Program leaves out CPI process and fails

Planning with CPI saves money

Not all the programs recently launched by MedPartners in La Habra, CA, were developed using the continuous process improvement (CPI) method. One notable failure, the Medicare-risk plan's Silver Sneakers health promotion program, turned its back on CPI and is currently struggling for survival as a result.

"This is the story of the un-CPI project," says Marcia Anderson, RN, BS, CDMS, CCM, director of utilization management for MedPartners. "The core component of the program is an aerobic program done while sitting in a chair. Membership is free and it includes a T-shirt with the Silver Sneakers logo."

The multimillion-dollar project was developed by the plan's marketing department with no input from other departments, Anderson says. "There was no team involvement. There was no needs assessment done. At the time, we didn't even have adequate information about our patient population. We later learned a large percentage of our seniors were over age 85 and unlikely to participate in an exercise program."

Anderson sat in on one Silver Sneakers planning session. She raised several concerns with the marketing group. Those included:

o What happens if a member falls at the gym? Will gym personnel know to get the member to a network hospital?

o What about incident reports?

o What is the projected participation rate?

"We knew that PacifiCare, another California health plan, had a senior health program, and only 10% of their members joined and less than half of those members participated in the program regularly after joining," she says. "We only have 130,000 Medicare-risk patients, so the potential participation seemed very low, and we were spending a lot of money."

In addition, the marketing group left out several essential steps in the CPI process necessary for success, notes Anderson. Those included:

o There was no mission statement.

"Without a mission statement, we had no physician buy-in, and patients were not referred to the program," she notes. (For more information on steps in the CPI process, see p. 130.)

o There was no research on alternatives.

"Right in our own building, we had a twice-weekly senior exercise program that was well-liked and well-attended. We have a cafeteria, and our seniors come for class and then stay for lunch," Anderson says.

The Silver Sneaker program was set up in area gyms. "The marketing people said they had a beautiful facility that was only 30 miles away," she says. "In fact, most seniors rarely travel more than 2.2 miles from home for any services."

o There were no strategies for growing membership or improving program content.

"They hadn't even set up a system to evaluate whether the program is valuable," Anderson says. "Now, the program is failing, and they've asked for help to fix it."