RL RMP Workshop: Responsibilities | Tad aaa ee Regional Medical Program for Western New York - New Goals and Objectives m1 telah) ee ¢Putting It All Together Page 3 January, 1972 on nN 13 19 23 29 32 33 35 Contents Part 1 Foreword Part 2. Why A Workshop Part 3. How The Workshop Was Organized The Agenda Part 4 Introductory Address: Irwin Felsen, M.D., President, Health Organization of Western New York, Inc. Part 5 Executive Director’s Address: John R.F. Ingall, M.D. Regional Medical Program for Western New York Part 6 Regional Medical Program Mission Statement Part 7 National Review Criteria Part8 RMP’WNY Goals and Objectives 1972-1975 Photomontage of Workshop Activities Part 9 Comments of Workshop Participants Participants NOTE: On March 1, 1972, the name of the program was changed from Regional Medical Program for Western New York to Lakes Area Regional Medical Program, Inc. 1. Foreword The following document gives a description of the organization and purposes of the Regional Medical Program for Western New York (RMP/WNY) Workshop held September 23-24, 1971, at the Holiday Inn in Fredonia, New York. The theme of the conference was “Responsibilities in Health Planning.” About 50 health professionals affiliated with the RMP/WNY from throughout the Western New York-Pennsylvania region, including members of the Health Organization of Western New York, Inc. (H.O.W.N.Y.) Board of Directors, participated. At the Workshop, the mission of the RMP was reviewed, the framework for decisions established for the future, and priorities set. Participants considered the new concepts of the RMP mission and discussed the needs of our own region in the light of this understanding. This conference provided a forum for the critical review of the Pro- gram’s newly proposed goals and objectives. The Board of Directors of H.O.W.N.Y., Inc. adopted the new goals and objectives on October 14, 1971. H.O.W.N.Y. serves as the Regional Advisory Group (RAG) to the Regional Medical Program for Western New York. Our sincere thanks are due to all those who participated in this extremely successful Workshop. John R. F. Ingall, M.D. Executive Director Regional Medical Program for Western New York Dr, Ingall 2. Why a Workshop? Regional Medical Programs across the nation are currently pursuing new directions. Locally, areas of emphasis encouraged by the original legislation (P.L. 89-239) are being reconsidered in order to align future activities with national priorities in meeting the health care needs of the region. These proposed changes were thoroughly discussed with members of the Regional Advisory Group, the RMP staff, and other interested health professionals from throughout the region at a two-day conference held in Fredonia, New York, away from the distractions of the central office. We originally achieved our identity upon the categorical labels of Heart Disease, Cancer, Stroke, and Related Diseases. The need to subsume these categories in broader policies was seen as a major change in our program emphasis. By participating in RMP planning, those at the Workshop gained the understanding needed to implement proposed changes. An outcome of the workshop was a statement of goals and objectives upon which the Regional Medical Program for Western New York could act over the next three years. Guidance was sought in the RMP Mission Statement, which serves as a basis for interpreting the law, and in the National Review Criteria, which serve asa guide to local management. The conference was an educational exercise that resulted in better understanding of the Regional Medical Program. This understanding is the basis upon which beneficial changes in our operation can be implemented. Dr. Felsen 3. How the Workshop was organized The groundwork for the September workshop was laid the previous summer, when RMP staff met with each member of the Regional Advisory Group (RAG) and with members of the county committees. These personal meetings brought awareness of the new purposes and directions of RMP to RAG members. They provided an opportunity for discussions of health care problems in our region and of new approaches to solve these problems. Important insights brought back by staff members heiped shape the work- shop agenda. Committees of the core staff of RMP/WNY and of the Regional Advisory Group considered the issues to be discussed and developed an appropriate agenda. They cooperated in the preliminary planning necessary for a successful workshop. A set of suggested goals and objectives was pre- pared that would stimulate comment. The agenda provided topics to be considered and a general time-frame, but left enough flexibility to take advantage of spontaneous discussion. It was decided to divide the participants into three groups for discus- sion of the proposed goals and objectives. The group leaders were: Edward F. Marra, M.D., Chairman of the Department of Preventive Medicine, School of Medicine, State University of New York at Buffalo; Herbert E. Joyce, M.D., Past President, H.O.W.N.Y., Inc., general practitioner; and Alan Drinnan, M.D., D.D.S., Professor, Chairman of the Department of Oral Medicine, School of Dentistry, State University of New York at Buffalo. The sessions were vigorous, lasting well into the night. On the second morning, group leaders presented to the workshop the results of the three evening sessions. A concensus was reached by the work- shop on substantive issues; the three group leaders formed a committee to reconcile small points of difference among the reports and developed a final statement of goals and objectives. These were accepted as modified by the RMP/WNY Regional Advisory Group on October 14, 1971. In the final session of the workshop, an executive committee selected the proposals most pertinent to the goals and objectives that had been developed. Request for funding these selected projects was included in RMP/WNY’s triennial grant application. esteageanedt al The Agenda Thursday, September 23 12:00 Lunch 1:00 Welcome: Irwin Felsen, M.D., President, H.O.W.N.Y., Inc. 1:30 John R. F. ingall, M.D., Executive Director, Regional Medical Program for Western New York 2:00 RMP Mission Statement 2:30 Discussion of RMP Mission Statement: Dr. Felsen 3:00 RMP National Review Criteria 3:30 Discussion of RMP National Review Criteria: Dr. Ingall 5:00 Executive Session 6:00 Hospitality Hour 7:00 Dinner 8:30 Group Discussions Friday, September 24 8:00 Breakfast 9:00 Summary Report of Three Group Sessions 10:30 Executive Committee Meeting 12:00 Adjournment From left to right, Miss Kellberg, Dr. Felsen, Mrs. Hoff Dr, Felsen 4. Introductory Address Irwin Felsen, M.D., President, Health Organization of Western New York, Inc. Some days ago Dr. John Ingall, our director, in a personal conversation, asked me to put down on paper my ideas and feelings about the RMP. The timing could not be more appropriate because | vividly recalled the lessons reflected from my heritage at this time of Rosh Hashana, the New Year. Our teachers exhorted us: “Repent and examine your consciences. Seek new directions through examination of your heritage. Seek interaction with others rather than thinking only of yourself.” And so, with much thought, | express myself on the subject of RMP, thusly: It is a recurring paradox of our present world with its overwhelming scientific, economic, and social complexities, that so many responses to human problems are so easily simplified. We tend to complicate the simple and to make the complex simplistic. The dangers of over-simplification extend into so many areas today, that one can be isolated briefly here— Man’s misuse of his most singular gift of language. Bureaucratic language, like jargon as a whole, is immoral because it is deceptive and avoids the complexities of the real world which it attempts to explain. Political language is largely the defense of the indefensible—and every issue, insofar as it involves any attempt to be persuasive or convincing, is a political issue. The decay of language into vague, trite, insincere expression is directly re- lated to political confusion on every level. The uncertainty of our times is not made easier by pompous, round-about and distorted phrasing. The solu- tion is that the re-ordering of Society can begin at the verbal level if we will return to concreteness of expression. But Washington, of course, is merely one obvious realm in which the immoral and inhuman use of language to obscure rather than to express the truth is apparent. We are constantly fed confusing clarifications. Double Talk Obscures Double talk seems to be the lingua franca of social scientists, lawyers, university administrators and Madison Avenue. Among many intellectuals, labored obscurantism is rapidly becoming pandemic. The art of non- communication, deftly wielded, quickly changes the trivial or obvious into something seemingly significant, occult, and worthy of a research grant. Caution as well as dishonesty motivate much of our jargon and euphemistic language. (Why say spit when we can say expectorate?) Those of us involved in this workshop recognize that the best we can do for the membership is to force them beyond caution, to take a stand on issues, to risk an opinion on what they read and hear (and also to learn about them- selves in the process). If we need a rationale for a workshop of this kind it is that man learns about himself by seeing how he interprets other things. | trust all of you will be fully critical and perceptive, and make meaningful choices. Express yourselves clearly and honestly that we might be better able to bring order to the complexity of the health care system. The outlook is not all dark. continued 10 Introductory Address Program Benefits Questioned Recently, at one of our Board meetings, as well as on the Senate floor, hard questions were raised about the usefulness and efficiency of HEW’s programs. Former HEW Secretary Abraham Ribicoff, now a Democratic Senator from Connecticut, told the Senate, and | quote: ‘What disturbs me—with each passing year | am more and more disturbed—is whether or not the bills and the programs we pass here are really accomplishing the objec- tives we think they are. | think one of the tragedies is our failure to ever repeal a law that has been passed. Instead we continue to pass more and more such laws.” Much of the blame for the undoubted waste and inefficiency at HEW (and elsewhere in government for that matter) must be laid at Congress’ doorstep. Hundreds of millions of dollars are Spent every year by HEW for what may be called “planning and conferring” programs whose ultimate benefit to the consumer is questionable. When cost conscious administrators suggest paring such activities they are greeted with congres- Ribicoff noted that some $31 billion will be Spent this year at all levels of government on poverty programs. And yet, it is questionable whether any of these programs have removed a single person from poverty. “It might be intriguing for senators to contemplate that if we eliminated all these pro- grams and bureaucracies, and divided the $31 billion among the people who are under the poverty line, every family of four would receive a total of $4,800, almost $1,000 over the poverty line. We would eliminate poverty completely in America. Perhaps the time has come for all of us to start taking a very hard look at these programs instead of automatically. con- tinuing them. But with each passing year, | am more and more convinced that it is incumbent upon us in the Senate to be more critical of the actual performance of many of the programs we pass.” continued a2 Introductory Address Caution Urged And so at a time when Congressmen are starting to try to outbid each other on massive new programs for national health care, we should raise some cautionary flags about the kind of programs that are really needed and can do the most good. The nation doesn’t know yet why the existing huge outlays on medical care do not produce better results. And it could use more evidence before rushing into a radical restructuring of the entire medical care system. Who determines eligibility or necessity for medical care? What are our health problems? Do we suffer from too few doctors or is the problem one of maldistribution both geographically and in terms of specialties? Poverty itself causes much physical and emotional illness. Is poor health in the slums a medical problem or, rather, a sociological one? Does not this problem involve better housing, jobs, education, example, and habit? A thousand of the best doctors in the world could march into the slums of any big city with the best intentions and without any discernible improvement. There are no easy solutions until we begin to solve the problems of the community. We must not ignore all the complex social forces at work. Too much of our money gets swallowed up in terms of just keeping alive ideas that -are no longer truly pioneering and ought to be shifted to private expenditure. We need a greater role for consumer involvement in the delivery of health care. We need in our health agencies a conception of how other program sectors outside of the medical service area relate importantly to health. RMP Key Program Now, there should be many ways in which the present medical care system can be intelligently and humanely improved, and these needed and useful improvements can be made within the context of a continued pluralistic system. We need not assume that our proposals and recommenda- tions at this workshop will introduce a Utopia. However, | am convinced that the RMP may be the key Federal program around which all these problems will pivot. We must also get accustomed to the idea that RMP depends on other structures and is not standing by itself. And we should resist being pulled into areas where our competence is limited. We have an opportunity to make RMP and H.O.W.N.Y. the key program for moving in- telligently and successfully to improve the health care system. This is a conference in the sense of setting goals and priorities. Where are we going and how do we get there? We must be both pragmatic and visionary as well as innovative and experimental. Though this is not a sensitivity training program, | ask of you to participate as equals. Let us not act without conviction.D 11 5.Executive Director’s Address John R.F. Ingall, M.D. Regional Medical Program for Western New York Ladies and Gentlemen: | would like to endorse Dr. Felsen’s welcome. | would also like to take this opportunity to stress that the staff of the RMP/WNY have provided for you as clearly as possible some indications on the way we should look to making future decisions. | might add that if the arguments and intramural lobbying are a capsule of things to come, we are heading for a very active session. In earlier discussions we have had a number of concerns presented to us, namely, the multitude of Federal programs that have health components and difficulty of coordinating these. An even greater and more nebulous issue has been forcefully brought to my attention, namely, the concern by the physician that in treating the medical manifestations of the social ills, he will be considered as culpable for those ills. Perhaps he is, but only in part. | am quite sure that the voices of my colleagues, raised in concern, bespeak a genuine desire to work for solutions. We cannot today venture into the aforementioned. We are convened to make decisions on the goals, objectives, and priorities of this WNY/RMP. These must reflect your constructive suggestions and give guidance to the Board of Directors of H.O.W.N.Y. who, as you know, are the final decision- making body of the RMP/WNY. The Agenda Committee of the Board has been responsible for the sequence that will follow and it is hoped that digression from the program will be limited to the break time and cocktail hour. We have a great deal of serious business before us, to reiterate Dr. Felsen’s comment. My job today is to give you some of the legislative back- ground to the RMP. In my view, ability to look back and see change is a prelude to looking forward and effecting change. Furthermore, a program like ours which started off with a label of “another source of funds” or ‘money for heart, stroke and cancer” has changed. | am sure many of you will remember how we started. We had to identify, and rapidly, the needs in our Western New York area. We did not have a systematic means of doing so. What we did was called consensus planning. Furthermore, we had to develop a mechanism of project review, regional involvement and decision-making; staff competence and the concept of an integrated total program. Re-examine Objectives You are here today because facets of our total program are being discussed. We are reviewing our objectives, namely, where we are going, and we have to decide on restating these clearly and succinctly. Furthermore, we are also deciding on how we reach these objectives, the tactic, and the priorities we see in doing this. In somewhat school-boy language, our health objectives, i.e., what we are going to do, and secondly, and most important, our program objectives, namely, how we are setting about doing this, have to be refined and reappraised. continued 13 14 Now having decided on where we are g and how we are going to get there, we have to decide on a flexible hanism of priorities. We can all respond to setting our priorities as of date. What is vital in conducting our program in the future is that the priority mechanism has the ability to reflect change. For example, our priorities for RMP may be influenced and recast by the achievements of other programs. In effect, what | am saying is a clear priority today may no longer be so in a year’s time. It is the mechanism for reflecting this in our program upon which we need your informed participation and guidance. Categorical Emphasis Now to the legislation. The original law, P.L. 89-239 was one which was highly categorical in nature, and by categorical | mean that it defined certain disease areas in which we should make some of our prime efforts. It was clearly interpreted as a means to translate or transfer the results of clinically applicable scientific progress for the benefit of the patient. It was interpreted very dominantly as the hand maiden to continuing medical education and in some areas this remains the view. Dr. Robert Marston, to the best of my recall, coined the phrase “science to service” as a simple description of the RMP. What better method to transfer this than continuing medical educa- tion? We responded to the categorical emphasis and the need for trans- mission of usable measures, discoveries, or concepts to the patient. Initial projects were the Telephone Lecture Network and the Coronary Care Program. We used as our motto “‘communication means cooperation means science to service.”” Communication is essential if we are to obtain coopera- tion and cooperation is the essential precursor for applying science to service. | think communication still has a major role to play in the conduct of our program. Today | trust we will communicate and reach understandin even if we do not reach agreement. It is no good my talking if you don’t hear “and 1? you do hear, you may Trot understand. If you do not understand you cannot respond, at least, not in the terms of what has been presented. | suppose the people are very often vociferous because of their ability to be so in the absence of hearing. We meet this in the medical school ogcasionally.. — Early Projects Under the old legislation we have developed projects which have been successful. The early projects were not necessarily related, but sincere attempts were made to relate them using the guidelines then at our disposal. As the projects became greater in number, so did the staff, and indeed, their competence. It’s gratifying to look back on a small closet, 6 by 12 with two occupants. In effect, the projects that we had, and have had over the years, were the stepping stones to a program. Under the continuation resolu- tion in Washington and the extension of the RMP law, we now see ourselves evolving as a total program, and not just a series of successful, isolated grants: a program that can not only define a need but promote mechanisms to satisfy that need. Total Program The total program is the mechanism whereby we use the information that we have mustered in the past few years and will continue to use in the future. We will use this information, this data, to state our objectives and, indeed, decide upon priorities. continued Executive Director’s Address Now this, with your help of course, is what we are about today. | hope as a result of this workshop, we shall do three basic things: 1) agree upon our goals and objectives; 2) agree upon our priorities; 3) gain an insight that will enable H.O.W.N.Y., the RAG to this RMP, to make basic decisions upon our currently approved but unfunded projects, and to decide on how they fit into our revised criteria. This is especially true in relationship to a number of projects approved a year ago which may receive a totally different ranking in relationship to the decisions to be made here over the next 24 hours. RAG Decision The decision is, of course, the responsibility of the RAG, namely, H.O.W.N.Y., who are the prime authorities as to our needs in this Western New York area. There are many authorities as to our needs and many of them are here. It is important that our projects within the total program are not what the nebulous Washington says we should have, but what we say we should have! This does not, of course, mean an absolutely free hand. We have the law to refer to, the interpretation of our program in relationship to this law, and the Mission Statement—something we will come to later on this afternoon. | think | should reiterate that the decisions are the final responsibility of the Board members and the material here in front of you is intended to help guide those decisions. RMP Impact Now the new law is not so important as the manner of its implementa- tion—how it is to be effected. It is a modification of the old; it specifies kidney disease, it specifies participation of the Veterans Administration, and the review and comment required from the Comprehensive Health Planning Council. ’ll come back to this briefly later. What | would like to mention to you now is some of the discussion that has been going on at the executive level and in the two Houses of Congress. At the hearings in Washington the case for RMP was made with considerable impact. This was equally so at the Committee on Interstate and Foreign Commerce of the 91st Congress. The full Senate Appropriations Sub-Committee requested an increase of $40 million over the House appropriation and it has become patently obvious that both the Senate and the House of Representatives saw the RMP as a vital and viable component throughout the country. It was “‘a viable link between the Federal mechanism and the private and voluntary agencies.” This was very encouraging because, as you know, many of us were wearing drab clothes with the feeling that RMP was moribund. The House Appropria- tions Sub-Committee agreed to $102.8 million for RMP to which should be added a $34.5 million carry-over which adds up to $137.3 million. This is not bad, of course, in a year when we anticipated approval of only $70 million. In addition to this, and in order that there would be no mistake with regards to both Houses of Congress in their support, an extra $10 million supplement was added to the carry-over which brings us to a figure of $147.3 million. continued 15 16 Executive Director's Address The Mission Statement to which Dr. Felsen will refer gives clear indication as to the way in which we should implement our program. The National Criteria, which we shall also run through this afternoon, gives further indication as to the interpretation of the law. The word ‘‘subsume” by the way, seems to be a Washington vogue word, It is passed across my desk so often that I relish using it. | think it sate to we-emphasize that projects which are presented to the RMP or, indeed, which we seek, must relate to established needs and clearly fit the program which we have defined today. The impact that these decisions may have on the delivery process, may subsume all the categories in which the RMP attained its identity. | have now used my word! Focus on Patient A nurse does not have to tend exclusively cancer or coronary patients, and transplantation may properly be the province of a transplant surgeon} rather than the anatomical subcategory from whence he emerges. New con- cepts that embrace the patient as a total component rather than the disease as an incident in his history would appear to be the way that things are going. At no point in our thinking must the population to be helped, be they the providers, or through them, the patients, be forgotten. We will still remain a patient-oriented program. Now, I’ve touched on the legislation in general terms because | am convinced that the interpretation of the legislation is much more exciting than those familiar with the original document would ever have conceived. During the coming year | think we can anticipate — | am sure we can anticipate, — an expanding role for the RMP. Local autonomy in decision- making is but one step in this direction. The equity of our investment and furthermore the visibility of it in times of restricted funds, should be very seriously considered. We have got to decide how to widen our portfolio, how not to put too many eggs in one basket or, for those of you who: have investment interest, too much money in a doubtful issue. continued Dr, Fischman Dr. Drinnan Executive Director's Address Attack Identifiable Problems Finally, | would like to just make a comment from Dr. Merlin DuVal who, some of you will be aware, has taken over the role of Assistant Secretary for Health and Scientific Affairs. He, of course, is now the person to whom &cretary Elliott Richardson looks to for a great number of deci- sions. And he has said recently, “In the area of social progress as in the practice of medicine, we have witnessed the development of an incredible interdependence among parts of the public body, and we have learned the treatment of one segment without the consideration of the whole can result in great harm. This kind of recognition produces growing impatience with pie-in-the-sky solutions which some have offered as therapy for the afflic- tions suffered by our health care mechanism.” He goes on to say that we should tackle our ailments constructively, restricting ourselves for an increasingly positive attack on problems that we have successfully identified thus far. Now, Miss Elsa Kellberg will give you an idea of what resources we have used in our local diagnosis and Mrs. Patricia Hoff will present for your consideration and discussion, our goals and our objectives. This evening you will find yourselves divided into three groups to discuss these objectives and our own proposals. | think it very important to make this point at this time—that none of the deficits we see or that we define are pointed out in an accusatory fashion; they are part of our local diagnosis. We don’t want you to miscon- strue this any more than we would scold someone for having a hot appendix or chide someone for manifesting the measles. ; | hope you will provide us with the guidance we need to capitalize on the expertise of those present. This certainly is going to influence the Board members of H.O.W.N.Y. in its decisions and they, of course, will give us the instructions on how to implement these decisions. Finally, you’ve all seen the RMP change and in my view change is healthy. The capacity to encourage it is even healthier. Money (and this is the first time | dare mention it) is a matter that will inevitably raise its head. Money is restricted and | feel it should be plain to all those present that the money available has got to be used in a manner that will really give us the best possible return for our investment and the best possible way of giving identity to this RMP for the benefit of the community in the Western New York area. 17 6.RMP Mission Statement (This statement was used as the basis of discussion for the Workshop) The initial concept of Regional Medical Programs was to provide a vehicle by which scientific knowledge could be more readily transferred to the providers of health services and, by so doing, improve the quality of care provided with a strong emphasis on heart disease, cancer, stroke, and related diseases. The implementation and experience of RMP over the past five years, coupled with the broadening of the initial concept especially as reflected in the most recent legislation extension, has clarified the operational premise on which it is based — namely, that the providers of care in the private sector, given the opportunities, have both the innate capacity and the will to provide quality care to al! Americans. Given this premise, the purpose of this statement is to specify (1) what Regional Medical Programs are, (2) what their evolving mission has become, and (3) the basis on which they will be judged. RMP — The Mechanism RMP is a functioning and action-oriented consortium of providers responsive to health needs and problems. It is aimed at doing things which must be done to resolve those probiems. RMP is a framework or organization within which all providers can come together to meet health needs that cannot be met by individual practitioners, health professionals, hospitals and other institutions acting alone. It also is a structure deliberately designed to take into account local resources, patterns. of practice and referrals, and needs. As such it is a potentially important force for bringing about and assisting with changes in the provision of personal health services and care. RMP also is a way or process in which providers work together in a structure which offers them considerable flexibility and autonomy in determining what it is they will do to improve-health care for their com- munities and patients, and how it is to be done. As such, it gives the health providers of this country an opportunity to exert leadership in addressing health problems and needs and provides them with a means for doing so. RMP places a great corollary responsibility upon providers for the health problems and needs which they must help meet are of concern to and affect all the people. continued 19 20 RMP — The Mission RMP shares with all health groups, institutions, and programs, private and public, the broad, overall goals of (1) increasing availability of care, (2) enhancing its quality, and (3) moderating its costs — making the organization of services and delivery of care more efficient. Among government programs RMP is unique in certain of its salient characteristics and particular approaches. Specifically: (1) (2) (3) RMP is primarily linked to and works through providers, especially practicing health professionals; this means the private sector largely. RMP essentially is a voluntary approach drawing heavily upon existing health resources. Though RMP continues to have a categorical emphasis, to be effec- tive that emphasis frequently must be subsumed within or made subservient to broader and more comprehensive approaches. it is these broad, shared goals on the one hand and the characteristics and approaches unique to RMP on the other, that shape its more specific mission and objectives. The principal of these are to: (1) Promote and demonstrate among providers at the local level both new techniques and innovative delivery patterns for improving the accessibility, efficiency, and effectiveness of health care. At this time the latter would include, for example, encouraging provider acceptance of and extending resources supportive of Health Maintenance Organizations. Stimulate and support those activities that will both help existing health manpower to provide more and better care and will result in the more effective utilization of new kinds (or combinations) of health manpower. Further, to do this in a way that will insure that professional, scientific, and technical activities of all kinds (e.g., informational, training) do indeed lead to professional growth and development and are appropriately placed within the context of medical practice and the community. At this time emphasis will be on activities which most effectively and immediately lead to pro- vision of care in urban and rural areas presently underserved. Encourage providers to accept and enable them to initiate regionalization of health facilities, manpower, and other resources so that more appropriate and better care will be accessible and available at the local and regional levels. In fields where there are marked scarcities of resources, such as kidney disease, particular stress will be placed on regionalization so that the costs of such care may be moderated. Identify or assist to develop and facilitate the implementation of new and specific mechanisms that provide quality control and improved standards of care. Such quality guidelines and per- formance review mechanisms will be required especially in relation to new and more effective comprehensive systems of health services. continued Even in its more specific mission and objectives, RMP cannot function in isolation, but only by working with and contributing to related Federal and other efforts at the local, state, and regional levels, particularly state and areawide Comprehensive Health Planning activities. Moreover, to be maximally effective requires that most RMP-supported endeavors make adequate provision for continuation support once initial Regional Medical Program grant support is terminated; that is, there generally must be assurance that future operating costs can be absorbed within the regular health care financing system within a reasonable and agreed upon period. Only in this way can RMP funds be regularly re- invested. RMP — The Measure It follows that the measure of a Regional Medical Program, reflecting as it does both mission and mechanism, must take into account a variety of factors and utilize a number of criteria. The critera by which RMP’s will be assessed relate to (1) intended results of its program, (2) past accomplish- ments and performance, and (3) the structure and process developed by the RMP to date. A. Criteria relating to a Regional Medical Program’s proposed program, and the intended or anticipated results of its future activities, will include: (1) The extent to which they reflect a provider action-plan of high priority needs and are congruent with the overall mission and objectives of RMP. (2) The degree to which new or improved techniques and knowledge are to be more broadly dispersed so that larger numbers of people will receive better care. (3) The extent to which the activities will lead to increased utilization and effectiveness of community health facilities and manpower, especially new or existing kinds of allied health personnel, in ways that will alleviate the present maldistribution of health services. (4) Whether health maintenance, disease prevention, and early detection activities are integral components of the action-plan. (5) The degree to which expanded ambulatory care and out-patient diagnosis and treatment can be expected to result. (6) Whether they will strengthen and improve the relationship between primary and secondary care, thus resulting in greater continuity and accessibility of care. continued 21 2 ~ RMP Mission Statement There are, moreover, other program criteria of a more general character that also will be used. Specifically: (7) (8) (9) The extent to which more immediate pay-off in terms of accessibility, quality, and cost moderation, will be achieved by the activities proposed. The degree to which they link and strengthen the ability of multiple health institutions and/or professions (as opposed to single institutions or groups) to provide care. The extent to which they will tap local, state and other funds or, conversely, are designed to be supportive of other Federal efforts. B. Performance criteria will include: (1) (2) (3) Whether a region has succeeded in establishing its own goals, objectives, and priorities. The extent to which activities previously undertaken have been _ productive in terms of the specific ends sought. Whether and the degree to which activities stimulated and initially supported by RMP have been absorbed within the regular health care financing system. C.. Process criteria will include: (1) (2) The viability and effectiveness of an RMP as a functioning organization, staff, and advisory structure. The extent to which all the health related interests, institutions and professions of a region are committed to and actively participating in the program. The degree to which an adequate functioning planning organiza- tion and endeavor has been developed in conjunction with CHP, at the local (or subregional) level. The degree to which there is a systematic and ongoing identifica- tion and assessment of needs, problems, and resources; and how these are being translated into the region’s continuously evolving plans and priorities. The adequacy of the region’s own management and evaluation processes and efforts to date in terms of feedback designed to validate, modify, or eliminate activities.O 7. National Review Criteria 1. GOALS, OBJECTIVES, AND PRIORITIES a. Have these been developed and explicitly stated? b. Are they understood and accepted by the health providers and institutions of the Region? c. Where appropriate, were community and consumer groups also consulted in their formulation? d. Have they generally been followed in the funding of opera- tional activities? e. Do they reflect short-term, specific objectives and priorities as well as long-range goals? f, Do they reflect regional needs and problems and realistically take into account available resources? 2. ACCOMPLISHMENTS AND IMPLEMENTATION a. Have core activities resulted in substantive program accomplishments and stimulated worthwhile activities? b. Have successful activities been replicated and extended throughout the region? c. Have any original and unique ideas, programs or techniques been generated? d. Have activities led to a wider application of new knowledge and techniques? e. Have they had any demonstrable effect on moderating costs? f. Have they resulted in any material increase in the availability and accessibility of care through better utilization of man- power and the like? g. Have they significantly improved the quality of care? h. Are other health groups aware of and using the data, expertise, etc. available through RMP? i. Do physicians and other provider groups and institutions look to RMP for technical and professional assistance, con- sultation and information? j. If so, does or will such assistance be concerned with quality of care standards, peer review mechanisms, and the like? 3. CONTINUED SUPPORT a. 1s there a policy, actively pursued, aimed at developing other sources of funding for successful RMP activities? b. Have successful activities in fact been continued within the regular health care financing system after the withdrawal of RMP support? continued 23 24 4, MINORITY INTERESTS a. b. B. PROCESS Do the goals, objectives, and priorities specifically deal with improving health care delivery for underserved minorities? How have the RMP activities contributed to significantly increasing the accessibility of primary health care services to underserved minorities in urban and rural areas? How have the RMP activities significantly improved the quality of primary and specialized health services delivered to minority populations; and, have these services been developed with appropriate linkages and referrals among in- patient, out-patient, extended care, and home health services? Have any RMP-supported activities resulted in attracting and training members of minority groups in health occupations? Is this area included in next year’s activities? What steps have been taken by the RMP to assure that minority patients and professionals have equal access to RMP-supported activities? Are minority providers and consumers adequately repre- sented on the Regional Advisory Group and corollary com- mittee structure; and do they actively participate in the deliberations? Does the core staff include minority professional and supportive employees and does it reflect an adequate con- sideration of Equal Employment Opportunity? Do organizations, community groups, and institutions which deal primarily with improving health services for minority populations work closely with the RMP core staff? Do they actively participate in RMP activities? What surveys and studies have been done to assess the health needs, problems, and utilization of services of minority groups? , 1. COORDINATOR a. b. Cc, Has the coordinator provided strong leadership? Has he developed program direction and cohesion and established an effectively functioning core staff? Does he relate and work well with the RAG? 2. CORE STAFF a. Does core staff reflect a broad range of professional and discipline competence and possess adequate administrative and management capability? Are most core staff essentially full-time? Is there an adequate central core staff (as opposed to institu- tional components)? continued REGIONAL ADVISORY GROUP Are all key health interests, institutions, and groups within a. the region adequately represented on the RAG (and corollary planning committee structure) ? b. Does the RAG meet as a whole at least 3 or 4 times annually? c. Are meetings well attended? d Are consumers adequately represented on the RAG and corollary committee structure? Do they actively participate in the deliberations? e. Is the RAG playing an active role in setting program policies, establishing objectives and priorities, and providing overall guidance and direction of core staff activities? f. Does the RAG have an executive committee provide more frequent administrative program guidance to the coordinator and core staff? g. Is that committee also fairly representative? GRANTEE ORGANIZATION a. Does the grantee organization provide adequate administra- tive and other support to the RMP? b. Does it permit sufficient freedom and flexibility, especially insofar as the RAG’s policy-making role is concerned? PARTICIPATION a. Are the key health interests, institutions, and groups actively participating in the program? b. Does it appear to have been captured or co-opted by a major interest? c. Is the region’s political and economic power complex in- volved? LOCAL PLANNING a. Has RMP in conjunction with CHP helped develop effective local planning groups? Is there early involvement of these local planning groups in the development of program proposals? Are there adequate mechanisms for obtaining substantive CHP review and comment? ASSESSMENT OF NEEDS AND RESOURCES - a. Is there a systematic, continuing identification of needs, problems, and resources? Does this involve an assessment and analysis based on data? Are identified needs and problems being translated into the region’s evolving plans and priorities? Are they also reflected in the scope and nature of its emerging core and operational activities? continued 8. MANAGEMENT a. b. Cc, Are core activities well coordinated? Is there regular, systematic and adequate monitoring of projects, contracts, and other activities by specifically assigned core staff? Are periodic progress and financial reports required? 9. EVALUATION a. b. Is there a full-time evaluation director and staff? Does evaluation consist of more than mere progress reporting? Is there feedback on progress and evaluation results to program management, RAG, and other appropriate groups? Have negative or unsatisfactory results been converted into program decisions and modifications; specifically have unsuccessful or ineffective activities been promptly phased out? Cc. PROGRAM PROPOSAL 1. ACTION PLAN a. b. g. Have priorities been established? Are they congruent with national goals and objectives, including strengthening of services to underserved areas? Do the activities proposed by the region relate to its stated priorities, objectives and needs? Are the plan and the proposed activities realistic in view of resources available and Region’s past performance? Can the intended results be quantified to any significant degree? Have methods for reporting accomplishments and assessing results been proposed? Are priorities periodically reviewed and updated? 2. DISSEMINATION OF KNOWLEDGE a. 26 Have provider groups or institutions that will benefit been targeted? Have the knowledge, skills, and techniques to be disseminated been identified; are they ready for widespread implementation? Are the health education and research institutions of the Region actively involved? is better care to more people likely to result? Are they likely to moderate the costs of care? Are they directed to widely applicable and currently practical techniques rather than care or rare conditions of highly specialized, low volume services? UTILIZATION MANPOWER AND FACILITIES a. Will existing community health facilities be more fully or effectively utilized? Is it likely productivity of physicians and other health man- power will be increased? Is utilization of allied health personnel, either new kinds or combinations of existing kinds, anticipated? Is this an identified priority area; if so, is it proportionately reflected in this aspect of their overall program? Will presently underserved areas or populations benefit significantly as a result? IMPROVEMENT OF CARE a. Have RMP or other studies (1) indicated the extent to which ambulatory care might be expanded or (2) identified problem areas (e.g., geographic, institutional) in this regard? Will current or proposed activities expand it? Are communications, transportation services and the like being exploited so that diagnosis and treatment on an out- patient basis is possible? Have problems of access to care and continuity of care been identified by RMP or others? Will current or proposed activities strengthen primary care and relationships between specialized and primary care? Will they lead to improved access to primary care and health services for persons residing in areas presently underserved? Are health maintenance and disease prevention components included in current or proposed activities? If so, are they realistic in view of present knowledge, state-of- the-art, and other factors? SHORT-TERM PAYOFF a. Is it reasonable to expect that the operational activities pro- posed will increase the availability of and access to services, enhance the quality of care and/or moderate its costs, within the next 2-3 years? Is the feedback needed to document actual or prospective pay-offs provided? is it reasonable to expect that RMP support can be with- drawn successfully within 3 years? continued 27 28 REGIONALIZATION a. Are the plan and activities proposed aimed at assisting multiple provider groups and institutions (as opposed to groups or institutions singly)? Is greater sharing of facilities, manpower and other resources envisaged? Will existing resources and services that are especially scarce and/or expensive, be extended and made available to a larger area and population than presently? Will new linkages. be established (or existing ones strengthened) among health providers and institutions? Is the concept of progressive patient care (e.g., OP clinics, hospitals, ECF’s home health services), reflected? OTHER FUNDING a. Is there evidence the region has or will attract funds other than RMP? If not, has it attempted to do so? Will other funds, (private, local, state, or Federal) be available for the activities proposed? Conversely, will the activities contribute financially or other- wise to other significant Federally-funded or locally- supported health programs? Dr. Vance JOHN R.F. INGALL, M.D., F.R.C.S., F.A.C.S. Medical Director BAT @ THERAPY PAIN CENTER™ OF SOUTHEASTERN MICHIGAN lhe ky Su Te LA ‘on ” eusted — \. Ne » CRED DIT ~ a mr _ TR WIN eon eset 46220: A 71 — SOB (sae a tex tant? ~— Cave A CHAD Dept..of Health Julian Ambrus, M.D. — Roswell Park Memorial Institute Virginia Barker, Ph.D. — Dean, School of Nursing, Alfred University Sandy Berlowitz — Scientific Writer, RMP/WNY Ernst Beutner, Ph.D. — School of Medicine, S.U.N.Y. at Buffalo Lester H. Block — Legal Counsel, H.O.W.N.Y., Inc. Catherine Brownlee — Model Cities, Erie, Pa. Gene Bunnell — Associate for Planning, RMP/WNY Evan Calkins, M.D. ~— Chairman, Dept. of Medicine, S.U.N.Y. at Buffalo Michael Carey — Director, Lake Area Health Education Center, Erie, Pa. Clifford Carpenter — Director, Comprehensive Health Planning Council of W.N.Y., Inc. Max Cheplove, M.D. — Erie County Chairman, RMP/WNY Dennis Chiaramonte — Model Cities, Erie, Pa. Floyd Cogley, Jr. — Associate for Grant Development, RMP/WNY Margaret Connelly, R.N. — Allegany County Health Dept. Alan Drinnan, M.D., D.D.S. — School of Dentistry, S.U.N.Y. at Buffalo Kenneth Eckhert, M.D. — Dept. of Legal Medicine, S.U.N.Y. at Buffalo Stuart Fischman, D.M.D. — Assistant Dean, Dept. of Oral Medicine, S.U.N.Y. at Buffalo john Fortune — Erie County Health Dept. Elemer Gabrieli, M.D. — Director, Clinical Information Center, S.U.N.Y. at Buffalo Joseph Gerbasi, M.D. — Assistant Prof of Surgery, S.U.N.Y. at Buffalo Martin Gerowitz — Comprehensive Health Planning Council of WNY, Inc. Ivan Harrah — Executive Director, W.N.Y. Hospital Association Ernest R. Haynes, M.D. — Director, Family Practice Center Patricia Hoff, R.N. — Director for Nursing Affairs, RMP/WNY Myroslaw Hreshchyshyn, M.D. — Professor, Gynecology-Obstetrics, S.U.N.Y. at Buffalo Herbert Joyce, M.D. — Past-President, H.O.W.N.Y., Inc. Elsa Kellberg — Associate for Evaluation and Research, RMP/WNY Bert Klein, Pod. D. — Board Member, H.O.W.N.Y., Inc. Robert Ludwig — Comprehensive Health Planning Council of W.N.Y., Inc. Edward Marra, M.D. — Chairman, Dept. of Social & Preventive Med., S.U.N.Y. at Buffalo Ruth McGrorey — Dean, School of Nursing, S.U.N.Y. at Buffalo Jean Miller — Information Dissemination Service — S.U.N.Y. at Buffalo James H. Morey — Alternate, H.O.W.N.Y., Inc. Olean, N.Y. William Mosher, M.D. — Commissioner, Erie County Health Dept. Joseph Nechasek, Ph.D. — Assistant Dean, School of Health Related Pro- fessions-S.U.N.Y. at Buffalo Mary Northington — Comprehensive Health Planning Council of W.N.Y., Inc. Gary Reynolds — Administrative Associate for Business & Personnel, RMP/WNY Joseph Reynolds — Coordinator, Telephone Lecture Network Rita Smyth — Assistant to the Dean of the Dept. of Pediatrics, S.U.N.Y. at Buffalo Harry Sultz, D.D.S. — Board Member, H.O.W.N.Y., Inc. Marion Sumner — Administrative Associate for Business & Personnel, RMP/WNY Gerald Surette — Administrative Associate for County Committees, RMP/WNY H. Gregory Thorsell, M.D. — Secretary, H.O.W.N.Y., Inc. John Vance, M.D. — Director, Chronic Respiratory Disease Program Gene Wilczewski — Comprehensive Health Planning Council of W.N.Y., Inc. Anthony Zerbo — Director of Communications, RMP/WNY