This form requests background information (e.g., key stakeholders, arguments for change, challenges, formulas) that you used to make the case for a new program/idea or expansion of an existing service. Please provide as much information as possible, but you don’t have to complete all comment boxes if some are not applicable. The Business Case Toolkit Workgroup Members will work with you on refining your tool to share nationally.

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* 1. Contact Information

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* 2. Proposed new program / idea or expansion of existing service:

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* 3. Demographics (setting of care, geographic location, size of institution, staffing):

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* 4. Arguments for change and factors considered (e.g., value proposition, economic analysis, assessment of (potential) risk-based contracts):

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* 5. Tools/Resources (e.g., IHI age-friendly health systems calculator, formulas, data used, existing literature):  

Please note if any tool/resource was of particular value in making a successful case.

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* 6. Key stakeholders involved and their roles (e.g., departments/divisions/centers, presenters, sponsors, decision makers, external/community). You may also include a champion or specific person you brought on board for change: 

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* 7. Approach to engaging stakeholders and garnering their support (including champions, allies, supporters, opponents): 

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* 8. Economics (e.g., personnel cost, upfront investment):  

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* 9. Challenges faced and approach to addressing challenges:

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* 10. Any additional information you think would be helpful (e.g., tips for others): 

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* 11. Upload a File

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