health pei business plan

HEALTH PEI Business Plan - Prince Edward Island HEALTH PEI Business Plan 2017-2018 Message from the...

Business Plan

Telephone: (902) 368-6130

(902) 368-6136

Mail: Health PEI

16 Garfield Street PO Box 2000

Charlottetown, PE CANADA C1A 7N8

[email protected]

Web: www.healthpei.ca

Twitter: @Health_PEI

Prepared by: Planning, Evaluation and Audit Published by: Health PEI PO Box 2000 Charlottetown, PE Canada C1A 7N8 October 2017

Printing: Document Publishing Centre Available online at: www.healthpei.ca

Printed in Prince Edward Island

1 Message from the Acting Chief Executive Officer

2 Vision, Mission and Values

3 Strategic Direction

4 Introduction

5 Accountability Framework and Performance Monitoring

7 2017-18 Focus Areas

8 Goals and Strategic Priorities

19 Budget and Resource Summary

20 Appendices

26 Reference List

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Message from the Acting Chief Executive Officer

As Acting CEO of Health PEI, I am pleased to present the Health PEI 2017-18 Business Plan. This is the first business plan of Health PEI’s new three-year strategic plan which provides direction for 2017-2020. This business plan outlines key actions to move forward with Health PEI’s new strategic direction and the key areas supporting the goals of: Quality and Safety, Access and Coordination, and Innovation and Efficiency. Development of the business plan builds on extensive stakeholder engagement for our strategic plan and was completed under the direction of Health PEI executive leaders and the Board of Directors in accordance with the Health Services Act.

Over the coming year, we will continue to focus on improving the care provided to Islanders by expanding engagement opportunities throughout Health PEI; improving access to services across the province; enhancing safety and security at our facilities; and increasing the use of innovative technologies to provide care.

I look forward to continuing to work with the dedicated staff, physicians and volunteers at Health PEI, as well as our health care and community partners, throughout the coming year to move forward with our new strategic direction.

Respectfully submitted,

Denise Lewis FlemingActing Chief Executive Officer Chief Operating Officer

Denise Lewis FlemingActing Chief Executive Officer

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Our vision statement guides current and future actions and practices of the organization. The vision statement remains unchanged from the Health PEI Strategic Plan 2013-2016.1 Health PEI recognizes its vision as a future state that the organization will continue to strive toward. The vision statement was validated through the engagement process surrounding the development of the Health PEI Strategic Plan 2017-2020.2

One Island health system supporting improved health for Islanders.

Our mission statement describes the purpose of Health PEI and reflects the broad functions of the organization as defined in the Health Services Act. Our mission statement remains unchanged from the previous plan. The statement was reaffirmed during the engagement process for the development of the 2017-2020 Strategic Plan.

Working in partnership with Islanders to support and promote health through the delivery of safe and quality health care.

Core values are integral to our activities and relationships as health care professionals and providers at Health PEI. Our current values are consistent with those found in our previous plan, as well as Health PEI’s Code of Conduct document entitled How We Live Our Values.3 Participants in the engagement process surrounding the development of the 2017-2020 Strategic Plan agreed that Health PEI’s current values are critical and reinforced that all staff and physicians within the organization should possess these values in the workplace.

Caring: We treat everyone with compassion, respect, fairness and dignity.

Integrity: We collaborate in an environment of trust, communicate with openness and honesty, and are accountable through responsible decision making.

Excellence: We pursue continuous quality improvement through innovation, integration and the adoption of evidence-based practices.

Vision, Mission and Values

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Strategic Direction

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Health PEI’s Strategic Plan outlines the organization’s direction and guides decision making and activities over the next three years (2017-2020). As a foundational document outlined in the Health Services Act, the strategic plan provides a basis for public reporting and Health PEI’s performance and accountability framework which includes the release of an annual business plan.4 The business plan, developed at the beginning of each fiscal year, serves as the annual operational work plan for the organization. The plan will guide Health PEI toward achieving its goals and key actions approved by the Health PEI Board in the 2017-2020 Strategic Plan directly complementing the Government of PEI’s priorities for health care, including: access to care, focus on specific populations and addressing the changing health needs of Islanders.5

The business plan is supported by the quality and patient safety plans for 2017-18, in addition to existing plans, strategies and initiatives in place within Health PEI’s units/teams, service areas and divisions. Health PEI must support current service requirements (daily operations) and respond with new strategies or key actions to address unmet health care needs of Islanders and service area pressures. To accomplish this work, Health PEI must build on what is currently working well and maximize benefits from investments identified each fiscal year while managing existing resources. Investments approved for the 2017-18 fiscal year include:

Quality and Safety

• Hillsborough Hospital Security

Access and Coordination• Women’s Wellness Centre

• Provincial Renal Program Expansion

• PEI Cancer Strategy

• New Geriatrician and Neurologist

Innovation and Efficiency • QEH Emergency Department (ED) Physician Hours

Introduction

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Indicators In order to monitor progress on each goal and priority area identified in the 2017-2020 Strategic Plan, Health PEI monitors strategic performance indicators (SPIs) and business plan indicators on an ongoing basis. A SPI is a measure that is reported quarterly or annually and provides relevant and actionable information about health system performance and characteristics including effectiveness of an organization’s strategies and operational efficiency.6,7

The SPIs selected reflect the wide scope of health care services provided and reflect health system performance. The indicators also enable Health PEI to compare its performance with national and regional practices. Due to the changing nature of health care, it should be noted that key actions may have to be adjusted to achieve goals outlined. At the business plan level, indicators are in place to monitor progress on implementation of key activities that support the achievement of strategic goals. Indicators collected for the 2017-18 Business Plan will primarily focus on process indicators that will track progress on the creation or implementation of new processes, programs and services. These indicators will be tracked by different Health PEI areas. The business plan indicators are summarized under each goal area and are provided in detail in Appendix A. These indicators have been reviewed and agreed upon by leaders within the organization and are a key component in determining where progress is being made within Health PEI, as well as where adjustments or additional focus is required. Subsequent business plans will include an increased number of outcome indicators building on the processes established this fiscal year.

Leadership Accountability

Each Health PEI executive leader has been issued a mandate letter outlining their responsibilities toward leading the successful implementation of the strategic plan. The 2017-18 Business Plan is a reflection of the areas that Health PEI and its leaders will focus on to assist the organization in moving forward to better serve Islanders. Current processes for monitoring the progress of the strategic plan include: the development of the Health PEI Annual Report at the end of each fiscal year, a review of the organization’s Audited Financial Statements and regular compliance reports to the Health PEI Board of Directors.

Accountability Framework and Performance Monitoring

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Source: Accreditation Canada

Integrated Quality and Safety Framework

Health PEI’s Integrated Quality and Patient Safety Framework includes the eight dimensions of quality as defined by Accreditation Canada.8,9 The quality dimensions align with the goals and strategic priorities outlined in Health PEI’s Strategic Plan. Throughout the business plan, the quality dimensions and symbols below are connected to strategic priorities and key actions to demonstrate the alignment and integration of the quality dimensions with the strategic plan and business plan. To further support the business plan and the achievement of Health PEI’s goals, quality and patient safety plans for 2017-18 have been developed. Quality and patient safety plans will be updated on an annual basis with the business planning cycle.

DIMENSION TAGLINE

Safety Keep me safe

Client-Centered Services Partner with me and my family in our care

Worklife Take care of those who take care of me

Efficiency Make the best use of resources

Appropriateness Do the right thing to achieve the best results

Accessibility Give me timely and equitable services

Population Focus Work with my community to anticipate and meet our needs

Continuity Coordinate my care across the continuum

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Financial Sustainability Financial sustainability will be built upon Health PEI’s fundamental goal of working within its approved budget. In recognition of the growth of health care services provided, changing population needs and the current fiscal climate on Prince Edward Island, Health PEI will strive toward becoming more efficient and integrated across the province. Health PEI leadership will address challenges through fiscal management, developing its workforce and the implementation of best practices. As an organization, Health PEI will identify opportunities for efficiency and to work effectively to provide high quality health care to Islanders. In collaboration with the Department of Health and Wellness, Health PEI will work to achieve the goal of sustainability.

Health System AccreditationHealth care accreditation through Accreditation Canada’s Qmentum program is an ongoing process of assessing health care organizations against national standards of excellence to identify what is being done well and what needs to be improved. Accreditation helps health care organizations improve quality and safety, create stronger teams and demonstrates a commitment to quality, safety and accountability. In September of 2017, surveyors from Accreditation Canada visited PEI to assess Health PEI’s services and programs. Health PEI is striving toward maintaining accreditation status to demonstrate its commitment to quality and safety in the delivery of services and programs.

2017-18 Focus Areas

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Health PEI has developed three-year strategic goals and priorities based on significant input provided by stakeholders throughout an extensive engagement process and analysis of national and provincial literature and data. These goals and priorities build on Health PEI’s mission, vision and values. Strategic priorities outline areas requiring focus to achieve the goals with the key actions providing details on how the goals will be accomplished each year. Key actions supporting this business plan are presented in the following pages that focus on the development and establishment of many new initiatives. Subsequent business plans in the 2017-2020 strategic planning cycle will highlight or include system outcomes as opposed to establishing processes and initiatives. The following pages include a brief description of each goal, identified strategic priorities, key actions and related business plan indicators for the 2017-18 fiscal year.

Goals and Strategic Priorities

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Support a culture of quality, safety and security in Health PEIHealth PEI is committed to a culture of quality, safety and security for patients, their families and those providing their care. Safety awareness and practices in the workplace can significantly reduce the risk of injury to employees. Building on this, a key driver for creating a culture that embodies quality, safety and security is one where engage-ment takes place with patients, families, staff and the general public on a daily basis. Perspectives and input provided by these groups are essential in guiding change and making improvements to the health care system.

Strategic Priorities

1. Improve patient and workplace safety and security

2017-18 Focus: Key Actions

Patient Safety

• Implement the patient safety culture action plan to enhance and support a just culture of patient safety by developing implementation plans for Health PEI facilities

• Continue medication reconciliation, including an auditing process to ensure that accurate and complete medication information is communicated to patients with a focus on acute care, community mental health and addictions (MHA)

Workplace Safety and Security

• Build on preliminary work completed as a result of the Hillsborough Hospital Safety and Security Review through planning for camera placements, fire safety and electrical work, and continue meetings with staff and unions to provide updates on progress

• Continue the peer-led Leadership Development Safety Series to provide managers and staff with education on employee safety

• Workplace wellness: continue supporting the Smoking Cessation Program at Queen Elizabeth Hospital (QEH), promoting workplace wellness during Healthy Workplace Month, including Mental Illness Week and Influenza Immunization Awareness Month

Goal 1 | Quality and Safety

Linkage to Quality and Safety Framework

Safety Worklife

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2. Embed patient and family-centered care at all levels of the organization including, direct care, program and service planning and leadership to enhance patient experience

• Implement and monitor the Health PEI Family Presence Policy which improves patient and family- centered care by removing formal visiting hours

• Implement Health PEI’s Patient and Family-Centered Care (PFCC) Steering Committee’s annual work plan focusing on communication, education and training resources that can be used across Health PEI to support patient and family-centered care

• Build on current patient and family participation on groups, including the Provincial Cancer Steering Committee; Patient Flow Advisory Committee; Provincial Ambulatory Care Steering Committee; Patient and Family Advisory Councils for the Provincial Renal Program and Prince County Hospital (PCH); West Prince working groups for in-patients; Diabetes; Stroke Steering Committee and Cardiac/Respiratory Programs

• Develop and implement key actions for quality practices from the Health PEI Nursing Strategy 2017-202010

• Adopt quality nursing practices which optimize the patient/family experience (e.g. bedside hand-off reporting, 4P Rounding and senior friendly initiatives in hospitals) through the year one implementation of the Health PEI Nursing Strategy 2017-2020

• Continue to have patient and family-centered care as a focused discussion topic at staff and management forum meetings to ensure responsive action to client feedback from frontline patient discussions – discussion points for meetings will be developed as a component of education and training resources

Client-Centered Services

• Join as a signatory to the national declaration of the commitment to Psychologically Healthy and Safe Workplaces (PHSW) for the health care sector and support the work of the Health PEI advisory committee responsible for PHSW

• Develop a Health PEI policy on PHSW

• Integrate PHSW competencies into the leadership LEADS framework, providing tools and resources for Health PEI leaders to support staff members

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3. Increase engagement with patients, staff, members of the public and communities

• Increase communication and engagement through staff meetings and management forums

• Work with patients, families, community partners and staff to identify new and innovative opportunities for engagement

• Provide opportunities for education on engagement for staff, physicians and volunteers

• Collaborate with the Chief Nursing Office to develop a systematic approach for engaging with patients and families

• Leverage work undertaken through PHSW to engage with staff

Performance Measures  

Business Plan Indicators  Baseline 2016‐17 

Target 2017‐18 

1stQuarter 2017‐18 

Percentage of medication reconciliation completed on admission: 

For acute care  57%  61%  75% 

For community mental health  N/A  N/A  75% 

For addictions  N/A  N/A  75% 

Percentage of quality teams with two patient/family reps  25%  100%  40% 

 * For detailed Health PEI Scorecard, refer to Appendix A (Page 21-22).

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Provide access and coordination to community health and mental health and addictions to meet the needs of IslandersHealth PEI is committed to working closely with Islanders to support creating and maintaining healthy people in Island communities. In order to achieve this, Health PEI must ensure that Islanders are able to access programs, services and providers when they are needed. Therefore, Health PEI will continue to focus on increasing access to primary care providers, MHA and community-based services. Having all professionals in the system trained and working to full scope of practice will be vital for ensuring that the most appropriate provider has sufficient time to spend with patients and families that need their services the most.

1. Improve access to primary care services

• Develop a business case for implementing changes to the Patient Registry with regular reporting on the status of patients on the registry and those removed from the registry

• Continue implementation of services and programs for the Women’s Wellness Centre: sexual health, reproductive health programs, provision of pre-natal care for unaffiliated patients and provision of pregnancy terminations

• Consider the addition of nurse practitioners (NP) to primary care health centres

• Through key actions in the Health PEI Nursing Strategy 2017-2020, enable nurses to practice to the level to which they are educated and licensed by determining barriers for nurses, partnering with professional associations, reviewing policies, practices, and current legislation.

• Conduct research on evidence-based opportunities for NPs, registered nurses (RNs) and licensed practical nurses (LPNs) that can strengthen nursing across different areas such as primary care, MHA and long-term care (LTC)

Goal 2 | Access and Coordination

Accessibility Appropriateness

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2. Improve access to mental health and addictions services

• Transfer additional psychiatry hours to outpatient mental health services and treatment, pending recruitment of clinicians

• Hire a resource to coordinate and launch the Collaborative Mental Health Care in Primary Care Program across the province

• Continue work with Aboriginal and refugee populations through dedicated psychiatry support

• Provide MHA staff with evidence-based best practices through focused training on: suicide prevention therapy, workbook use, group therapy, Community Reinforcement Approach and Family Training (CRAFT), crisis intervention, cognitive behaviour therapy (CBT), dialectical behaviour therapy (DBT) and trauma- informed therapy

Accessibility Continuity

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3. Improve access to community-based specialized care programs for chronic and complex clients

• Increase the number of patients enrolled in the Remote Patient Monitoring (RPM) Program

Accessibility Continuity Population Focus

• Implement a communication campaign to increase the number of eligible/at risk Islanders participating in PEI’s cancer screening programs

• Conduct a feasibility study to determine if a lung cancer screening program will be launched

• Identify patients that are currently being screened outside of the Colorectal Cancer Screening Program

• Chronic Kidney Disease (CKD) Clinics – RNs to lead CKD clinics and provide ongoing monitoring of stable CKD clients

• Build on additional allied health (e.g. social worker, dietitian, pharmacist) supports in the Provincial Renal Clinic to improve support and access to services

• Continue to conduct RN-led education sessions and presentations to medical staff across the province

• Include chronic obstructive pulmonary disease (COPD) patients to the program

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2. Enhance home care services

• Enhance home care services in the community through collaboration between home care and the newly hired internist geriatrician

• Develop and update provincial standards for the delivery of geriatric care as directed by best practices and following Accreditation Canada standards

• Continue to promote enhanced palliative care in the home program to physicians

• Focus on three priority populations: frail seniors, post acute and palliative populations through the implementation of the 2017-2020 Home Care Development Plan

• Implement the Caring for Older Adults and Caregivers in Community and at Home (COACH) Program in Prince County to connect frail seniors to the right services to help them remain at home

Performance Measures

* For detailed Health PEI Scorecard, refer to Appendix A (Page 21-22).

Number of Women’s Wellness procedures performed in ambulatory care at the PCH  101  ‐  226 

Number of residents with COPD/heart failure participating in the RPM Program  53  100  

30  

Number of clients enrolled in the COACH Program  60  15‐20% increase  47 

Number of palliative care clients in home care  962  10% increase  316 

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Develop new and innovative approaches to improve the efficiency and utilization of acute care services and ambulatory care resourcesHealth PEI is committed to effectively managing the use of its resources to benefit the health outcomes of Islanders and their access to services while also reducing cost and creating sustainability. It is important to enhance how patients flow within acute care and community services, and to optimize transitions between sites, sectors and programs. Health PEI must also continue to streamline and improve existing processes and resource allocations to increase efficiency where possible. The increased use of telemedicine and other innovative technologies will improve access to care and support for staff.

1. Improve patient flow

Patient Flow

• Implement year one of the Patient Flow and System Utilization Strategy 2017-202011 with a focus on provincial bed management

• Launch patient flow and system utilization projects, including an application process and the promotion of opportunities

• Activate and support activities to meet the requirements of the Accreditation Canada Client Flow standards

Hospital (Acute Care) Utilization

• Develop a provincial bed map that includes the designation of all acute care beds according to the care provided to determine profile of bed (level, suitable patient)

• Develop and roll-out provincial over capacity policy and protocol

Goal 3 | Innovation and Efficiency

Efficiency Appropriateness

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2. Reduce wait times in emergency departments

• Pilot a short stay unit (Clinical Decision Unit) at the QEH ED, with the aim of reducing inpatient admissions and providing an alternate pathway for patients

• Pilot a collaborative project with the QEH ED and home care liaison to ensure the frail elderly population being seen in the ED are assessed for the need of increased services or change in services

• Strengthen and continue collaboration between MHA and EDs through mental health representation on the ED Quality Team and ED representation on the Mental Health Quality Team

• Continuing “Drip and Ship” protocol for myocardial infarction (MI). Patients are transferred to St. John, New Brunswick post thrombolytic. This initiative reduces wait times for patients requiring cardiac catheterization and reduces/eliminates hospital admission to the QEH

Efficiency Accessibility Continuity

3. Ensure appropriate use of ambulatory care resources

• Focus on developing ambulatory care processes for data standardization and service delivery

Appropriateness

• Work to create standard orders across ambulatory care

• Develop process to review new requests for services

• Review current services

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4. Increase use of innovative practices 2017-18 Focus: Key Actions

• Use of telemedicine and other innovative technologies across the province

• Establish telemedicine linkages between different sites and specialty areas including nephrology at PCH and Western Hospital; neurology; telepsychiatry at PCH ED; LTC; Telestroke; and Pediatric Psychiatry

• Install connections to different boardrooms

• Install online e-scheduling and application database for volunteers at Community Hospital O’Leary (CHO)

• Continue Strongest Families, an online and telehealth program for children and youth and their families, to improve mental health service access

• Distribute utilization reports and Choosing Wisely best practice information on lab and diagnostic imaging (DI) tests to clinicians

• Partnering with provincial stroke and hyperacute stroke committees to reduce door to thrombolytics for stroke patients and develop a “Drip and Ship” model for clot retrieval. This will help to improve outcomes for patients and reduce length of stay (LOS) in hospital in the acute and rehab phases and long term

Median wait time in the ED for admitted patients  16.7 hrs  8.0 hrs  

16.7 hrs  

Median wait time for physician initial assessment for triage level 3 in the ED  1.4 hrs  1.0 hr  

1.4 hrs  

Volume of telemedicine services  338  ‐  

91  

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Budget and Resource SummaryHEALTH PEI

2017-2018 2016-2017 2016-2017Budget Forecast Budget

$ $ $EXPENDITURE*

CORPORATE SERVICES AND PHARMACARE…….………..…………… 54,493,400 50,164,800 49,769,100 MEDICAL AFFAIRS…………………………………………………………. 164,476,100 169,907,000 156,335,900 EHS, LTC AND HOSPITAL SERVICES EAST……………………………….. 284,676,700 275,725,100 275,029,500 FAMILY, COMMUNITY MEDICINE AND HOSPITAL SERVICES WEST 109,671,000 102,563,900 102,023,000 MENTAL HEALTH AND ADDICTIONS………………………………….. 45,043,900 41,483,500 42,139,300 NURSING, ALLIED HEALTH AND PATIENT EXPERIENCE…………… 381,900 359,500 377,600 HUMAN RESOURCES……………………………………………………….. 4,817,800 4,770,100 4,433,400 QUALITY AND SAFETY……………………………………………………. 1,323,100 1,319,100 1,206,400 GROSS EXPENDITURE…...…...…..…………..……………………………. 664,883,900 646,293,000 631,314,200

HEALTH PEI TOTAL REVENUE 24,731,100 25,399,300 26,619,600

NET HEALTH PEI EXPENDITURE………..……………………………………. 640,152,800 620,893,700 604,694,600

CAPITAL PROJECT CONTRIBUTIONS - External Organizations 3,000,000 3,686,500 3,424,900

Capital Plan"Capital Improvements and Repairs 22,866,800 6,973,700 16,185,300 Capital Equipment 3,839,000 7,225,600 5,229,900 Total Capital Expenditures 26,705,800 14,199,300 21,415,200

Full-Time Permanent Equivalents 2017-18 2016-17 2015-16(Direct FTEs)Corporate Services and Pharmacare 150.05 154.55 152.55 Medical Affairs 138.16 129.12 115.12 EHS, LTC and Hospital Services East 2,253.04 2,224.82 2,216.48 Family, Community Medicine and Hospital Services West 964.22 940.83 931.08 Mental Health and Addictions 423.83 415.81 396.30 Nursing, Allied Health and Patient Experience 3.85 3.80 2.00 Human Resources 36.00 36.00 36.00 Quality and Safety 13.70 24.80 25.55 Total FTEs 3,982.85 3,929.73 3,875.08

* PEI Estimates of Revenue and Expenditures 2017/18

"2017-18 Capital Budget and Five Year Capital Plan. Capital Investments ensure the province's health infrastructure is maintained and modified or expanded to meet health service needs of changing demographics. The health sector invests in health facilities, such as hospitals (e.g., Expansion of PCH ambulatory care), manors and clinics. Capital investment is also made in medical equipment including hemodialysis machines, a new linear accelerator and surgical equipment. Five year capital plans are prepared annually to ensure that the significant costs associated with capital investments are strategic, cost-effective, and align with other health sector planning.

Full time equivalency information for 2017-18 was derived from Health PEI salary budget documents. Permanent FTEs, including permanent vacancies are included. Please note that due to 2016-17 organizational changes, positions moved from Corporate Services and Pharmacare and Quality and Safety to other divisions within Health PEI.

FTEs for Medical Affairs include all staff, including salaried physicians. Fee-for-service, contract and sessional physicians are not included.

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Appendix A: Health PEI Scorecard

Appendix B: Business Plan Indicator Definitions

Appendix C: Organizational Structure

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Appendix A – Health PEI Scorecard

 PERFORMANCE LEGEND    Meeting target – 100%    Almost meeting target – 75%     Not meeting target – 50%  

TREND LEGEND  √  Meeting target or on track to meet target  X  Not meeting or will not meet 

target  ∆  Caution – needs work to meet target  →  Trending towards target  ◊  No established target, 

standard, or benchmark  

BUSINESS PLAN INDICATORS FY 2017‐18 ‐ QUARTERLY REPORTING  

Goal  Indicator 1st

Quarter 2017‐18 

Baseline 2016‐17 

Target  Trend  Executive Director/ CAO/Chiefs  Comments 

Quality and Safety 

For acute care  61%  

57%  

75%  ∆  Rick Adams   

  For community mental health  N/A  N/A  75%  ‐   Tracked twice a year. First audit Aug 2017 

  For addictions  N/A  N/A  75%  ‐   Tracked twice a year. First audit Aug 2017 

  Percentage of quality teams with two patient/family reps  40%  25%  100%  ∆  Rick Adams  

Access and Coordination 

Number of Women’s Wellness procedures performed in ambulatory care at the PCH  226  101  ‐  ◊  Arlene Gallant‐Bernard, Dr. Andre Celliers 

FY 2016‐17 is a partial year. Started Jan 17 

Number of residents with COPD/heart failure participating in the RPM Program  30  53  

100  

√  Arlene Gallant‐Bernard, Dr. Andre Celliers 

Quarterly target minimum 25 

Number of clients enrolled in the COACH Program  47  60  15‐20% increase  √  Arlene Gallant‐Bernard, 

Dr. Andre Celliers Quarterly target minimum 18 

Number of palliative care clients in home care  316  962  10% increase  √  Arlene Gallant‐Bernard, 

Dr. Andre Celliers Quarterly target minimum 265 

Innovation and Efficiency 

Median wait time in the ED for admitted patients  16.7 hrs  16.7 hrs  8.0 hrs  X Arlene Gallant‐Bernard, Dr. Andre Celliers , Jamie MacDonald, Dr. Tom Dorran 

Median wait time for physician initial assessment for triage level 3 in the ED  1.4 hrs  1.4 hrs  1.0 hr  → Arlene Gallant‐Bernard, Dr. Andre Celliers , Jamie MacDonald, Dr. Tom Dorran 

Volume of telemedicine services  91  338  ‐  ◊ 

Arlene Gallant‐Bernard, Dr. Andre Celliers , Jamie MacDonald, Dr. Tom Dorran, Verna Ryan,  Dr. Heather Keizer 

QEH and PCH 

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What is accreditation?

Accreditation is a voluntary method of quality assurance.

Accreditation Canada provides hospitals with an external peer review process that is used to improve services provided to patients based on standards of excellence.

Accreditation Canada uses a process called Qmentum which is a combination of the words “Quality and Momentum” and focuses more on staff, physician, and volunteer involvement.

Accreditation for Health PEI took place from September 25 – 29, 2017.

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Appendix B – Business Plan Indicator DefinitionsQuality and SafetyPercentage of medication reconciliation completed on admission for acute care, community mental health, addictions

Acute care medication reconciliation reflects the ratio of admission medication reconciliation completed within 24 hours to the number of patients admitted within the specified time period. Community mental health and addictions medication reconciliation reflects the ratio of admission medication reconciliation to the service (for those where medication is part of their treatment) to the number of patients admitted to the service within the specified time period.

Percentage of quality teams with two patient/family representatives

This indicator displays the number of quality teams with two patient/family representatives divided by the total number of quality teams, displayed as a percentage.

Access and CoordinationNumber of Women’s Wellness procedures performed in ambulatory care at the PCH

This indicator displays the number of procedures performed through ambulatory care at the PCH related to Women’s Wellness. The types of procedures include options/birth control counseling, surgical abortions, IUD (post-op), post-abortion counseling, post-abortion follow-up, miscarriage counseling, crisis counseling, postpartum depression counseling, IUD insertions, IUD removal, IUD removal & insertion, IUD recheck, endometrial biopsy, loop electrosurgical excision procedure (LEEP), cryotherapy cervix, vulvar biopsy, urodynamic study, pap, STI swab, gynecological - not otherwise specified (NOS) and contraception counseling.

Number of residents with COPD/heart failure participating in the RPM Program

This indicator displays the number of people participating in the RPM Program who have COPD and heart failure. There are 30 kits available for use. Clients can be referred through:

• Primary care (family physician)

• Acute care

• Self-referral

• Heart failure report (created from the ED)

H E A L T H P E I B u s i n e s s P l a n 2 0 1 7 - 2 0 1 8 24

Volume of clients enrolled in the COACH Program

The COACH Program is Caring for Older Adults in Community and at Home. This indicator represents a unique count of Personal Health Numbers (PHNs) for the fiscal year.

Volume of palliative care clients in home care

This indicator represents the number of home care clients who are identified as palliative in Integrated Services Management (ISM).

Innovation and EfficiencyMedian wait time in the ED for admitted patients

This indicator represents the median LOS in the ED from the time of registration to the time the client is transferred to their unit. This is represented in hours.

Median wait time for physician initial assessment for triage level 3 in the ED

This indicator displays the median wait time from the time of registration in the ED to the time of physician initial assessment (PIA). This is represented in hours.

Volume of telemedicine services

This indicator displays the overall use of telemedicine in ambulatory care settings.

H E A L T H P E I B u s i n e s s P l a n 2 0 1 7 - 2 0 1 825

Appendix C – Organizational Structure

Senior Management

Audit, Compliance & Monitoring Committee

Quality & Safety Committee

Public Engagement Committee

Nursing, Allied Health and Patient Experience

Emergency Health Services, Long-Term Care and Hospital Services East

Mental Health and Addictions Services

Family and Community Medicine, and Hospital

Services West

Human ResourcesQuality and Patient Safety Corporate Services and Pharmacare

Department of Health and Wellness

Health PEI Board

Health PEICEO

H E A L T H P E I B u s i n e s s P l a n 2 0 1 7 - 2 0 1 8 26

1 Health PEI Strategic Plan 2013-2016

2 Health PEI Strategic Plan 2017-2020

3 Health PEI’s Code of Conduct, How We Live Our Values

4 Health Services Act, R.S.P.E.I. 1988, Cap. H-1.6.

5 Government of PEI Budget Address 2017. Retrieved from: https://www.princeedwardisland.ca/en/information/finance/budget-address-2017

6 Canadian Institute for Health Information (CIHI) Health Indicators. Retrieved from: https://www.cihi.ca/en/cihi-health-indicators

7 Alberta Health Services. Healthy system outcomes and measurement framework, 2014. Retrieved from: https://open.alberta.ca/publications/health-system-outcomes-and-measurement-framework

8 Health PEI’s Integrated Quality and Patient Safety Framework, 2017.

9 Accreditation Canada Quality Standards

10 Health PEI Nursing Strategy: 2017-2020. Retrieved from: https://www.princeedwardisland.ca/en/information/health-pei/health-pei-nursing-strategy-2017-2020

11 Health PEI Patient Flow and System Utilization Strategy: 2017-2020. Retrieved from: https://www.princeedwardisland.ca/sites/default/files/publications/patient_flow_and_system_utilization_ strategy_2017-2020.pdf

Reference List

H E A L T H P E I B u s i n e s s P l a n 2 0 1 7 - 2 0 1 827

List of Acroynms Used ACRONYM    DEFINITION  ACRONYM    DEFINITION

Cognitive Behaviour Therapy

Community Hospital O’Leary

Chronic Kidney Disease

Caring for Older Adults in Community and at Home

Chronic Obstructive Pulmonary Disease

Community Reinforcement Approach & Family Training

Dialectical Behaviour Therapy

Diagnostic Imaging

Emergency Department

Integrated Services Management

Length of Stay

Licensed Practical Nurse

Long-Term Care

Mental Health and Addictions

Myocardial Infarction

Nurse Practitioner

Prince County Hospital

Patient and Family-Centered Care

Personal Health Number

Psychologically Healthy and Safe Workplaces

Physician Initial Assessment

Queen Elizabeth Hospital

Registered Nurse

Remote Patient Monitoring

Strategic Performance Indicator

Health Tech Net July 15, 2005 Robert M. Kolodner, MD Acting Deputy CIO for Health & Acting Chief Health Informatics Officer Veterans Health Administration.

Pei Health Jobs

Health Disparity Reduction & Minority Health Audrea Woodruff Acting Section Manager.

Health Summary Flowsheet Objects Lori Moore, Pharm D. Acting SFSU CAC Acting ABQ Area CAC.

County of Del Norte PEI plan - Californiaarchive.mhsoac.ca.gov/Counties/PEI/docs/PEIplans/PEI_DelNorte.pdf · County of Del Norte Department of Health and Human Services Mental Health

Quality & Patient Safety - Health PEI

Board of Health PEI - Gov

Data Entry PEI Outcome Measures Application for Mental Health Integration Program (MHIP)

HEALTH PEI Strategic Plan Public Engagement Strategy · 1 | Page Health PEI 2017‐2020 Strategic Plan: Engagement Strategy Introduction As Health PEI strives toward becoming a high

2015 - Welcome to Engineers PEI | Engineers PEI

How We Live Our Values - Prince Edward Island · How We Live Our Values The Health PEI Code of Conduct. Its About living Our Values ... • Based on the Health PEI Values Caring •

Health PEI Annual Report 2019-2020 - Prince Edward Island...Health PEI Annual Report 2019-2020. ANNUAL REPORT. 2019–2020. Telephone: (902) 368-6130. Fax: (902) 368-6136. Mail: Health

basic concrete - RAK concrete... · recreados en tonos de blanco, gris oscuro, negro, marfil, ... PEI-5 PEI-4 PEI-4 PEI-3 PEI-3. 24 RAk CERAMICS 201 25 Glazed Porcelain Tiles Gres

Poverty and environment initiative (Pei) - Home | Economic ...esrf.or.tz/PEI/docs/PEI-Bunda District.pdf · Poverty and environment initiative (Pei) a Study to assess institutional

School / Student Health Promotion...To share information on youth health projects and programs taking place in PEI school communities. To map the landscape of youth health in PEI,

Acting Now for Better Health

Senate Committee on Health and Human Services · 2016/9/13 · PEI Five-year Strategic Plan Goals 1. PEI will adopt a public-health framework to prevent child maltreatment and fatalities

Directions from Acting Chief Health Officer in accordance ...

Federal government, P.E.I. sign deal in principle for health care funding

Province getting $288m in new funding over next decade, plus $9m one-time topup.

Social Sharing

The federal government and the province of  Prince Edward Island have signed a bi-lateral agreement on health-care funding. 

Some details of the "agreement in principle" announced Thursday were discussed at a Wednesday evening news conference that included representatives from both levels of government.

It boils down to $966 million over the next decade, $288 million of which is new funding, and $9 million through an immediate, one-time Canada Health Transfer top-up to address urgent needs.

P.E.I. Premier Dennis King told reporters some of the funding will go toward establishing a more collaborative health-care model.

• Federal, Ontario and Atlantic Canadian governments reach agreement on health-care funding
• Premiers accept federal health-care funding proposal

He said the province shares priorities the federal government outlined on the deal, including recruitment of health-care professionals, and clearing surgery backlogs.

"The system needs to change and adapt," King said. "We all know that change is hard. It takes time and energy, but in signing this deal, it provides our province with the financial stability needed to continue to make the necessary changes and innovations, many of which are underway."

One of the changes involves a reorganization of how primary care is delivered on P.E.I., by pooling family doctors, nurse practitioners and other medical care providers into group operations known as medical homes and neighbourhoods .

The premier said the province will have 14 medical homes confirmed by the end of March, and 90 new positions have been approved to ensure the medical homes are adequately staffed.

As well, a team is set to travel to Dubai looking to recruit internationally trained health-care professionals for the province.

• Doctors in Atlantic Canada will soon be able to work in any of the 4 provinces
• 'No quick fix' to staffing shortages, CEO of Health PEI says

King said the province will invest in settlement services for any newcomers to ensure they're supported and choose to stay in P.E.I.

Word that an agreement in principle had been reached for Prince Edward Island came on the same day the federal government hailed similar deals with the other Atlantic provinces and Ontario.

Related Stories

• Ottawa police in line for $50M federal funding boost to patrol parliamentary precinct
• N.S. government, teachers' union reach 'agreement in principle'
• Alberta government closing in on new pay model to attract family doctors
• B.C. earmarks $155M to recruit, retain specialized health workers
• RCMP still probing alleged meddling in federal elections but offering few details

External Links

• Prince Edward Island patient registry

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Wipro to Implement Independent Health’s Medicare Prescription Payment Plan Platform

Wipro’s Medicare Prescription Payment Plan Platform will streamline prescription payments

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO), a leading technology services and consulting company, today announced they have been selected by Independent Health, Western New York’s only 5-Star Rated Medicare Advantage Plan, to implement Wipro’s Medicare Prescription Payment Plan (MPPP360) platform for the upcoming open enrollment period.

Starting in 2025, the Medicare Prescription Payment Plan will allow enrollees to make capped monthly payments for out-of-pocket prescription drugs, amongst other changes. The new law aims to improve access to affordable treatments and strengthen Medicare.

Wipro’s MPPP360 platform will assist Independent Health in streamlining the payment process to seamlessly integrate these new provisions, simplifying prescription cost management for Medicare recipients in Western New York.

Narayan Iyer, Vice President, Healthcare, Wipro Limited , said “We are excited to introduce our Medicare Prescription Payment Plan360 platform, better known as MPPP360, to Western New York. This project exemplifies our dedication to transforming the Medicare landscape through innovative technology solutions. Together with Independent Health, we are committed to enhancing efficiency and convenience for beneficiaries, thereby elevating their healthcare journey.”

“Independent Health prides itself on being a leading, highly rated, Medicare Advantage plan. With the forthcoming changes to Medicare Part D, and the pharmaceutical industry’s continued escalation of prescription drug pricing, we want to make sure our members can afford their medications. It is important that our members have access to their medications and take them as prescribed to maintain their health and well-being,” said Dawn Odrzywolski, Vice President, Medicare Programs, Independent Health. “This prescription drug payment program complements our efforts to provide our members with innovative solutions to meet their varying healthcare needs, which in turn supports our efforts in achieving our industry leading 5-Star rating from CMS for three consecutive years.”

About Wipro Limited

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com .

About Independent Health

Independent Health is an independent, not-for-profit health plan headquartered in Buffalo, New York, providing innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, Independent Health offers a comprehensive portfolio of progressive products including HMO, POS, PPO and EPO products, Medicare Advantage and Medicaid plans, individual Exchange products, consumer-directed plans, health savings accounts, and coverage for self-funded employers. Our subsidiaries and affiliate companies include a third-party administrator of health benefits, pharmacy benefit management, specialty pharmacy and the Independent Health Foundation. In all, Independent Health and its affiliates serve a total of more than 550,000 lives across the country. Independent Health has been recognized nationally for its award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers. For additional information, visit www.independenthealth.com .

Forward-Looking Statements

The forward-looking statements contained herein represent Wipro’s beliefs regarding future events, many of which are by their nature, inherently uncertain and outside Wipro’s control. Such statements include, but are not limited to, statements regarding Wipro’s growth prospects, its future financial operating results, and its plans, expectations and intentions. Wipro cautions readers that the forward-looking statements contained herein are subject to risks and uncertainties that could cause actual results to differ materially from the results anticipated by such statements. Such risks and uncertainties include, but are not limited to, risks and uncertainties regarding fluctuations in our earnings, revenue and profits, our ability to generate and manage growth, complete proposed corporate actions, intense competition in IT services, our ability to maintain our cost advantage, wage increases in India, our ability to attract and retain highly skilled professionals, time and cost overruns on fixed-price, fixed-time frame contracts, client concentration, restrictions on immigration, our ability to manage our international operations, reduced demand for technology in our key focus areas, disruptions in telecommunication networks, our ability to successfully complete and integrate potential acquisitions, liability for damages on our service contracts, the success of the companies in which we make strategic investments, withdrawal of fiscal governmental incentives, political instability, war, legal restrictions on raising capital or acquiring companies outside India, unauthorized use of our intellectual property and general economic conditions affecting our business and industry.

Additional risks that could affect our future operating results are more fully described in our filings with the United States Securities and Exchange Commission, including, but not limited to, Annual Reports on Form 20-F. These filings are available at www.sec.gov . We may, from time to time, make additional written and oral forward-looking statements, including statements contained in the company’s filings with the Securities and Exchange Commission and our reports to shareholders. We do not undertake to update any forward-looking statement that may be made from time to time by us or on our behalf.

Media Contact: Wipro Media relations [email protected]

View source version on businesswire.com: https://www.businesswire.com/news/home/20240501297911/en/

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Walmart Health Is Closing

April 30, 2024

BENTONVILLE, Ark., April 30, 2024 — Back in 2019, we launched Walmart Health centers. During our five-year journey, we made meaningful impacts with patients while continuing to learn, pivot and evolve. While our mission to help people save money and live better remains, today we are sharing the difficult decision to close Walmart Health and Walmart Health Virtual Care. Through our experience managing Walmart Health centers and Walmart Health Virtual Care, we determined there is not a sustainable business model for us to continue.

The decision to close all 51 health centers across five states and shut down the virtual care offering was not easy. We understand this change affects lives – the patients who receive care, the associates and providers who deliver care and the communities who supported us along the way. This is a difficult decision, and like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.

Our priority will be ensuring the people and communities who are impacted are treated with the utmost respect, compassion and support throughout the transition. We do not yet have a specific date for when each center will close but will share as soon as decisions are made.

While we will no longer operate health centers, we will take what we learned as we provide trusted health and wellness services across the country through our nearly 4,600 Pharmacies and more than 3,000 Vision Centers. For 40 years, we have provided these high quality, accessible and affordable points of care that are integral to their respective communities.

• Over the past few years, the importance of Pharmacies has continued to grow, and we have expanded the clinical capabilities of the services we provide. We continue to offer immunizations and have grown to provide Testing and Treatment services, access to specialty pharmacy medication and care, as well as other essential services such as medication therapy management and a variety of health screenings. With more than 4,000 of our stores in medical provider shortage areas, our pharmacies are often the front door of healthcare.
• Our optical business, which is growing and evolving to serve customers how and when they want, recently expanded with more than 200 Vision Centers brought under Walmart ownership. We also launched a suite of optical tools, including virtual try-on capabilities that make getting a pair of glasses even easier.

Our culture of innovating and trying new formats and services has helped our company become stronger and better able to serve customers. We will continue to innovate as we grow our core businesses and launch even more services like the Walmart Healthcare Research Institute and health programs to join our fresh food and OTC offerings in helping our customers live better.

Today and in the coming days, we are focused on continuity of care for patients and providing impacted associates with respect and assistance as we begin the closing process of the health care centers. The associates and providers have made an incredible difference for their patients and communities, and they are a priority:

• All associates are eligible to transfer to any other Walmart or Sam’s Club location.
• All associates will be paid for 90 days, unless they transfer to another location during that time or leave the company.
• After 90 days, if they do not transfer or leave, eligible associates will receive severance benefits.
• Our provider partners will continue to serve existing patients while clinics are open. Through their respective employers, these providers will be paid for 90 days, after which eligible providers will receive transition payments.

We are deeply grateful to these associates and providers for their caring service to patients in our communities and to the patients who trusted us with their care.

About Walmart

Walmart Inc. (NYSE: WMT) is a people-led, tech-powered omnichannel retailer helping people save money and live better – anytime and anywhere – in stores, online, and through their mobile devices. Each week, approximately 255 million customers and members visit more than 10,500 stores and numerous eCommerce websites in 19 countries. With fiscal year 2024 revenue of $648 billion, Walmart employs approximately 2.1 million associates worldwide. Walmart continues to be a leader in sustainability, corporate philanthropy and employment opportunity. Additional information about Walmart can be found by visiting corporate.walmart.com , on Facebook at facebook.com/walmart , on X (formerly known as Twitter) at twitter.com/walmart , and on LinkedIn at linkedin.com/company/walmart .

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The following outline provides a high-level overview of the FTC’s proposed final rule :

• Specifically, the final rule provides that it is an unfair method of competition—and therefore a violation of Section 5 of the FTC Act—for employers to enter into noncompetes with workers after the effective date.
• Fewer than 1% of workers are estimated to be senior executives under the final rule.
• Specifically, the final rule defines the term “senior executive” to refer to workers earning more than $151,164 annually who are in a “policy-making position.”
• Reduced health care costs: $74-$194 billion in reduced spending on physician services over the next decade.
• New business formation: 2.7% increase in the rate of new firm formation, resulting in over 8,500 additional new businesses created each year.
• This reflects an estimated increase of about 3,000 to 5,000 new patents in the first year noncompetes are banned, rising to about 30,000-53,000 in the tenth year.
• This represents an estimated increase of 11-19% annually over a ten-year period.
• The average worker’s earnings will rise an estimated extra $524 per year. 

The Federal Trade Commission develops policy initiatives on issues that affect competition, consumers, and the U.S. economy. The FTC will never demand money, make threats, tell you to transfer money, or promise you a prize. Follow the  FTC on social media , read  consumer alerts  and the  business blog , and  sign up to get the latest FTC news and alerts .

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Preparing your Business Plan

Your business plan is a put-your-thoughts-down-in-writing approach to bringing your business from an idea to reality. It is a clear description of your business, a written summary of what you hope to accomplish in business and how you intend to organize your resources in order to meet your goals. There are many resources available, including templates to guide the development of your business plan.

Why should I develop a business plan?

There are practical advantages to preparing a solid business plan before you advance too far in your business start up.

• Preparing a business plan encourages an objective, unemotional look at your business project in its entirety. It allows you to define areas of strength and weakness, highlight needs you may have overlooked and identify problems before they arise, helping you avoid costly mistakes.
• The finished business plan is the blueprint for building your company, a reliable operating tool to help you manage your business successfully.
• Most lending institutions will require your professional business plan before approving any capital investment in your business. Use your business plan as a basis for your financial proposal and to communicate your ideas to others. It is a good idea to contact your lending institution before going to them for a funding request to confirm the type of information they require in your business plan.

How should I structure my business plan?

A business plan generally has two components: a written description of the entire project and the financial data .

Your written section should include the following:

• Business description: type, status, business purpose and objective, and unique aspects;
• Marketing strategy: your target customers, why they will want your product or service and how you will reach them;
• Competition analysis: all your competitors, their strengths and weaknesses, and how you will differ;
• Location analysis: your proposed location, the reasons for your site selection and the type of facility you plan to use;
• Production analysis: what and how you will produce and equipment needed;
• Management and personnel requirements:  staff qualifications,  specific duties and wages

Your financial section should include the following information:

• All funding sources and applications: where you will get your money, how and for what you will use it;
• A capital equipment list: equipment needed and what it will cost;
• Financial statements: balance sheet, projected income statement and projected cash flow analysis;
• Historical business records (if an existing business)

The financial information in your business plan is critical to accurately evaluate the feasibility of your idea and to plan the investment required to bring your business to a stable level of operation. Be realistic in your projections; over-optimism can result in business failure. A professional consultant should review your business plan to ensure it includes all necessary information.

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Collusion in Health Care Pricing? Regulators Are Asked to Investigate

A data analytics firm has helped big health insurers cut payments to doctors, raising concerns about possible price fixing.

By Chris Hamby

Chris Hamby has been investigating the lucrative business of out-of-network medical claims.

Recent revelations about a data analytics firm’s role in determining medical payments have heightened concerns about possible price fixing in health care and led to a call for a federal investigation.

In a letter this week, Senator Amy Klobuchar asked federal regulators to examine whether algorithms used by the firm, MultiPlan, have helped major health insurers conspire to cut payments to doctors and leave patients with large bills. She cited a New York Times investigation last month into MultiPlan’s dominance of the lucrative business of pricing out-of-network medical claims.

“Algorithms should be used to make decisions more accurate, appropriate and efficient, not to allow competitors to collude to make health care more costly for patients,” Ms. Klobuchar wrote to the heads of the Justice Department’s antitrust division and the Federal Trade Commission.

When patients see a medical provider outside their plan’s network, insurers often send their claims to MultiPlan, which uses proprietary algorithms to recommend how much to pay. By driving down payments to providers, MultiPlan and the insurers can collect higher fees for themselves, The Times reported, but this can lead to higher bills for patients, who may get charged the unpaid balance.

UnitedHealthcare, Cigna, Aetna and other major insurers use MultiPlan’s pricing recommendations, and the firm has boasted to investors that it is “deeply embedded” in its clients’ claims-processing systems.

In interviews, Ms. Klobuchar, a Democrat from Minnesota, and experts in antitrust law said this arrangement could amount to price fixing: Rather than competing to offer better coverage, insurers could use the low prices recommended by MultiPlan’s algorithms, knowing their competitors would likely do the same.

“This should trigger an investigation by the agencies,” said Barak Orbach, a law professor at the University of Arizona. “There seems to be a really strong case.”

The F.T.C. and Justice Department declined to comment, but both agencies have raised concerns in the past about similar arrangements in other industries.

In a statement, MultiPlan did not address the price-fixing allegations, instead emphasizing its commitment “to helping make health care transparent, fair and affordable for all.” In legal filings, the firm has denied allegations of collusion and said that insurers are free to reject its pricing recommendations or negotiate higher payments with providers.

Insurers have said that MultiPlan’s tools help combat outrageous billing by some providers, including consolidated hospital systems and private-equity-backed staffing firms.

Documents reviewed by The Times indicate that MultiPlan has sometimes told insurers how their unnamed competitors were using the firm’s pricing tools. In a 2017 presentation to UnitedHealthcare, MultiPlan shared “Recent Client Strategies to Improve Results,” which included techniques that could reduce payments to providers.

After a 2019 meeting, a UnitedHealthcare senior vice president reported to her colleagues that a MultiPlan executive “did not specifically name competitors but from what he did say we were able to glean who was who.” She then described how Cigna, Aetna and some Blue Cross Blue Shield plans were apparently using the firm’s pricing tools.

Three hospital systems have sued MultiPlan, accusing it of colluding with major insurers to set unreasonably low payments for medical care, and patients and providers have complained to the F.T.C. about MultiPlan, records obtained through a public records request show.

One provider reported slashed payments from UnitedHealthcare, Cigna and an Aetna subsidiary after the insurers routed claims to MultiPlan’s most aggressive pricing tool . Another said the tool “has decimated my life” and caused “the closing of my business,” which has “left patients having to travel 2.5 hrs for surgery.”

Patients complained to the agency of receiving large bills after insurers used MultiPlan-recommended prices. “This is now affecting my credit score,” wrote one patient, describing a bill that had been sent to a debt collector. Another reported being billed thousands of dollars “since they refuse to pay my providers the correct amount.”

Pricing algorithms have driven MultiPlan’s growth over the past 15 years. The firm previously focused on controlling costs by negotiating with medical providers, but after being sold to private equity investors, it embraced automated, algorithm-based tools, which typically yield lower payment recommendations.

Access to data from hundreds of clients has helped entrench the firm’s dominance, executives have told investors. “We build our algorithms on a much larger data lake,” one executive said in a 2020 presentation.

The focus on MultiPlan’s automated pricing tools highlights growing concern among regulators and some in Congress that algorithms are supercharging price-fixing schemes and driving up costs for consumers.

During the Biden administration, companies’ increasing embrace of technological advancements has collided with aggressive enforcement efforts by regulators. The results have been mixed, as the agencies seek to apply laws enacted to combat 19th-century oil and railroad robber barons to 21st-century technology firms.

“Algorithms are the new frontier,” the Justice Department wrote in a brief in one case. “And, given the amount of information an algorithm can access and digest, this new frontier poses an even greater anticompetitive threat than the last.”

Regulators and some antitrust scholars worry that algorithms can enable sophisticated collusion that is difficult to police. Competitors no longer need to meet in secret to hatch a conspiracy and communicate among themselves to perpetuate it. They can simply agree to use a common pricing algorithm.

Weighing in on private lawsuits involving apartment rents and hotel room prices , the agencies have argued that such an arrangement is illegal, even if competitors agree with a wink and a nod rather than a formal pact.

But in one case, a judge disagreed in a December ruling, allowing the lawsuit to go forward but requiring renters to offer more explicit evidence that landlords had conspired to raise prices using an algorithm.

Ms. Klobuchar has introduced legislation that would effectively make the agencies’ position the default. Courts would presume it illegal for competitors to share nonpublic data with a middleman and use the pricing recommendations that the firm’s algorithms produced.

“It is not clear whether current antitrust laws are sufficient to stop this practice,” Ms. Klobuchar said in an interview. “It is much better just to clarify this and to close the loophole.”

The bill would also require companies to tell consumers if they are buying something that was priced using an algorithm, and it would give regulators greater authority to demand details about how an algorithm works.

Chris Hamby is an investigative reporter for The Times, based in Washington. More about Chris Hamby

Walmart is shuttering all its 51 health centers and ending virtual care services as Amazon leans into the space

• Walmart will shut down the health clinics it has at 51 stores across five states.
• The retailer cited a "challenging reimbursement environment and escalating operating costs ."
• The move reverses recent plans to double the number of of clinics at its retail stores.

Walmart says it will shut down the 51 health clinics it has at retail stores across five states, as well as its virtual care operation as the business has become "unsustainable."

"The challenging reimbursement environment and escalating operating costs create a lack of profitability," the company said Tuesday.

The announcement did not provide a specific date for the closures, but sources told the Dallas Morning News and CNBC they would happen over the next 45 to 90 days.

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Walmart opened its first health clinic in Georgia in 2019 and since expanded to Arkansas, Florida, Illinois, and Texas.

Staffed by physicians and licensed care providers , the clinics offered services ranging from primary care to behavioral health, as well as labs and X-rays. Virtual care was also available through walmarthealth.com.

Earlier this year, the company had planned to double the number of clinics, but a spokesperson told the Dallas Morning News the decision to close was made after the company received new information about reimbursements from insurers.

Meanwhile, Amazon last year expanded a  benefit  for Prime members, giving them access to online services and visits at hundreds of One Medical clinics in cities across the US.

By contrast, Walgreens said last month it would close 160 Village MD clinics after taking a $5.8 billion hit in the business.

Walmart continues to operate pharmacies at about 4,600 stores across the US, with over 4,000 those in what it calls "medical provider shortage areas."

"Our pharmacies are often the front door of healthcare," the company said.

Watch: Walmart shooter started the massacre in a staff break room

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Biden officials indefinitely postpone ban on menthol cigarettes amid election-year pushback

FILE - Menthol cigarettes and other tobacco products are displayed at a store in San Francisco on May 17, 2018. For the second time in recent months, President Joe Biden’s administration has delayed a plan to ban menthol cigarettes, a decision that is certain to infuriate anti-smoking advocates but could avoid angering Black voters ahead of November elections. (AP Photo/Jeff Chiu, File)

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WASHINGTON (AP) — President Joe Biden’s administration is indefinitely delaying a long-awaited menthol cigarette ban , a decision that infuriated anti-smoking advocates but could avoid a political backlash from Black voters in November.

In a statement Friday, Biden’s top health official gave no timeline for issuing the rule, saying only that the administration would take more time to consider feedback, including from civil rights groups.

“It’s clear that there are still more conversations to have, and that will take significantly more time,” Health and Human Services Secretary Xavier Becerra said in a statement.

The White House has held dozens of meetings in recent months with groups opposing the ban , including civil rights organizers, law enforcement officials and small business owners. Most of groups have financial ties to tobacco companies.

AP AUDIO: Biden officials indefinitely postpone ban on menthol cigarettes amid election-year pushback.

AP correspondent Ed Donahue reports on political pushback on a proposed ban on a type of cigarette.

The announcement is another setback for Food and Drug Administration officials, who drafted the ban and predicted it would prevent hundreds of thousands of smoking-related deaths over 40 years. The agency has worked toward banning menthol across multiple administrations without ever finalizing a rule.

“This decision prioritizes politics over lives, especially Black lives,” said Yolonda Richardson of the Campaign for Tobacco-Free Kids, in an emailed statement. “It is especially disturbing to see the administration parrot the false claims of the tobacco industry about support from the civil rights community.”

Richardson noted that the ban is supported by groups including the NAACP and the Congressional Black Caucus.

Previous FDA efforts on menthol have been derailed by tobacco industry pushback or competing political priorities. With both Biden and former President Donald Trump vying for the support of Black voters , the ban’s potential impact has been scrutinized by Republicans and Democrats heading into the fall election.

Anti-smoking advocates have been pushing the FDA to eliminate the flavor since the agency gained authority to regulate certain tobacco ingredients in 2009. Menthol is the only cigarette flavor that wasn’t banned under that law, a carveout negotiated by industry allies in Congress. But the law instructed the FDA to continue studying the issue.

More than 11% of U.S. adults smoke, with rates roughly even between white and Black people. But about 80% of Black smokers smoke menthol, which the FDA says masks the harshness of smoking, making it easier to start and harder to quit. Also, most teenagers who smoke cigarettes prefer menthols.

For decades, tobacco companies focused menthol advertising and promotions in Black communities, sponsoring music festivals and neighborhood events. Industry documents released via litigation also show companies viewed menthol cigarettes as a good “starter product” because they were more palatable to teens.

The FDA released its draft of the proposed ban in 2022 . Officials under Biden initially targeted last August to finalize the rule. Late last year, White House officials said they would take until March to review the measure. When that deadline passed last month, several anti-smoking groups filed a lawsuit to force its release.

“We are disappointed with the action of the Biden administration, which has caved in to the scare tactics of the tobacco industry,” said Dr. Mark Mitchell of the National Medical Association, an African American physician group that is suing the administration.

Separately, Rev. Al Sharpton and other civil rights leaders have warned that a menthol ban would create an illegal market for the cigarettes in Black communities and invite more confrontations with police.

The FDA and health advocates have long rejected such concerns, noting FDA’s enforcement of the rule would only apply to companies that make or sell cigarettes, not to individuals.

An FDA spokesperson said Friday the agency is still committed to banning menthol cigarettes.

“As we’ve made clear, these product standards remain at the top of our priorities,” Jim McKinney said in a statement.

Smoking can cause cancer, strokes and heart attacks and is blamed for 480,000 deaths each year in the U.S., including 45,000 among Black Americans.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.