Program Administration & Operations Toolkit

Each toolkit includes a definition of the area being addressed, a checklist of recommended activities for that area an organization should consider in their move from fee-for-service to pay-for-value, and tools and resources associated with each line item.

For the purposes of this HIMSS Alternative Payment Model Infrastructure Toolkit, the definition of Program Administration and Operations is as follows.  Program Administration provides the strategic vision, direction, management and coordination of inter-departmental activities necessary to carry out the organizational mission as defined by senior leadership and the Board.  It involves management of the complex relationships between clinical, administrative, financial, and health IT departments; monitoring of overall performance within these programs; and provides the framework for identifying and resolving issues that raise significant management or regulatory compliance implications.

Components of Program Administration may include:

  • Establishing systems for smooth program functioning
  • Managing staff to carry out the mission of the program
  • Planning and budgeting financial resources
  • Managing organizational change
  • Establishing systems to monitor and evaluate organizational performance
  • Recruiting, selecting, and orienting personnel
  • Overseeing systems for the supervision, retention and professional development of staff
  • Establishing partnerships with Board members, community representatives, civic leaders and other stakeholders to design and improve services
  • Political advocacy

Operations refers to the administration of business practices required to support program administration in the most efficient way possible.  For the purposes of an APM entity, the primary goal of operations is to transform resources or data into the most efficient, highest quality of care possible to maximize patient satisfaction and the organization’s financial performance.  Operations may include:

  • Developing and overseeing business process flows that maximize internal resources, reduce inefficiencies, eliminate redundancies and ensure highest levels of employee and patient satisfaction
  • Optimizing operational processes that impact health outcomes or health status scores
  • Management of inventory levels (supply chain economics)
  • Execution of effective quality control models
  • Materials handling policies
  • Maintenance policies
  • Balancing costs with revenue to achieve highest net operating profit possible
  • Implementing and monitoring business practices designed to maintain organization’s regulatory compliance
  • Coordinating activities among appropriate departments and individuals to ensure health IT resources are fully leveraged to support organizational goals and mission