Paloma Community Hospital is considering opening two new programs at the same time, but is having second thoughts. Paloma will proceed with one or the other, but presently, cannot afford to proceed with both. You are on the subcommittee which will recommend which of these programs should be funded at the present time. Your subcommittee will participate in a cost benefit analysis of the two alternatives:

1. Postnatal care program for first-time low-income single mothers
2. Healthy nutrition program for post-cardiac surgery patients

You have to do an analysis of both services and compare them to justify the more favorable of the programs you select. You need to take your situation (data provided) into account. I want evidence of deep, well-rounded, big picture thinking.

Description of postnatal care program: provides support for postnatal moms who may not have the more traditional support mechanisms in place to provide care to an infant and to navigate services and potential resources available to first-time, low-income single mothers. Eligible program participants are Medicaid and CHIP enrollees. Capital expenditures include re-modeling an area for a simulation lab/classroom where moms can practice caring for their infant under supervision, teaching, and collaboration with the program facilitator and other moms in a supportive environment. Program related operating funding include federal grant dollars for postpartum depression assessment and mitigation, and WIC nutritional benefits. State grants for breastfeeding counseling, and family case management. Program specific operating costs include: program facilitator, topic specific coaches and educators, clerical staff, and program materials. Program goal is to prevent infant morbidity and mortality related to socioeconomic factors. Primary in-house support from OB and Pediatricians. External support from the local health department, local childcare, early intervention, and mental health advocacy groups.

Description of healthy nutrition program: provides nutrition education for eligible post-cardiac patients whose poor nutrition contributed to their disease, those with hypertension, or whose sequela may lead to congestive heart failure. Capital expenditures include re-modeling an area for a kitchen/classroom where patients can learn and participate in diet planning, preparing meals, shopping for food, and learning how to manage the nutritional component of their post-surgery recovery and continued heart-healthy life with teaching, coaching, and support with the program facilitator and other patients. Program related operating funding is available from the USDA and private foundations. Program specific operating costs include program facilitator, nutritional counselors, a chef, ingredients, clerical staff, and program materials. Program goal is to improve cardiac postsurgical outcomes. Primary in-house support from Cardiologists and Surgeons. External support from the local health department and the local wellness coalition.

Your payer mix is: 30/% Medicare, 20% Medicaid, 40% Commercial Insurance, and 10% other. Your hospital is 130 beds. Your medical staff is 80. The size of your community is 65,000. The nearest hospitals are smaller CAHs. The next largest hospital is 55 miles away. You have a local community college. The largest employer in your vicinity is a Subaru manufacturing plant, which employs over 2400 workers. It is located between you and your next largest hospital.

The crux of any CBA is a determination of the "Costs" in relation to the "Benefits" to be considered in the analysis. For each of the two programs, identify some key direct costs associated with the program. Consider the start-up costs of these two programs. As appropriate, you should consider costs that accrue to the hospital, the patient, or to other parties.

Factors to include:

1. What are the direct cost accounts of the postnatal program?
2. What are the direct cost accounts of the healthy nutrition program?
3. Identify some major potential benefits that are likely to accrue from each program. Attempt to consider personal health benefits, health resource benefits, non-health benefits, and other non-financial benefits.
4. Consider the cost/consequence evaluation of your non-financial benefits.
5. Consider the pros and cons of selecting one over the other.
6. What is the recommendation of your subcommittee?