it convenient to visit when their doctor is unavailable. In that case, it’s good that it is a separate facility from the public health agency. In the case of pregnancy services for teens, the team placed the clinic in the area of their county with the highest teen pregnancy rate so that transportation would not be an issue, and it is housed with other public health agency offerings, to protect teens’ privacy.

More and more, prevention is key. Also, individual health problems, if not treated early, have huge impacts on cost for all of society. Both of these Management Academy teams’ projects are promising and impressive ways to address these challenges.

-- Anne Menkens

From the Management Academy Director

Public Health Business Planning is based on the Management Academy for Public Health curriculum. The book and the program culminate in the development of a business plan focused on a public health issue in a community. This year's Management Academy session included 2 cohorts of 9 teams from North Carolina, South Carolina and Wisconsin.
Each of the teams developed their business plan throughout the nine-month program and then presented them to a team of business plan experts, public health professionals and their colleagues.
Here is a brief summary of the business plans:

North Carolina Teams

• Wilkes County Health Department

The team developed an 8-week "Fun and Fit Family Health and Fitness Center" licensed summer day-camp for a maximum of 110 children. The day-camp will be offered to children entering kindergarten through eight grade, five days a week, with operating hours from 7:00am to 6:00pm. The children who attend camp and their families will then be supported through case management and educational sessions by a "Health Coach" throughout the rest of the year. The goal is to increase awareness of the importance of physical activity, good nutrition and family time in the prevention of childhood obesity.

• New Hanover County Health Department

New Hanover County has several safety net options for medical care for the low-income uninsured, but there are not enough to meet the demand. At the same time, the number of low-income uninsured is rapidly growing, especially in this uncertain economic climate. As a result, too many low-income uninsured patients are using the emergency room as their primary care home. The team proposed a Primary Care Clinic at the New Hanover County Health Department, on the same campus as the emergency room at New Hanover Regional Medical Center. The Clinic will treat enough paying patients to subsidize the care of low-income uninsured patients, many of them likely referred from the ER. The Clinic will provide those patients a medical home, relieving the burden on the rest of the safety net.

• Northwest Partnership for Public Health

The team, made of staff from four local health departments, proposed a project focused on a medical billing consultant who will provide services to local county health departments in northwest North Carolina. The consultant will be available to help with coding issues, billing problems, evaluations, consultations and training in various areas. Additionally, the consultant will be able to assist the health departments with credentialing with insurance companies and with third party billing.

• Gaston County Health Department

The team developed a M.A.S.T. Program (Making a Successful Teen) that will provide specialized maternity and contraceptive services for Gaston County teens - tailored to their unique and complex needs. The services provided will include contraceptive services, comprehensive services, comprehensive prenatal services and education, periodontal screening and referral for dental health care. The program will operate using a model of comprehensive, interdisciplinary adolescent health care. The objectives of the program are to decrease the low birth weight percentage for infants born to teen mothers, increase the number of teens in Gaston County that initiate long-term contraceptives, increase percentage of teens in Gaston County that receive adequate prenatal care, increase the percentage of teens that remain in school during their pregnancy and have all program participants receive dental screening and treatment as indicated.

• Wilkes County Health Department

The second team from Wilkes County Health Department developed a program entitled Wilkes Goes Green. The project is a recycling business. The business will reduce the amount of solid waste in the Wilkes County Landfill and generate revenue through the sale of recyclable materials.

• North Carolina Division of Public Health

State and local public health departments experience an overall lack of formal education in public health, and therefore have deficits in core public health skills, including evaluation, epidemiology and statistics. Despite documented evidence of this problem, many state health departments lack funding and flexibility within the government system to ensure a competent workforce. The team developed a program entitled EpiSmart as a cost-effective, convenient, and targeted approach to training local public health department employees in core public health skills and on deliverables required for local health department accreditation. The goals for EpiSmart focus on increasing epidemiology, evaluation and statistics capacity, improving the quality of outcome and evaluation data, equiping local health departments for accreditation and providing an opportunity for peer-to-peer mentoring and learning in evaluation and statistics.

South Carolina Teams

• South Carolina Department of Health and Environmental Control

One of the South Carolina teams developed a worksite wellness program, "Wellness Works". The program will offer employees an opportunity to live a healthier lifestyle. The program will be offered four times annually at 12-week intervals with weekly follow-up with each employee during each 12-week period. The components of the program include a health assessment, with baseline health information, nutrition education with measurements of body mass index (BMI), walking program and the option of participation in a Weight Watchers program at the site defined locations.
By offering "Wellness Works", employees will receive information on the importance and benefits of physical activity, proper nutrition and weight loss/maintenance. The program will provide tools to empower employees to take responsibility for their health.

• South Carolina Department of Health and Environmental Control

Youth obesity is a growing epidemic in South Carolina. Currently, there are no programs dedicated solely to eradicating obesity among children in Spartanburg. The two hospitals do not offer classes or outpatient services to overweight children. The Spartanburg County Health Department will offer "Stepping Up", a weight management program for overweight and/or obese children in the 10-12 year age group. The program will address physical activity, nutrition, and behaviors needed for a health lifestyle. The program will be motivational, hands on and fun-filled and is designed for improving fitness, nutrition and self-esteem.

Wisconsin Team

• Milwaukee/Waukesha County Consortium for Emergency Public Health Preparedness

The team from the Milwaukee/Waukesha County Consortium for Emergency Public Health Preparedness along with local public health agencies will develop and implement a Quality Rating System (QRS) for licensed child care centers in Milwaukee and Waukesha Counties. The centers will receive a rating score after the completion of an on-site assessment of their written plans or proof of their compliance in the areas of: communicable disease prevention, immunization rates and records management, staff education, emergency plans, and early childhood curriculum. Revenue will be generated by fee for services for trainings, plan development, record audits, onsite immunization clinics and selling home emergency preparedness kits.

For more information about the 2 selected Award-winning business plans, see www.maph.unc.edu

The site has the complete business plans posted for the Northwest Partnership for Public Health and the Milwaukee/Waukesha County Consortium.
Please take a look and let us know what you think.

Congratulations to all of the teams that have successfully completed their business plans and now the real work of implementation begins!