University of Mississippi eGrove Honors College (Sally McDonnell Barksdale Honors Theses Honors College) 2016 Leading as Nudging: Optimizing Healthcare Delivery Systems Management in Mississippi Grant Beebe University of Mississippi. Sally McDonnell Barksdale Honors College Follow this and additional works at: https://egrove.edu/hon_thesis Part of the Business Administration, Management, and Operations Commons Recommended Citation Beebe, Grant, "Leading as Nudging: Optimizing Healthcare Delivery Systems Management in Mississippi" (2016).edu/hon_thesis/352 This Undergraduate Thesis is brought to you for free and open access by the Honors College (Sally McDonnell Barksdale Honors College) at eGrove. It has been accepted for inclusion in Honors Theses by an authorized administrator of eGrove. For more information, please contact egrove@olemiss.
Leading as Nudging: Optimizing Healthcare Delivery Systems Management in Mississippi by Silas Grant Beebe A thesis submitted to the faculty of The University of Mississippi in partial fulfillment of the requirements of the Sally McDonnell Barksdale Honors College and School of Business Administration for the Bachelor of Business Administration degree. Oxford May 2016 Approved by ___________________________________ Advisor: Dr. Milorad Novicevic ___________________________________ Reader: Dr. Jody Holland ___________________________________ Reader: Dr.
Debra Young ii 2 © 2016 Silas Grant Beebe ALL RIGHTS RESERVED iii 3 ABSTRACT Rx Mississippi: An Assessment of Healthcare Delivery Systems in Mississippi (Under the direction of Dr. Milorad Novicevic) Three factors predominantly affect the delivery of healthcare services in the State of Mississippi: 1) the ability to access comprehensive, preventative care; 2) negative perceptions of the Affordable Care Act and similar reform efforts on the part of state and federal agencies; and 3) evolving reimbursement structures affecting the revenue streams of providers. There is a growing consensus among residents, providers, managers, and policy makers, which are key stakeholders in the overall wellness of our State, that preventative care addressing these three factors could play a pivotal role in improving public health. Through the development of a nudge framework of entrepreneurial leadership, I examine the least researched among public influence mechanisms, the nudge.
The use of the nudge in my framework for developed for the case of Mississippi requires my analysis of both latent barriers and potential solutions to increase the likelihood that Mississippians would elect to seek meaningful provider relationships, embrace comprehensive schedules of care, and adopt and practice wellness management strategies. If more Mississippians were nudged with the use of my framework to make sound decisions about their health, the State would increasingly become healthier overall. iv 4 ACKNOWLEDGMENTS The graciousness and patience of Dr. Milorad Noviccevic throughout the entire process of developing this thesis, enduring support of Dr.
Young and all proud members of the Sally McDonnell-Barksdale Honors College family, and continuing encouragement of Dr. Jody Holland and the Trent Lott Leadership Institute have made my experience as an undergraduate student at the University of Mississippi truly exceptional. For JoAnn Edwards’ continuing to believe in and actively challenge me, I thank her. Ann Angle, and Mrs.
Stacy Harrison no less brightened many a day and have offered me opportunities to succeed. To all who have been a part of my time in Oxford, I thank you – it is with much love and adoration for the phenomenon of the place that we share that I am happy to present the following culmination of my research concerning health care management in the State of Mississippi for your consideration. v 5 The Moon Exactly How it is Tonight Taylor Mali When Mount Everest was measured in 1856 it was discovered to be 29,000 feet exactly. But since no one would have believed the figure, sounding as it does too much like something rounded off, two extra feet were found, invented out of thin air, the thinnest on earth, and added to the mountain’s top to provide the appearance of precision.
Twenty-nine thousand and two. So too, tonight, a cloud has passed before the moon in such a way that were I able to describe it exactly how it is, no one would believe me. Which is why I need two extra feet of moonlight or dark cloud, or to be fair, one foot of each. The following work is dedicated to my parents, Bobby and Susan, in thanks for their unwavering faith, and to the many residents of Highland Home who inspire me to remember that wellness begins with “we.” Belief is not measured in the height of the achievement, but in the magnitude of faith, support, and love that have made my endeavors possible.
vi 6 TABLE OF CONTENTS Chapter One: Introduction 9 Chapter Two: Theoretical Foundation 16 Chapter Three: Methodology 31 Chapter Four: Mississippi Care Management: State of the Art 35 Chapter Five: Exemplary Case Analysis 58 Chapter Six: Proposed Framework for Mississippi Case 85 Chapter Seven: Discussion 95 Addenda: Charts of Mississippi Care Survey 104 Bibliography 107 vii 7 LIST OF FIGURES Chapter Two: Theoretical Foundation Figure 2.1: Thaler and Sunstein’s Model of Libertarian Paternalism 21 Chapter Four: Mississippi Care Management: State of the Art Table 4.1: Division of Survey Population Ranges 48 Figure 4.1: Mississippi 2015 Population to Physician Representation 49 Figure 4.2: Mississippi Hospitals Identified as “Most at Risk” 57 Chapter Five: Exemplary Case Analysis Figure 5.1: Swiss DRG Reimbursement Formulary 68 viii 8 Chapter One: Introduction “Illness begins with ‘I.’ Wellness begins with ‘we.’” – Sivananda Saraswati Research Context The system of healthcare delivery in the United States is increasingly viewed as unsustainable (McDonough and Addashi, 2014). In particular, observing the grim prospects for wellness promotion as management strategy Dr. Jo Ivey Boufford, MD, President of the New York Academy of Medicine (NYAM) opened a 2013 compendium, produced in collaboration with the Trust for America’s Health (TFAH), by evaluating the present economic, social, and political forces affecting healthcare delivery in the United States. Introducing a market in which consumer costs have accelerated at unsustainable rates, Boufford cites estimates published by The World Bank (2016) that value healthcare expenditures to amount to 17% of the United State’s gross domestic product.
To this end, Boufford notes that among the costliest conditions in the United States – cardiovascular disease, cancer, injuries resulting from acute trauma, osteoarthritis, asthma, high blood pressure, and diabetes – a number of risk factors could be neutralized through the promotion of comprehensive wellness management. (New York Academy of Medicine, 2013, p.1) 9 Following the 2008 release of a report produced by the Trust for America’s Health, The New York Academy of Medicine and Urban Institute collaborated to analyze the balance of cost containment and prevention initiatives actively deployed throughout the United States. Emphasizing lifestyle interventions that can be implemented as complementary efforts alongside clinical treatments, the joint findings report that stakeholders – be they consumers, clinicians, managers, or policymakers - recognize that savings could result from the deployment of comprehensive wellness strategies. Among successful clinical screening and therapeutic activity plans, “population-level interventions conducted by non-medical personnel were less well-known” among available options (New York Academy of Medicine, 2013, p.
During the five-year period between the publication of the TFAH 2008 report and 2013 compendium, a number of researchers had begun to provide positive evidence of the impact of elective interventions and community-level programs as wellness promotion strategies implemented throughout the United States. Moreover, the literature review conducted before publication of the 2008 TFAH publication highlighted 23 examples of community efforts, but this number has grown to 79 presented in 2013. The evaluated interventions were oriented to “direct policymakers to specific interventions ready for broader implementation 10 and to inspire recognition of the potential to prevent disease and create a healthier population overall” (New York Academy of Medicine, 2013, p. The 2013 compendium provides a set of exemplary case studies, which includes the case of entrepreneurial public leadership in Hernando, Mississippi where leaders effectively engaged the community in wellness promotion activities at the population-level (New York Academy of Medicine, 2013).
In this thesis, I structure this case and other exemplary cases to develop a framework for the integration of public influence mechanisms with comprehensive, community-focused preventative care that supplements the delivery of healthcare services in rural Mississippi. Research Objectives In my framework development, I focus on three factors that have been evaluated as predominately affecting the delivery of healthcare services in Mississippi: 1) the ability to access comprehensive, preventative care; 2) negative perceptions of the Affordable Care Act and similar reform efforts on the part of state and federal agencies; and 3) evolving reimbursement structures affecting the revenue streams of providers. There is a growing consensus among residents, providers, managers, and policy makers, which are stakeholders in the overall 11 wellness of our State, that preventative care addressing these three factors could play a pivotal role in improving public health. I recognize that multiple tools could be utilized in my framework intended to influence meaningful interaction between these stakeholders and effective delivery of the services themselves, but I give preference to the tool that has been least researched among these options - the nudge.
The use of the nudge in my framework developed for the case of Mississippi requires my analysis of both latent barriers and potential solutions to include objectives to increase the likelihood that Mississippians will elect to seek meaningful provider relationships, embrace comprehensive schedules of care, and adopt and practice wellness management strategies. If more Mississippians were nudged with the use of my framework to make sound decisions about their health, the State would increasingly become healthier overall. In my analysis, I address not only current conditions but also the antecedent causes derived from examining case studies proposing internationally tested and regionally active policy options for implementation. Additionally, I analyze closures of Mississippi rural access hospitals and service providers alongside the shuttering of Louisiana emergency departments as failures that could indicate the degree to which the State requires comprehensive care.
Conducting this analysis for the framework development has informed the 12 integration of the nudge as a mechanism to increase public awareness about opportunities to access care and promote wellness management that will improve healthcare system efficiency and efficacy in Mississippi. In summary, the purpose of this thesis is to propose a framework aimed at the development, integration, and implementation of community screening and referral protocols that increase the ability of community service providers in Mississippi to become more available to address health-related social needs and manage diagnoses as established in the routine of care, alike. The associated management practices, public policy, economic impacts, and consumer advocacy perspectives are examined in order to evaluate the context of existing partnerships between care organizations. My main goal is to develop a framework through which community resources and funding sources can better integrate their efforts, and which identifies public influence mechanisms to improve overall health performance expressed through increasing the quality of life enjoyed by individual Mississippians.
My proposed framework is developed to help integrate the health-related social needs with strategic concerns relevant to managers operating within the complex domain of health care in order to formulate a holistic wellness management strategy that reduces overall care costs and decreases outpatient 13 care utilization. By addressing the unmet needs of community stakeholders, the proposed framework is instrumental to a manager to (1) evaluate the health effects of community services that address specific health-related social needs (e., housing problems, food insecurity, and the like); and (2) evaluate approaches to linking patients with community services.