IHP 670 Module 8 Milestone Three Example

Milestone Three: Paying for Steady Steps Now and After the Grant

[Student Name]

Southern New Hampshire University

IHP 670: Program Design, Planning and Evaluation

Module Eight Milestone Three

[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.

Milestone Three: Paying for Steady Steps Now and After the Grant

Many community programs end when their first grant does, leaving participants and partners with nothing but a report. This milestone sets out how Steady Steps will spend its three-year, $1.2 million state grant, what partners contribute in kind, what the program costs per participant, why that is good value and how it will be funded after year three.

Budget Principles

The budget follows three principles: fund the elements that evidence and the logic model say matter most, especially trained instructors and sustained classes; build capacity that remains after the grant, such as certified local instructors and a referral pathway in the electronic record; and reserve funds in year three to bridge to new funding sources.

Three-Year Budget

Personnel costs make up the largest share. A full-time coordinator manages sites, referrals and instructors, and a half-time analyst supports evaluation. Instructor pay covers about 120 class series over three years. Other costs include instructor certification, transportation, a one-time referral build in the hospital electronic record, outreach, assessment supplies and participant incentives, class equipment and the department's indirect cost rate.

Table 1. Steady Steps Three-Year Budget

Note. Composite budget; in-kind contributions listed separately.

In-Kind Contributions

Partners contribute resources not paid by the grant: senior center and YMCA space valued at about $86,000 over three years, volunteer drivers' time, primary care staff time for screening and advisory group members' time. Recording these shows funders the community's investment and identifies what partners already provide that can continue.

Budget by Year

Spending is front-loaded. Year one costs about $430,000, including instructor certification, the referral build and a partial year of classes. Year two, at full delivery across nine centers, costs about $410,000. Year three costs about $360,000, including the $127,000 transition reserve, as senior centers take over scheduling and the analyst's time shifts toward final evaluation. This pattern lets the program demonstrate results before the funding transition begins and avoids a cliff in the final months.

Controlling Costs

Several choices hold costs down. Classes use donated space, and senior centers handle registration. Instructors are paid per session rather than salaried, so costs track demand. The program uses standard curricula rather than developing its own materials. Volunteer drivers receive mileage reimbursement rather than a contracted van service except in the most remote township. The coordinator will review spending monthly against the budget and report variances greater than 10% to the department's finance office.

Cost per Participant

If Steady Steps enrolls its target of 1,800 older adults, the grant cost is about $667 per participant, or about $600 excluding the transition reserve. Costs per participant fall over time, since training and the referral build occur early and later class series draw on already certified instructors.

The Value Case

Florence et al. (2018) put the national medical bill for older adults' falls at roughly $50 billion for 2015, most paid by Medicare and Medicaid. Carande-Kulis et al. (2015) analyzed three community fall prevention programs, including tai chi for balance and a multi-week group education and exercise program, and found that each produced positive returns, with estimated savings from prevented falls exceeding program costs. Their tai chi estimate was especially favorable. These analyses suggest that Steady Steps, if delivered with fidelity, could save more in medical costs than it spends.

A Local Estimate

If participants' falls decline by 20% and each participant would otherwise average about 0.5 falls a year, 1,800 participants would experience about 180 fewer falls a year. If one in ten prevented falls would have led to medical care averaging about $10,000, the program would avoid roughly $180,000 in medical costs a year among participants alone, before counting benefits beyond the first year or reduced long-term care. These savings accrue mainly to Medicare, Medicaid and health plans, which matters for sustainability.

What Helps Programs Last

Scheirer and Dearing (2011) set out a research agenda on the sustainability of public health programs, describing a sustained program as one whose activities, benefits or community capacity carry on once start-up money runs out. They identified factors likely to influence it, including the program's fit with host organizations, the presence of champions, partnerships, organizational capacity, evidence of effectiveness and funding stability. Steady Steps' plan addresses each.

Sustainability Strategies

Four funding streams will be pursued. The local Area Agency on Aging can direct federal Older Americans Act funds designated for evidence-based health promotion to support classes. Several Medicare Advantage plans in the region offer fall prevention programs as supplemental benefits and could contract with Steady Steps. Both hospital systems can support screening and classes through their community benefit spending, which nonprofit hospitals must report. The county's general fund will be asked to continue the coordinator position at half time if evaluation shows results.

Building Capacity That Stays

Beyond money, the plan builds lasting capacity. By year three, two senior center staff will be certified to train new instructors, the referral pathway will be part of routine clinic workflow and senior centers will schedule classes themselves. A modest sliding-scale fee, waived for low-income participants, will be tested in year three to gauge willingness to pay without excluding priority groups.

Transition Timeline

In year two, the coordinator will present interim results to the Area Agency on Aging, health plans and hospital community benefit committees. By the middle of year three, agreements for continued funding should be signed, with the transition reserve covering any gap of up to six months.

Risks

If evaluation results are weak, funders may not continue support; the program will then focus on the components with the strongest results. Health plan interest may depend on members' enrollment, which the program will track by plan.

Conclusion

Steady Steps' budget concentrates grant funds on trained instructors, sustained classes and lasting infrastructure, at about $667 per participant. Evidence suggests the program can save more than it costs, and a plan built on multiple funding streams, champions and site ownership gives it a realistic chance to outlive its first grant.

References

Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70. https://doi.org/10.1016/j.jsr.2014.12.007

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304

Scheirer, M. A., & Dearing, J. W. (2011). An agenda for research on the sustainability of public health programs. American Journal of Public Health, 101(11), 2059-2067. https://doi.org/10.2105/AJPH.2011.300193