The cycle of health program/policy planning and evaluation should reflect the mission and vision of the organization. In essence, any rule that a hospital establishes should enhance the wellness of the clients and staff. Planning and evaluation are essential to achieving goals for healthy people. It is necessary to include the medical team, administrators, and clients in assessing the effectiveness of internal procedures. The hospitals should always be specific and detail the inclusion and exclusion criteria of services affected by the new regulations. External experts can be engaged in assessing the success of the program or policy before its full integration. The paper exemplifies the evaluation of the CMS03.01 policy for John Hopkins Health Care (JHHC), Which is concerned with the Medicare coverage database. Medicare is a federal program implemented at the state level, hence subject to differences about eligible beneficiaries, services covered, and disbursement amount.
Outcomes
One of the outcomes was a more coordinated response to the clients regarding their eligibility for Medicare coverage. The health professionals received the information on how they can evaluate the benefits given under the contract. Mainly, the JHHC considers regular patient care or diagnostic criteria, treatment, clinical monitoring, and investigational drug necessary for medical review. Moreover, after the evaluation and approval of the policy for adoption in the medical procedures doctors were able to identify a patient’s diagnosis early and initiate early management. The beneficiaries of Medicare can now understand the requirements for joining a plan and using the cover to access services at the JHHC.
Success Measures
The research coordinators at JHHC did clinical research involving actual clients to gauge the success of the program. The survey for the patients to determine if the policy was appropriate for their Medicare plans is one of the measures used for evaluation (John Hopkins Healthcare, 2021). The trials were conducted in three different phases before providing a comprehensive report on the outcome. In addition, observation by the healthcare professionals on the efficiency of providing care after implementation of the policy was a useful tool. For instance, after JHHC implemented policy CMS 03.01, there was better coordination between the clients and their providers which is proof of success.
People Reached
There were three phases of the formal evaluation of the policy, each reaching a different number of people. In the first part, the researchers involved a few people ranging from 20 to 80, mainly from the cancer center. Next, the participants were increased to include hundreds of individuals who met the criteria. Lastly, a sample of thousands of patients gave consent to participate in the study before the adoption of the policy. Notably, many people were included because the resources were available, and the procedure was crucial for JHHC.
Impact
Upon full implementation of the policy, it is going to affect millions of individuals. Notably, there are about 12 million people in the United States who have both the Medicaid and Medicare programs (CMS Innovation Center, 2021). The impact of using the policy is that the individuals can have a better health plan inform of a contract for three years which is comprehensive and coordinated care. The other impact is that the clients save on their money due to the cost-efficient nature of the program.
Evaluation Point
The program was initiated in 2011, and the informal evaluation started immediately. However, the three researcher phases started six years later and were completed in 2021 (CMS Innovation Center, 2021). The implication is that it took eleven years for the complete assessment and review of the policy. The coordinated evaluation of the policy is still ongoing as clients can rate their experience at the JHHC website. Thus, evaluation is an ongoing endeavor to help improve the outcomes.
Data Sources and Unintended Consequences
There were several sources of data, including the questionnaires, and medical and financial records. The research sought to understand the experiences of the patients, and their direct opinions were considered for evaluation. In addition, the total expenditure of patients with Medicaid and Medicare programs after the implementation of the policy was relevant. The patients had a chance to give their star ratings to help JHHC understand their performance. There were no unintended consequences because the evaluation was done by experts.
Stakeholders
The program evaluation was primarily conducted by external experts hired by the Center for Medicaid Services. The healthcare professionals at JHHC also helped in recording and providing the data used for efficiency measurements. The people that will benefit most from the program are the patients who are eligible for both the Medicaid and Medicare funding. For example, they will receive a blended payment for much more comprehensive and well-coordinated care. Thus, they can increase their savings while experiencing faster and more holistic care.
Meeting Original Intent
The original intent of the program was to offer people dually enrolled on the Medicaid and Medicare programs a better experience of care. The second aim was to better align Medicaid and Medicare programs with relevant financial incentives. After the implementation and three-phase evaluation, the surveyors were convinced, that the policy dully satisfies the research question. The patients were better able to align their financial programs with healthcare. Moreover, the provision of care was more efficient for both the clients and the healthcare providers.
Recommendation of Program
I would recommend the policy to my place of work as it enhances efficiency in the provision of healthcare to clients using the Medicaid and Medicare programs. I believe that the program is effective in enhancing more coordinated care and cost reduction. Moreover, Medicare and Medicaid are used by many citizens, some of whom seek medical services from our facility. It would be prudent to implement the policy because CMS has given its approval. Thus, being one of the pioneers in integrating the national and state regulations in our hospital programs will ensure that we are on the safe side of the law.
Tools
After one year of practice, I can help in policy evaluation by using tools such as interviews and questionnaires to assess the level of satisfaction of the patients. Notably, the qualitative and quantitative results are important for the assessment of almost all kinds of programs as they provide evidence-based results (Issel et al., 2021). I will also use the health records to determine if there is an improvement in the efficiency of patient care. Specifically, assessing the ease with which clients receive patient-centred service is an essential approach.
Advocacy
I will provide feedback to the committee involved in the implementation and evaluation of the policy. For instance, I can directly tell them about my observation and thoughts on the regulations using scientific evidence. The professional advice is relevant for the administrators to remain objective by not implementing a service that fails to meet the needs of clients. I can also propose an alternative program and give recommendations for improvement of the law to enhance the quality of care.
References
CMS Innovation Center. (2022). Financial alignment initiative for Medicare-Medicaid enrollees. Web.
Issel, L. M., Wells, R., & Williams, M. (2021). Health program planning and evaluation: A practical systematic approach to community health. Jones & Bartlett Learning.
John Hopkins Healthcare Organization (2021). Clinical trials.Web.