MHA620 WEEK 4 ASSIGNMENT

Implementation of Strategy
Healthcare organizations require astute handling of strategy implementation.
The processes must be followed with a contingency plan in place for failed
strategic objectives leading to the goal.

 Review the stages of implementation in Chapter 13 of your

textbook.
 Review “340B Drug Pricing Program Oversight” case in your
textbook (Chapter 13).
 Provide a written analysis of the implementation phases that were
used/excluded in the “340B Drug Pricing Program Oversight” case.
 Explain what the literature (external scholarly source) suggest(s)
regarding health implementation strategy regarding drug pricing.
 Conclude with a summary of your research.

Your paper

 Must be four double-spaced pages in length (not including title and

reference pages) and formatted according to APA style as outlined
in the Writing Center.
 Must include a separate title page with the following:
o Title of paper
o Student’s name
o Course name and number
o Instructor’s name
o Date submitted
 Must use at least four scholarly sources in addition to the course
text.
 Must document all sources in APA style as outlined in the Writing
Center.
 Must include a separate reference page that is formatted according
to APA style as outlined in the Writing Center.

Carefully review the Grading Rubric Links to an external site.for the criteria
that will be used to evaluate your assignment.
MHA620 WEEK 4 ASSIGNMENT

MHA620 Week 4 Assignment

Student’s Name

Institution Affiliations

Instructor

Date
MHA620 WEEK 4 ASSIGNMENT

Implementation of Strategy

The United States spends a lot of money and has much debt because of healthcare.

Services like patient care and the cost of medications fall under this category. Still, the latter

has been steadily increasing in recent years, adding substantial healthcare debt to the United

States. In 2014, according to Sifferlin (2015), Americans spent almost $374 billion on drugs

after receiving 4.3 billion prescriptions. Even without including the 13% increase from last

year, the aforementioned sum has been identified as the largest dollar amount paid out for

drugs since 2001. As McLaughlin & McLaughlin (2014) notes, the primary goal of the

Affordable Care Act (ACA) was to increase insurance coverage and make healthcare more

affordable for all Americans. Increasing access to affordable prescription drugs was another

goal of the Affordable Care Act's passage.

The 340B Prescription Pricing Program is the latest iteration of a discount drug

program for the Veterans Administration that was first developed in the 1980s. According to

the American Society of Clinical Oncology., (2014), drug expenses have been reduced by

about 20% to 50% because of the 340B Program's participation. The 340B program is

managed by the Health Resources and Services Administration's Office of Pharmacy (OPA)

(HRSA). Before its expansion in 2003, the 340B program was only open to a small subset of

hospitals. After its first approval in 1992, however, the program was opened to a broader

range of medical facilities (Keough & Webster, 2009). This paper will assess the

implementation phases within the 340B Drug Pricing Program case study in the text, review

340B Drug Pricing Program oversight, define ideas from the text relating to health enactment

strategy for drug pricing, and conclude with a summary of the research.
MHA620 WEEK 4 ASSIGNMENT

Phases of Implementation

1. Scope and Planning: An initial implementation step must incorporate a planning stage.

During this stage, it is essential to discuss the "who," "what," "where," "when," and "how"

of the planned action. Stakeholders need to be identified, and they will be kept abreast of

advances in strategic decision-making during the implementation phase.

2. Work Breakdown: Work breakdown is the process of determining what has to be done

and who is accountable for doing it (McLaughlin & McLaughlin, 2014). Schedules and

reporting expectations will be spelled out, and procedures and principles will be set in

stone. A time study should be conducted to determine the expected duration of the project

and the significant checkpoints along the way. Instead of setting participants up for

disappointment by giving them impossible deadlines or workloads, decision-makers

should let them define their own goals and hold them accountable for seeing them through

to fruition.

3. Funding: Money must be planned for and suggested to stakeholders together with all

backup plans in case money is changed or delayed. As the project develops, this procedure

should be reviewed periodically. All relevant parties must be kept up-to-date on the

proposal's costs and expenses and any differences that may arise.

4. Risk Management: The objective of risk management is to identify and address the many

threats that could undermine the success of a plan. Unwanted disclosures may be avoided

if one is aware of the potential dangers and worries that could affect the implementation

beforehand (McLaughlin & McLaughlin, 2014).

5. Involvement/Engagement of Stakeholders: Stakeholders should be kept updated on

progress and invited to participate in group efforts. All parties involved must see the value
MHA620 WEEK 4 ASSIGNMENT

in the project and have input into its meticulous preparation. Finding out who among the

stakeholders might be a program's opinion leader or supporter, as well as whether any

potential enablers or barriers, is essential. To guarantee the success of an implementation,

stakeholders must be kept up-to-date on pertinent developments, actively participate in the

consultation process, and understand its significance.

6. Resources: Essential resources like staff, tools, supplies, ancillary services, and money

must be put up from the get-go. When none of the aforementioned are defined and

prepared for, delays are likely to occur (McLaughlin & McLaughlin, 2014).

7. Quality Assurance: Appraisal and reappraisal of assessment and projected results must

occur continuously throughout the implementation to ensure project success.

Examining the 340B Drug Pricing Program's Operational Phases for Analysis

There was a deliberate set of intentions behind the creation and rollout of the 340B

Drug Pricing Program. The original goal of the 340B program was to help the Veterans

Health Administration save money on pharmaceuticals. Initially, only a select few hospitals

were eligible for this benefit; later, more hospitals, hospital networks, rural health facilities,

and service providers were added. No effort was made during this stage to determine who the

stakeholders were. Hospitals, community pharmacies, regulatory bodies, patients, vendors,

and doctors who prescribe medications were considered stakeholders. Uninsured and

underinsured people, for example, were not considered when designing the program. It would

have been preferable to consider such problems during the planning stage. Upon inspection,

two things were clear: first, the reductions offered to program participants who are also

Medicaid recipients were doubled. As Dunnenberger et al. (2016) note, the second set of
MHA620 WEEK 4 ASSIGNMENT

facilities and hospitals not eligible for the program were those specified in the original

program.

On the other hand, a system for identifying and detailing the process necessary for

program compliance was built. There is now a regulatory body, but the department

responsible for ensuring compliance has yet to issue the appropriate directions and guidelines.

No one in the company could be called the "program champion." The OPA and HRSA should

have done a thorough review/survey of the program and conducted an in-depth analysis of the

program's participants. There needed to be someone monitoring the correct dispensing of

medications in drugstores. It is possible that some patients received ineligible prescriptions.

Further, the software does not adequately define what constitutes a "qualified patient"

(McLaughlin & McLaughlin, 2014).

There is no reporting setup in place to show program development. As was previously

indicated, surveys or evaluations were absent to ensure adherence to the program's defined

procedures. No thoughts on how to make it better or different were communicated. However,

after further inspection, it was clear that adjustments to the program were needed at the

national level. Compliance checks in the form of audits and surveys are HRSA's

responsibility.

The HRSA issued the regulations and standards in the Federal Register to disclose

findings for all problems and concerns recognized through the program, and the procedures

for discounts based on appropriateness were specified. Before the registry's release, they

provided an opportunity for questions and feedback. Legislation such as the Affordable Care

Act has proposed provisions to bolster the program's legitimacy. The following were among

the suggestions: Whether or not the revenue from the 340B program is being used to advance
MHA620 WEEK 4 ASSIGNMENT

the program goals (McLaughlin & McLaughlin, 2014); (2) whether or not the program's

mandated sale of specific goods might delay patients' availability to therapies; and (3)

whether or not the program's extension to cover the projected 47 million people who have

healthcare insurance once the ACA is implemented.

The inability to give feedback, evaluate service utilization, or identify cost savings to

healthcare organizations was highlighted as an omitted step. One of the most critical findings

from a 2011 GAO review and summary of multiple recommendations was the lack of HRSA

oversight (American Society of Clinical Oncology. 2014). The research also pointed to many

issues and gaps in the HRSA's direction and leadership. After that, some indicators were

specified to check for compliance before publication. The question raised by Senator Grassley

was insightful and essential. It is incredible how much money the three North Carolina

hospitals saved by participating in the 340B program. What was happening was not what the

program was designed to do. People with health insurance contributed heavily to keeping the

three hospitals' payer mix consistent. In terms of percentages, Medicare and commercial

payers far outnumbered those who paid out of pocket or did not have insurance. Senator

Grassley's research revealed a discrepancy between the money the hospital made and how

much was spent on treating the poor. One more way the chasm between the 340B Program's

stated goals and its actual implementation is shown.

In summary, the implementation mentioned earlier calls for a meticulously planned

and process-oriented approach. The 340B Drug Pricing Program was designed to target the

most vulnerable and financially constrained patients with the Medicaid drug discount

(Dunnenberger et al., 2016). This benefit aimed to improve medication compliance among

vulnerable populations, including those without health insurance, those with low incomes, and
MHA620 WEEK 4 ASSIGNMENT

illegal migrants. These patients would be unable to afford the expensive medications

necessary for disease management if not for the 340B program. This program helps people get

the medication they need without going to the emergency room or an urgent care center,

saving money and improving health outcomes. If appropriately implemented, the program

might help reduce healthcare costs, but for that to happen, healthcare providers will need to be

prepared to pass on some of their cost savings to patients.

MHA620 WEEK 4 ASSIGNMENT
MHA620 WEEK 4 ASSIGNMENT 10

References

American Society of Clinical Oncology. (2014). Policy statement on the 340B drug pricing

program by the American Society of Clinical Oncology. Journal of Oncology

Practice, 10(4), 259-263.

Dunnenberger, H. M., Biszewski, M., Bell, G. C., Sereika, A., May, H., Johnson, S. G., ... &

Khandekar, J. (2016). Implementation of a multidisciplinary pharmacogenomics clinic

in a community health system. American Journal of Health-System Pharmacy, 73(23),

1956-1966.

Keough, C. L., & Webster, S. A. (2009). 340B program presents opportunities--and

challenges. Healthcare Financial Management, 63(11), 42–47.

McLaughlin, C. P., McLaughlin, C. D., & McLaughlin, M. C. D. (2014). Health policy

analysis. Jones & Bartlett Publishers.

MHA620 WEEK 4 ASSIGNMENT 11

Sifferlin, A. (2015). Americans Spent a Record Amount on Medicine in 2014. Retrieved

March 20, 2016.