HCM 491 Module 6 Cost and Evaluation Short Paper Example

What Dental Bridge Costs and How We Will Know It Works

[Student Name]

Southern New Hampshire University

HCM 491: Health Sciences Capstone

Module Six Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

What Dental Bridge Costs and How We Will Know It Works

Marlow Regional Hospital's chief financial officer told the stakeholder review that support for Dental Bridge depends on two things: an honest budget and a way to tell quickly whether the program is working. This paper provides both. It itemizes the annual cost, estimates savings after accounting for revenue the hospital would lose, considers value that does not appear on a ledger and designs an evaluation built on plan-do-study-act cycles.

The Annual Budget

The largest cost is the navigator, a full-time community health worker, at about $58,000 in salary and benefits. Reserved slot fees paid to Riverside Community Health total $21,000, twelve slots a week for fifty weeks at $35 each. A patient assistance fund of $20,000 covers the minimum sliding-fee charge for about 500 uninsured patients, and transportation help adds $12,000. Training, supplies, printing, communications, evaluation time and program oversight account for the rest. Table 1 lists every item.

Table 1. Dental Bridge Annual Operating Budget

Note. Estimates from hospital finance, human resources and Riverside Community Health.

Start-Up Costs

One-time costs are modest: about $4,000 to recruit and orient the navigator, $2,500 to design and translate the discharge packet into Spanish and $1,500 to add a Dental Bridge referral order to the ED record. The total of about $8,000 would come from the community benefit budget, which already sets aside funds for projects addressing needs identified in the hospital's community health needs assessment.

Estimating Savings Honestly

A common mistake is to count the full cost of every avoided visit as savings. When a visit does not happen, the hospital also loses whatever it would have been paid. Marlow recovers about 38% of the $390 direct cost of a treat-and-release dental visit, so each avoided visit saves about $242 net. If the pathway cuts dental visits by 20% by year two, about 290 visits, net savings reach roughly $70,000. The objective comes from Module Four, and the evidence that coverage and coordination reduce visits, reviewed by Elani et al. (2020) and Jiang et al. (2022), suggests it is ambitious but reasonable.

Avoided Admissions

Admissions for facial infections are rarer but costlier. The hospital had 29 such admissions last year at about $9,800 in direct cost each, with payments covering around 45%. If earlier dental treatment prevents a third of them, about ten a year, net savings would be roughly $54,000. This estimate is less certain than the visit estimate, since infections depend on how quickly patients reach treatment, which is exactly what the navigator and reserved slots aim to speed up.

The Bottom Line

Combining the two, estimated net savings of about $124,000 against a $138,000 budget leave a net annual cost of roughly $14,000 in year two. The largest Medicaid health plan among Marlow's dental visitors has signaled interest in contributing $30,000 a year toward the navigator if first-quarter results are encouraging, which would turn the program modestly positive. Table 2 summarizes the estimate.

Table 2. Year Two Financial Summary

Note. Estimates by the author with hospital finance; year one savings expected at about half of year two.

Value Beyond Cash

Some benefits do not appear in Table 2. Avoiding 290 visits frees about 700 hours of ED treatment space a year, time that can go to patients waiting for other care during crowded evenings. Lower antibiotic and opioid use may reduce harms that cost other parts of the health system. The program's cost counts toward the hospital's reported community benefit. And patients leave with a path to having the tooth fixed, which is the reason the hospital exists.

Sensitivity of the Estimate

If the pathway cuts visits by only 10%, net savings from visits fall to about $35,000 and the net annual cost rises to roughly $49,000 before any plan contribution. If it cuts visits by 30%, the program saves more than it costs even without outside funding. This range tells the finance office that the program's financial case depends on performance, which is why an early, fast evaluation matters.

Evaluation Measures

The evaluation uses three kinds of measures. Outcome measures show whether patients are better off: the twelve-month repeat dental visit rate, total ED dental visits and the share of referred patients attending within seven days. Process measures show whether the pathway runs as designed: the share of eligible patients seen by the navigator, appointments booked, slot fill rate, callback reach and nerve block use. Balancing measures watch for harm elsewhere: ED length of stay for dental visits, Riverside's wait for its own patients and staff workload.

Using PDSA Cycles Well

Plan-do-study-act cycles let a team test a change on a small scale, learn and adjust. Taylor et al. (2014) reviewed published PDSA projects in healthcare and found that under a fifth of them showed a real series of linked, repeated tests while barely one project in seven steered its cycles with numbers gathered at least once a month. Many projects called one large change a PDSA. Dental Bridge's evaluation will avoid those weaknesses by writing a prediction before each cycle, starting small, using weekly data and documenting what changed between cycles.

Four Planned Cycles

Cycle one tests navigator booking for two weeks on weekday evenings, predicting that half of eligible patients will leave with an appointment. Cycle two adds morning callbacks for overnight patients, predicting that 40% of those reached will book. Cycle three trains two physician champions in nerve blocks and predicts block use on their shifts will reach 25%. Cycle four begins outreach to the 112 frequent visitors, predicting that a third will book a preventive visit within a month. Once a cycle closes, the navigator, nurse manager and Riverside lead agree in a brief huddle whether to keep, adjust or drop the change.

Table 3. Planned PDSA Cycles

Note. Cycles will be adjusted based on results of earlier cycles.

Data and Reporting

Each week the team will add the latest process figures to run charts; outcome figures get a new point once a month. The navigator will log every eligible patient, booking and callback in a shared spreadsheet, while Riverside will report attendance for Dental Bridge slots every two weeks. The one-page dashboard for executives, promised in the communication plan, will show the main outcome, process and balancing measures against targets, along with the running financial estimate.

Conclusion

Dental Bridge costs about $138,000 a year and, if it meets its objectives, recovers most of that through avoided visits and admissions, with possible outside funding making it slightly positive. The honest estimate depends on performance, so the evaluation is built for speed: small cycles with written predictions, weekly data and balancing measures to catch unintended harm. Module Seven will combine the analysis, pathway, stakeholder plan, budget and evaluation into the final proposal.

References

Elani, H. W., Kawachi, I., & Sommers, B. D. (2020). Changes in emergency department dental visits after Medicaid expansion. Health Services Research, 55(3), 367-374. https://doi.org/10.1111/1475-6773.13261

Jiang, L. G., Zhang, Y., Greca, E., Bodnar, D., Gogia, K., Wang, Y., Peretz, P., & Steel, P. A. (2022). Emergency department patient navigator program demonstrates reduction in emergency department return visits and increase in follow-up appointment adherence. The American Journal of Emergency Medicine, 53, 173-179. https://doi.org/10.1016/j.ajem.2022.01.009

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862