MHA FPX 5006 Assessment 3 Cost-benefit Analysis

Cost-benefit Analysis

Executive Summary

The cost-benefit analysis has been completed in this assessment, and the agency can determine that there are three strategic long-term solutions that address the current nursing shortage that has affected the agency in meeting its current client load. Three solutions have been identified and discussed: Remote Patient Monitoring (RPM), Telehealth Nurse Triage, and Enhanced HR Benefits & Retention Programs. The financial, operational, and organizational priority implications were considered when evaluating the options. RPM is one of the high-impact technological investments that can lead to significant reductions in the need for inpatient visits, nurse capacity increases, and empower the Agency to continue to scale services and maintain its rate of growth without hiring more nurses. The benefits of the model, related to operational efficiency, are moderate when using the Telehealth Nurse Triage model as a follow-up appointment and low-acuity assessment is shifted towards an online model. The alternative will support increases in access and competitiveness for the agency in the transforming environment of the industry and is particularly helpful to underserved clients. Workforce-oriented strategies to stabilize staffing levels, encourage organizational culture, and reduce turnover-related costs from certain investments in education, flexibility, and wellness provisions are known as Improved HR Benefits and Retention Programs. While varied in terms of time of results, scale, and investment, each of the three solutions is a different path to workforce sustainability and operational efficiency. RPM has the best LT scalability & takes the largest percentage of the above surplus budget. This flexible and affordable model has improved satisfaction for clients, increased efficiencies in operations, and aligns with the national trends in the evolution of telehealth. On the other hand, the HR benefits program holds the highest potential for long-term staffing by reducing turnover and improving retention, and may not fill existing capacity gaps in the current time.

Option 1: RPM System

Proposal

The agency will also implement RPM, which tracks the patient’s vital signs, symptoms, and adherence to care plans, but does not necessarily require a patient to be in the agency’s physical presence. In addition, clinically stable, low acuity clients moved to RPM-based care will significantly reduce the number of visits per week by nurses and improve the capacity of nurses (Azevedo et al., 2022). This approach aligns with the financial strategy of the organization, and scalable technologies are prioritized to improve the efficiency of the operations, boost quality outcomes, and support sustainability.

Benefits

• Low acuity clients: Reduces by up to 40 percent the need for in-person visits by the current nurses, thus allowing them to serve more clients.
• Helps to identify changes in clinical status earlier, decreases unnecessary hospitalizations, and improves satisfaction.
• Improves the agency’s mission by providing more access to the homebound clients who cannot be visited regularly.
• It will increase the efficiency of operations as the agency can increase the services without a corresponding increase in full-time employees.
• Improves the competitiveness in the market by providing technology-based services valued by consumers (payers, families, and referring partners alike).

Cost

• RPM site performance: 350,000 every year.
• Purchase 200 patient kits (BP cuff, Scale, Pulse Oximeter, and integration of the app) for 400,000 in all.
• Training of nurses and leadership: $50,000.
• IT integration, data infrastructure, and cyber security compliance: USD 75,000.
• Technical support and maintenance of equipment: 25000/year follows.
• (Total Year-1 Cost: $900,000)

Opportunity Cost

This would leave the entire amount of the surplus budget to be used for hiring four full-time nurses to serve the organization, which would cost the organization between $320,000 and $400,000 per year as a unit. Not only does it rule out the option of investing in a less expensive telehealth system (estimated at 250,000-300,000), but this system would not be as thorough as RPM, in terms of workload strain. It hinges on the choice of funding RPM; if so, the resources that would otherwise be spent on hiring people for short-term needs could be reallocated to long-term technologies.

Explanation

RPM is an alternative solution that directly impacts workload limitations at scale and for long-term solutions. With the current number of clients (20 clients/week/ nurse), reducing the use of an in-person service to approximately half the number of stable clients at the agency (around 160 clients) would create enough clinical space for the same number of clients to be cared for by 4 full-time nurses (Tan et al., 2024). This is in line with the agency’s mission to increase access to high-quality home-based care and serve its financial goal to enhance efficiency as compared to staffing-based models. While in the short term, the opportunity costs of recruitment-based solutions limit the application of such solutions, RPM provides a long-term thinking approach with a key benefit of productivity and workforce stabilisation, as well as a revenue-generating potential. Furthermore, this can be done in a continuous monitoring that would result in timely monitoring of clinical deterioration, reduce unnecessary hospitalization, and enhance patient satisfaction in the long-term. The incorporation of remote monitoring (RPM) will also help an agency to secure itself in a competitive, technology-driven marketplace, with more agencies undergoing the switch to RPM being implemented in their operations. Last, RPM integration enables sustainable development by building a more resilient, scalable, and efficient care delivery system in the future.

References

Azevedo, S., Guede-Fernández, F., von Hafe, F., Dias, P., Lopes, I., Cardoso, N., Coelho, P., Santos, J. E., Fragata, J., Vital, C., Semedo, H., Gualdino, A., & Londral, A. (2022). Scaling up digital follow-up care services: Collaborative development and implementation of remote patient monitoring pilot initiatives to increase access to follow-up care. Frontiers in Digital Health, 4, 1006447. https://doi.org/10.3389/fdgth.2022.1006447

Tan, S. Y., Sumner, J., Wang, Y., & Yip, A. W. (2024). A systematic review of the impacts of remote patient monitoring (RPM) interventions on safety, adherence, quality of life, and cost-related outcomes. Nature Partner Journals Digital Medicine, 7(1), 1–16. https://doi.org/10.1038/s41746-024-01182-w

Option 2: Telehealth Nurse Triage Program

Proposal

The Telehealth Nurse Triage Program (TNTP) is a scaled technology solution to expand nursing capacity and enhance the quality of patient care. In this alternative, the licensed nurses would provide virtual assessments, symptom evaluation, education of the patient, and scheduled follow-ups for the appropriate patients (low acuity). Transitioning a significant portion of face-to-face interactions to online interactions will enable the agency to significantly reduce the inefficiencies resulting from travel and fully focus efforts on getting to work each day and getting the daily batch of cases done (Kobeissi and Ruppert, 2021). The model fosters continuity of care, enhances clinical responsiveness, and aligns with the National trend of more popular hybrid and technology-assisted care delivery. The agency will have a strategic edge in meeting the increasing need for services provided by its telehealth program, while avoiding a corresponding increase in staffing requirements in a competitive labor market with a formalized telehealth triage program.

Benefits

• Increases nursing availability by facilitating the transition of an estimated 2,535 percent of follow-ups and evaluations of lower acuity patients to telehealth and freeing up nurses to focus on in-person visits to patients with higher acuity.
• Improves access to those who are home-bound, in rural areas, or who are otherwise constrained in their usual modes of transport, thereby decreasing disparities in care provision.
• Helps to enhance patient satisfaction by offering flexibility and reducing wait times, missed and cancelled patient visits.
• Facilitates the development of the agency since the agency can take more clients without necessarily having to raise the level of staffing.
• In line with the national trend of growing telehealth, payer incentives, and efficient and technology-driven care delivery demands.

Cost

• Subscription to the Telehealth platform: 150 000 per year.
• To buy 100 tablets/mobile devices, high-risk patients: 80000.
• Clinical and administrative staff: 25,000 trained.
• HIPAA, cybersecurity, and compliance enhancement – $40,000.
• IT and maintenance support: 30000/-/per/year continues to be available.
• Total Year-1 Cost: $325,000

Opportunity Cost

The allocation of a portion of the annual budget of 325,000 towards this telehealth project constrains the organization to make other competing investments like employing two more full-time nurses (between 160,000 and 200,000 dollars) or the HR benefit package to lower turnover (250,000-300,000 dollars). It can also set back the resource allocation to this programme, the capacity to provide short-term financing for other, more capital intensive programmes, such as full RPM, which can cost more than $900,000 to set up initially. The opportunity costs identified here illustrate the need to make trade-offs between innovation needs and short-term operational needs.

Explanation

This telehealth solution also aligns with the agency’s overall strategy of building service capacity without over-relying on the added full-time nurses, given the current shortage of full-time nurses and a competitive job market. The information on community needs reveals there is an increasing need for home-based services, especially for older people and for groups who are not being adequately served and who may have barriers to offline services. This makes Telehealth a timely and appropriate solution to the needs of the communities and accessibility issues. The trend aligns with the fact that the use of telehealth continues to rise nationally, as patients prefer it, payers approve it, and it has shown itself to be useful and efficient when it comes to value-based care models and delivery systems (Weiss et al., 2023). The cost and benefit analysis has revealed that these options require moderate initial investments and will yield high efficiency in the operation, better engagement of patients, and a scalable healthcare model, thus enhancing the competitive edge of the agency. The opportunity cost of telehealth relative to the alternative use of the money over the long-term is less than the long-term value of telehealth, so that telehealth is a strategically viable alternative.

References

Kobeissi, M. M., & Ruppert, S. D. (2022). Remote patient triage: Shifting toward safer telehealth practice. Journal of the American Association of Nurse Practitioners, 34(3), 444–451. https://doi.org/10.1097/jxx.0000000000000655

Weiss, C. R., Roberts, M., Florell, M., Wood, R. E., Johnson‑Koenke, R., Amura, C. R., Kissler, K., Barton, A. J., & Jones, J. (2024). Best practices for telehealth in nurse-led care settings—A qualitative study. Policy, Politics, & Nursing Practice, 25(1), 47–57. https://doi.org/10.1177/15271544231201417

Option 3: Enhanced HR Benefits and Retention Package

Proposal

The Enhanced HR Benefits and Retention Package serves to increase the long-term stability of the workforce of the agency by investing specifically into the development of the staff, flexibility, and well-being. The alternative expands traditional compensation packages to include tuition reimbursement, aimed promotions and career paths, and flexible scheduling options, and increased wellness amenities for nursing staff. It targets two specific objectives: to boost job retention and to incorporate an appealing working environment for attracting great candidates in a highly competitive job market (Bristol-Alagbariya et al., 2024). These priorities of professional development and organizational support will position the agency for a sustainable, satisfied, and high-performing workforce that is able to effectively meet the growing community needs. That’s because, as nursing shortages hit national levels, a retention strategy will help the agency stabilize its staffing and even get ready for growth in the future.

Benefits

• Restricts turnover, provides career development benefits, and improves job satisfaction.
• Attracts qualified nurses who value training and development, work flexibility, and part-time work.
• Promotes positive culture in the organization, encouraging participation, working in teams, and improving patient outcomes.
• Complies with community needs, via continuity of staffing, delayed service, and denies referrals.
• Fosters agency competitiveness for the market – home care, which will lead to future credibility and growth.

Cost

• Registered nurses already in service: reimbursement of tuition: 200,000 a year.
• Bonuses based on annual performance: $150,000.
• Wellness/Mental health support (EAP): Expansion: $50,000.
• Flexible scheduling material (cross-training, per diem staffing): $100,000.
• HR administration and program implementation – 75000.
• Total Year-1 Cost: $575,000

Opportunity Cost

A $575,000 broad retention package will reduce an agency’s ability to invest in any additional quick-fix solutions, such as a telehealth triage program ($325,000) or investing in full-scale RPM technology ($900,000). This investment also means that the organization can only have about 3-4 more full-time nurses (320,000-400,000 per year). The agency allocates resources for the sustainability of the staff over a longer term, rather than what can be done in relatively short-term capacity building, by focusing on retaining the staff rather than on recruiting new staff or on technical growth.

Explanation

Enhanced HR Benefits and Retention Package improves a long-term labour strategy of building labour stability rather than competing for labour in a tight market by being aggressive in recruitment. The studies have proved that good retention programs decrease turnover, enhance team cohesiveness, and continuity of care, which helps to achieve improved patient outcomes. While this alternative would not add the same number of visits as an increase in staff or technological solutions, it would have a greater staffing base from which to draw the future growth of the organization (Bharath, 2021). The reimbursement of tuition fees, a career growth program, wellness, and flexible work schedules will enable the agency to retain professionals with high ability and competencies who want to work with the organization’s mission. This will ensure good delivery of services, stable clinical quality, and most importantly, responsiveness to the needs of the community in the longer term if they have a well-developed and stable workforce. Furthermore, retention practices result in long-term cost and resource savings in the recruitment and training process, a higher employee satisfaction rate, and an employer of choice. In general, retention investment has considerable long-term payoffs through the decrease in instability in staffing, the creation of professional engagement, and the placement of the agency on the path of sustainable development in the next decade.

References

Bharath, M. (2021). Something beyond paycheque to boosting employee retention: Evidence from a South Indian hospital. Vilakshan – XIMB Journal of Management, 20(1). Emerald. https://doi.org/10.1108/xjm-03-2021-0072

Bristol-Alagbariya, B., Ayanponle, L. O., & Ogedengbe, D. E. (2024). Leadership development and talent management in constrained resource settings: A strategic hr perspective. Comprehensive Research and Reviews Journal, 2(2), 013–022. https://doi.org/10.57219/crrj.2024.2.2.0031

Conclusion

Results of the three strategic options—RPM, the Telehealth Nurse Triage Program, and the Enhanced HR Benefits & Retention Package—showed that each option has its unique strengths that align with the agency’s mission of providing high-quality, accessible, home-based care. RPM will have the biggest long-term impact on clinical capacity through decreasing the use of in-person visits and providing sustainability for capacity growth. The Telehealth Nurse Triage Program will be an efficient, cost-effective way to enhance follow-up care, as well as increase access to care for underserved populations and keep the agency connected to the national momentum towards virtual care. This Enhanced HR Benefits & Retention Package will help maintain a stable workforce, which is crucial for continuity of care within facilities, and will help mitigate turnover in the highly competitive job market.