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3 ONE PAGE PAPERS – SINGLE SPACEDPaper 1 – Resourcealso see attached titled Paper 1_Westgate_Top_7QuestionWhat does being a “servant leader” mean to you? What personal strengths will/do you leverage and weaknesses will/do you need to be sensitive to in order to be an effective leader?PAPER 2RESOURCEhttp://managedhealthcareexecutive.modernmedicine.c…https://youtu.be/6TVmxiyTBjgQUESTION”In your opinion, what is the most critical challenge cited in this article and why? How will it impact you as a manager? What will it change about the way a healthcare organization does business?PAPER 3RESOURCEattached file titled PAPER_3_SMITH_LEAN_BUDGETINGQUESTIONHow would you introduce an employee, with no formal financial education or training, to the concepts of budgeting and managing to budget? What approaches would you take? What concepts would you focus on and how would you measure understanding?
paper_1_westgate_top_7.pdf

paper_3_smith_lean_budgeting.pdf

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The List
TOP 7 LEADERSHIP DEFICIENCIES
MANAGED HEALTHCARE EXECUTIVE’S EDITORIAL ADVISORY BOARD SAYS HEALTHCARE
EXECUTIVES SHOULD WATCH OUT FOR THESE SEVEN LEADERSHIP DEFICIENCIES
b y A U B R E Y W ESTGATE
HAVING A CLOSED MIND
BEING RESISTANT TO CHANGE
“In many organizations, there
is a reluctance to take on risk
and/or a resistance to change.
Healthcare has historically been
a conservative industry so it’s
no surprise that many are still
clinging to the status quo.”
—Joel Brill, MD, CMO, Predictive Health, LLC
THE INABILITY TO LEAD A DIVERSE TEAM
“The biggest leadership dysfunction is not knowing
how to relate to the diversity in the workforce (age,
sex, cultural) and not knowing how to communicate
effectively to all these different people.”
—Douglas L. Chaet, senior vice
president, contracting and provider
networks, Independence Blue Cross
—Perry Cohen, PharmD, CEO, The Pharmacy Group
—Don Hall, principal,
DeltaSigma LLC
ASSUMING YOU KNOW
WHAT YOU DON’T KNOW
“Leaders that stop
listening to learn and
stop entertaining new
thoughts stifle creativity,
innovation and ultimately
passion in their teams.”
— Kevin Ronneberg, M D
vice president and associate
medical director, Health Initiatives,
Health Partners
NOT VALUING KEY PARTNERSHIPS
BEING INTIMIDATING
“The most prevalent leadership dysfunction today
remains an inability to effectively communicate,
collaborate and establish key ‘cross-functional’
relationships. Too often … we fail to recognize the
enormous strategic value and operational efficiencies
that can be achieved by taking the time to truly get to
know our peers in other areas and by building a more
trusted, mutually-beneficial work environment.”
“Good leaders create atmospheres where people are
encouraged to take risks and promote ideas that sometimes
will fail. On the other hand, dysfunctional leadership creates
a punitive environment where people are not encouraged to
speak their minds. I found having many viewpoints helps me
to think through all my options. I want our staff to feel free to
promote ideas … some of them will succeed and will be of
great benefit to our member plans.” □
—David Calabrese, vice president and chief pharmacy officer, OptumRx
—M argaret Murray, CEO, Association for Community Affiliated Plans
MANAGED HEALTHCARE EXECUTIVE
I
JULY 2016
Managed Healthcare Executive, com
Getty Images/Photographer’s Choice RF/Burazin
BEING RISK-AVERSE
“This is not necessarily a leadership
dysfunction, rather an inability for plans to
embrace value-based payment models such
as episode of care/bundles for services. Lots
of provider entities—physicians, facilities—are
interested in pursuing these models but plans
need to step up, and device and diagnostic
and pharmaceutical manufacturers need to be
collaborators (and share risk), not just vendors.”
“ Far too many leaders
surround themselves with
echo chambers that neither
allow nor foster productive
criticism and divergent
ideas. This ‘my way or the
highway’ thinking fosters
organizations that are
often characterized by low
morale, non-adaptation to
critical market trends and at
worst, serious compliance
issues.”
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Lean Budgeting: To Boldly Go Where
No Budget Has Gone Before
EARLY EDITION: MICHAEL C. SMITH
THE CONVENTIONAL BUDGET MODEL IS PRECISE, DETAILED, AND TIME.
TESTED. THE PROBLEM IS, IT’S NO LONGER WORKING.
Healthcare finance leaders are accustomed to working with a traditional
budgeting model that is familiar to anyone with an accounting
background: It produces a budget consisting ofpages ofnumbers and
variances, with a few points of data regarding volume to help put it all
into context. The problem with this model is that most of the people
within a healthcare organization who must work with the budget lack any
background in accounting. Their skill set tends to be focused more on
qualitative measures, and they are much better able to interpret irregular
vital signs, a flushed skin tone, or a raspy breath than to interpret an
income statement. So no matter how hard a healthcare organization’s
budget team might work to develop a traditional budget, and no matter
how pleased the team might be with the result, that satisfaction is all too
likely to tum to frustration when immediately after the budget is
published it becomes outdated and subject to misinterpretation.
Moreover, conventional budget processes often are dysfunctional in
several respects. Forecasted volumes can mask operational inefficiencies
and become a tempting avenue for pushing the budget toward unrealistic
organizational goals.
Lean principles, originally developed as a way to make manufacturing
more efficient, offer an altemative budgeting process that encourages
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realistic goals and deliverables that can be easily interpreted.Although
much of the work performed in preparing the budget is similar to that of
the conventional budget, the end product is much more user-friendly to
department managers, who make up the target audience. Also, it should
be noted that the conventional budget isn’t eliminated with this process
but is stowed in the background for its traditional uses.
HFMA RESOURCE LIBRARY
10 Ways to Reduce
Patient Statement
Volume (and Reduce
Costs)
N’:
t-ovri
pitticnts ar* ih,; si:l::t.
Five Lean Principles for Budgeting Success
A lean-based budgeting process is founded on five basic guiding
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” Identiff your customer, and define value from their perspective.
” Map the process, and scrutinize for value.
.
.
.
Optimize the process, designing for efficiency.
Let customer needs pull the process.
Keep iterating, improve incrementally.
Identiff your “customerr” and define value from their perspective.
The accounting mindset is grounded in detail, but it’s the front-line
departmental managers who hold the most immediate influence over
performance factors. A few percentage points of labor cost efficiency
from operational managers can double the organization’s margin, but
spreadsheet interpretation is an acquired skill and not intuitive for
managers with clinical backgrounds; thus, information provided in a
conventional budget format tends to be of little value to them.
A conventional budget would show only discrete financial amounts:
actual dollars versus budgeted dollars, each based on completely different
volume contexts. Any comparison, absent normalization for volume, is
invariably misleading.
For example, if a department’s labor expense were to come in under
budget by almost 12 percent, as shown in the exhibit below, the
department would be unlikely to look further. In this case, however, the
department would fail to notice that the reason for the reduced labor
expense was that its volume (patient days, surgery minutes, procedures,
etc.) had fallen short of budget by almost 18 percent.
Budget Comparison of Labor Expense with Volume
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Similarly, with other areas of the budget, department managers all too
easily can use a single-line interpretation ofthe general ledger tojustify
spending on specific items, failing to notice that they are over budget on
the broader category. They will feel entitled to spend budgeted funds
when under target within “supplies, office,” selectively overlooking that
they’ve overspent on “supplies, general.” To sharpen manager focus,
results need to be volume-normalized and presented with minimal clutter.
HFMA CLASSIFIED ADVERTISING
Find the Best Healthcare
Finance Talent
HFMA offers online, email, and
print opportunities to help you
recruit the most talented healthcare
finance professionals. Place your
classified ads today.
Map the process, and scrutinize for value. The conventional budget
model is driven by historical ratios applied to forecasted volume to derive
budgeted financial statements. The biggest problem arises in the
introduction of the forecasted volume. The fact that volume can never be
forecasted with complete accuracy is at the root of many flawed
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Containment
Drive down costs while improving
quality in a reform environment.
interpretations regarding departmental performance. Given a
predisposition for forecasting optimism, high volume usually justifies
somewhat high expense forecasts. When actual expense dollars come
close to forecast it’s too tempting to accept the dollar- to-dollar
comparison, rather than compare the spend within the context of actual
(usually lower) volume. By maintaining a focus on volume-normalized
ratios (as shown in the sidebar below), a valid comparison is encouraged.
JOIN
HFMA ls Where You Need
to Be
Stay informed about new directions
in healthcare finance. Share tools
and strategies for improving
performance. Be an active
participant in your profession.
Together, we’ll reshape the
business and practice of
healthcare. Join us.
Related Sidebar: Budget Process Flow, Analytical Measures
Optimize the process, designing for efliciency. Many organizations talk
about rolling forecasts, flex budgets, and the importance of being nimble,
but simply generating the standard model more frequently doesn’t add
much value. Consider the traditional approach for budgeting labor
expense, for example. The conventional budget framework, with the
entire chart ofaccounts and detailed labor projections by job code, is
cumbersome to generate and diffrcult to interpret. Condensing salaries,
benefits, and agency contracts into one aggregate labor expense shifts the
focus away from quibbling over FTEs and job code-level details, and
empowers managers to flex staffing where needed. For example, RNs
shouldn’t be answering phones simply because there was no specific lineitem budget for additional aides. An aggregated labor expense, however,
gives the deparlment manager flexibility to assign an aide to this task.
Ultimately, it’s much more important that expenses be managed
proportionately than managed to a discrete target, set months prior. A
condensed structure encourages departmental managers to think more
holistically.
Let customer needs putl the process. Outdated budgets serve no one. A
condensed, streamlined model can be updated frequently to reflect a
changing business environment. Departmental feedback can be
incorporated more promptly, and executive expectations or guidance can
be updated as needed. Locking a budget into a fiscal year timeline risks
giving it negligible relevance by the end of that year.
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