Relationships Between
Business Planning & Total Force
Management
23 September 2009
Manpower Conference Presentation
1
Agenda
• The Strategic Importance of Aligning Total
Force Management (Manpower & Personnel)
with Business Planning
• The Relationship Between Total Force
Management and the Tri-Service Business
Planning Tool (BPT)
• The Impact of Total Force Management on the
on the Business Planning Process-Real World
Examples
• Way Ahead
2
Navy Medicine
Business Planning
3
BLUF
(The Hummer vs. Prius)
• Accurate Validation of Quality Manpower/Personnel Data is critical to the success of achieving
Navy Medicine’s Strategic Priorities.
– Fiscally Responsible and Efficient Family Centered Care
– Mission, Functions, and Task
– Standard Organizational Compliance
– Validated Authorized Manning Document (M1 Annual/Quarterly Requirements)
– Accurate DMHRSi Data
• Successful Manpower/Personnel Management will Result in Achievement of Strategic
Priorities, Improved Healthcare Outcomes, and Optimization of Healthcare Resources.
– 70 percent of our cost of providing the healthcare is labor
– Managing to Pay-Roll
• Continuous Monitoring and Analysis is Required to Identify Manpower/Personnel Opportunities
for Improvement.
– Development and Measurement of Quantifiable Metrics
– The Relationships Between Operational Commitments and Labor Cost
• Defining the Cost and Impact of Operational Commitments will Enhance the Awareness of the
Organizational Leadership & Staff, and Allow for Contingency Mitigation for Maintaining the
Benefit.
– Individual Augmentation (IA)
– IA’s verses Teams
4
Designing for the Future
Business Planning Process
3rd and 4th Quarter
Business Planning (BP) Process
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
Guidance
Guidance
Issued
Issued DOD/Health Affairs Guidance BUMED Guidance
1. issued issued
Annual BP BUMED/IMS BP
Annual BP AMD Review
Tool Tool Training
Tool
2. Training
Training
Required
BP
BP
3. Submission
Submission
Timeline
Timeline MTF Begin BP BP
BP Submitted to Submitted to BP Submitted to
Development Regions BUMED by TROs
Regional
Commanders
Peer Review
Peer Review
and BP
and BP
4. Reconciliation
Reconciliation
Community Hospitals Clinics FP Teaching MED CTRS OCONUS
*Mission Specific Command BPs to be
considered in BP Process
5
2003: Business Planning Initiated, 2005 BPT Application Developed
Business Planning Tool
(BPT)
6
BPT Measurements
• Several measures are available through the tool
– Enrollment
– RVUs
– RWPs
– FTEs
– DWVs (not in BPT)
– Financial Impact
– Etc.
• For those that are not available, supporting
applications are available (M2, EAS IV, etc.)
7
Staffing in the BPT
• BPT is populated with data from EAS IV (fed by DMHRSi).
MTFs are given what their baseline values are from the
EAS IV data
• Requires MTFs to identify the skill type, skill type suffix,
personnel category, Service Occ Codes, MEPRS3 code,
assigned FTE and available FTE.
• MTFs can then change either the assigned or available
FTE, but it is done either manually or by uploading a
manually generated .csv file (A LOT OF WORK!).
• Far easier to have data fed correctly into EAS IV to
minimize time spent correcting data in BPT.
• The FTEs are used to project workload at each MTF; this
determines PPS funding. Have the wrong number of FTEs
listed and you will receive the wrong amount of funding for
the work you do.
8
Environmental Scanning
9
Market Production and FTEs
MTF A MTF B MTF C MTF D MTF E MTF F MTF G MTF H MTF I NAVMED
FY07 104,645 309,455 242,738 136,253 106,224 133,712 139,104 53,547 46,048 1,444,345
Eligibles 40 Mile Catchment FY08 107,016 305,615 240,403 136,797 145,263 67,104 147,460 55,591 47,097 1,436,391
FY10 118,532 301,294 242,223 140,019 150,546 65,804 145,841 54,596 47,697 1,448,278
FY07 39,262 110,559 90,232 61,533 35,002 41,752 52,066 31,579 13,906 755,714
Enrollment* Parent MTF FY08 27,387 109,387 90,962 60,399 33,132 42,059 49,311 33,115 13,204 735,818
FY10 27,387 109,522 91,000 58,842 33,860 48,153 57,696 34,750 13,439 748,133
FY07 218.2 388.5 375.4 140.0 103.9 94.4 138.3 89.6 76.3 2,353.6
Available FTEs** Type 1 and 2 FY08 220.8 265.0 395.0 174.9 139.6 107.6 132.2 85.3 66.4 2,429.1
FY10 285.0 254.7 393.6 174.1 146.9 107.2 151.4 87.9 66.4 2,541.3
FY07 813,497 1,304,489 1,473,992 563,057 480,097 444,753 492,891 306,050 252,810 8,661,356
Direct Care FY08 723,926 1,322,256 1,530,545 540,158 472,157 416,646 540,333 325,068 307,955 8,790,480
FY10 717,000 1,326,897 1,614,442 550,225 494,142 429,580 601,748 333,906 313,368 8,981,798
RVUs**
FY07 85,491 232,636 157,109 252,656 152,024 140,152 212,816 71,987 2,720 2,136,163
Purchased Care FY08 51,979 282,246 202,176 298,814 168,460 180,557 224,611 81,454 2,941 2,399,392
FY10 51,979 291,267 196,456 286,999 159,526 207,036 262,576 79,841 2,990 2,422,753
FY07 11,393 15,612 15,629 2,601 3,767 2,012 2,359 1,560 2,771 63,253
Direct Care FY08 10,104 14,926 15,462 2,523 3,478 1,866 2,425 1,627 2,592 60,183
FY10 9,767 15,678 15,554 2,681 3,754 1,997 2,512 1,634 2,605 61,456
RWPs
FY07 928 1,371 1,414 2,577 1,283 1,767 1,707 952 106 22,704
Purchased Care FY08 493 1,839 1,433 2,553 1,112 1,617 1,799 755 40 21,793
FY10 493 1,969 1,423 2,684 846 1,755 2,003 801 41 22,305
FY07 198,404 558,286 585,837 194,648 29,974 187,152 55,243 105,307 15,835 3,681,025
Direct Care
FY08 236,753 620,911 731,459 214,192 45,644 213,688 85,706 98,778 28,244 4,300,403
DWVs
FY07 1,870,967 3,065,719 2,378,153 7,375,272 2,798,251 2,671,610 308,935 371,650 666,188 30,253,210
Purchased Care
FY08 2,371,392 1,539,249 6,076,484 6,499,887 1,050,451 2,833,236 358,593 389,933 500,207 31,804,008
10
Market Production and FTEs
(Continued)………
MTF A MTF B MTF C MTF D MTF E MTF F MTF G MTF H MTF I
FY07 3,728 3,358 3,926 4,022 4,621 4,711 3,564 3,416 3,313
RVUs/FTE* FY08 3,279 4,990 3,875 3,088 3,382 3,872 4,087 3,811 4,638
FY10 2,516 5,210 4,102 3,160 3,364 4,007 3,975 3,799 4,719
FY07 256 295 283 76 76 61 74 47 82
Staffed Beds FY08 219 295 338 87 71 42 69 47 82
FY10 219 295 268 54 71 42 69 47 82
Occupancy Rate (Bed
FY07 41% 61% 63% 41% 52% 34% 41% 35% 36%
Days/Adjusted
Maximum Annual FY08 61% 56% 53% 28% 60% 56% 44% 36% 37%
Beddays) FY10 63% 58% 68% 56% 63% 61% 46% 38% 38%
11
High Cost/Volume Product Lines
MTF A MTF B MTF C MTF D MTF E MTF F MTF G MTF H MTF I
FY07 186,909 421,510 477,516 285,379 201,515 249,784 211,732 117,319 94,563
RVUs
FY10 137,687 412,686 514,460 269,117 198,148 234,858 215,605 122,044 110,085
FY07 55.9 131.6 118.2 71.6 49.4 49.8 64.6 33 30.9
FTEs
FY10 62.8 73.4 113.5 87.9 62.9 50.9 58.2 31.8 23.4
FY07 3,344 3,203 4,040 3,986 4,079 5,016 3,278 3,555 3,060
RVU/FTE
Primary Care FY10 2,192 5,622 4,533 3,062 3,150 4,614 3,705 3,838 4,704
Empanelment
(Enrollment/Primary FY07 702 840 763 859 709 838 806 957 450
Care FTEs) FY10 436 1,492 802 669 538 946 991 1,093 574
FY07 16,954 29,241 19,919 26,680 23,775 15,696 23,629 11,326 651
RVU (PC)
FY10 10,002 41,317 21,443 31,837 31,610 23,997 25,041 15,706 759
FY07 14.0 33.0 18.2 6.0 8.0 3.3 6.7 3.5 5.6
FTEs
FY10 12.8 24.5 20.7 6.9 11.9 2.9 6.9 5 6.5
FY07 76,168 139,783 120,366 30,211 44,707 18,623 33,022 16,604 24,625
RVU (DC)
FY10 74,463 139,103 116,322 28,526 51,651 16,523 37,584 21,247 39,049
FY07 5,441 4,236 6,614 5,035 5,588 5,643 4,929 4,744 4,397
RVU/FTE
FY10 5,817 5,678 5,619 4,134 4,340 5,698 5,447 4,249 6,008
OB/GYN
FY07 2,312 3,252 992 15,860 5,794 7,300 7,085 1,300 18
RVU (PC)
FY10 376 5,749 1,166 16,762 1,066 12,067 7,438 937 43
FY07 1,417 2,848 2,466 726 1,254 468 880 452 675
RWP (DC)
FY10 1,362 2,934 2,159 833 1,173 414 909 428 660
FY07 149 192 101 580 126 241 424 161 3
RWP (PC)
FY10 13 134 93 494 59 321 556 172 4
FY07 16.2 46.6 35.8 12.6 10.8 7.4 17.6 6.9 9.2
FTEs
FY10 37.2 31 41.1 15.9 15.9 9.9 16.7 6.5 9.3
FY07 85,651 157,231 154,030 58,786 56,314 45,727 65,517 24,799 34,944
RVU (DC)
FY10 83,114 152,888 167,507 65,769 55,090 43,338 77,529 28,550 39,387
FY07 5,287 3,374 4,303 4,666 5,214 6,179 3,723 3,594 3,798
RVU/FTE
FY10 2,234 4,932 4,076 4,136 3,465 4,378 4,642 4,392 4,235
ORTHO
FY07 16,009 18,616 21,537 46,237 22,986 27,473 63,776 12,252 71
RVU (PC)
FY10 7,231 35,522 49,989 51,482 23,911 44,556 77,420 11,214 44
FY07 1,468 2,502 1,636 187 600 237 118 124 360
RWP (DC)
FY10 1,172 2,821 1,638 173 409 591 133 112 304
FY07 210 134 148 397 290 321 246 50 0
RWP (PC)
FY10 44 160 176 385 218 355 411 57 3
Current State
• Total Available and Assigned FTE’s by MEPRS Codes
• Data shows a significant decrease in available compared to
assigned FTE’s in the B codes
• Total E code FTE’s average 29% & Total B code FTE’s average
26% of total FTE’s
12,000
10,000
2003
8,000 2004
2005
6,000
2006
4,000 2007
2008
2,000
0
Available
Available
Available
Available
Available
Available
Available
Assigned
Assigned
Assigned
Assigned
Assigned
Assigned
Assigned
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
FTEs
13
A B C D E F G
Current State
• Data shows a significant decrease in Skill Type 1 Provider FTE’s
available in the B Codes
• Does the decrease in available Total and Skill Type 1 FTE correlate
to what is seen in workload trends and PPS earnings?
• How good is the data?
2,500
2,000 2003
2004
1,500
2005
2006
1,000
2007
500 2008
0
Available
Assigned
Available
Assigned
Available
Assigned
Available
Assigned
Available
Assigned
Available
Assigned
Available
Assigned
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
Sum of
14
A B C D E F G
Defects – Recall Alerts
• Currently we do not have one easily minable system that
provides visibility of total force billets, bodies and FTE’s
• Current systems do not have common business rules
and are not reconciled
• Example below is current data from one MTF
FTE's by
Provider Specialty Code RVU's
Occupation Codes
Chiropractor 2,756 0
General Surgeon 3,604 0
Emergency Physician 14,868 0
Gastroenterologist 1,904 0
Flight Surgeon 522 0
IDC 2,972 0
Entry level Nurse Practitioner 138 0
15
Psychiatric Resident 1,861 0
Access to Care
Family Practice (BGA)
Access Command A Command B
Access to Care-Booking Success Rate 44.4% 55.8%
Access to Care-Patient Appts. with PCM 40.8% 41.2%
Access Management-Clinic Cancellations 3.5% 6.2%
Access to Care-3rd Avail. Appt. (Specialty) 100% 66.7%
28 Days
Access to Care-3rd Avail. Appt. (Wellness) 92.3% 100%
28 Days
Access to Care-3rd Avail. Appt. (Routine) 62.5% 100%
7 Days
Access to Care-3rd Avail. Appt. (Acute) 60.0% 83.0%
24 Hrs.
2008-Encounters per Average Avail. FTE 1,035.69 1,608.47
2008-Average Enrollment 29,076.25 27,596.67
RVUs per Average Avail. FTE 854.79 1,015.85
Appointment with PCM 35.7% 41.7%
16
Insight and M2 Data July 29, 2009
Average Available FTE’s:
Two Teaching Facilities
Command A Command B
BGA FY2008 FM 1-9, FY2008 FM 1-9
FY2009 FY2009
Skill Type 1 Assigned 15.83 17.50 8.38 8.96
Available 27.48 26.05 9.41 6.32
Skill Type 2 Assigned 6.39 7.43 7.31 7.61
Available 5.23 6.40 9.74 3.70
Skill Type 3 Assigned 8.19 8.56 6.10 13.93
Available 5.68 6.18 6.82 13.20
Skill Type 4 Assigned 26.43 20.56 18.30 19.39
Available 20.81 16.78 26.77 3.66
Skill Type 5 Assigned 12.29 8.10 3.49 3.93
Available 12.44 10.01 16.62 15.50
17
M2 Data Aug, 2009
NAVMED FTE Changes from
FY08 to FY09
Clinical Specialty: FY08 FTEs FY09 FTEs
Surgery/Medicine
General Surgery 100.46 159.38
OB-GYN 114.97 153.58
Orthopedics 102.48 127.90
Emergency Medicine 91.77 133.33
Internal Medicine 101.67 137.48
Psychology 115.85 161.18
•M2 Data Aug, 2009
•Skill Type 1 - 5 18
•Available FTEs
Way Ahead
• Development of a Population Based
Business Planning Model.
• Alignment of Total Force Management with
Business Planning Priorities:
Mission, Function, Task Development
Accurate AMD Validations
Mind Set of Management to Pay-Roll
Development of Key Monitoring Metrics
Identifying Relationships Between
Operational Commitments and Labor Cost
19
Designing for the Future
QUESTIONS?
20