Transcript DDP System Redesign Review of Assessment Tools and Rate Models
State of Montana
When a Field of Dreams Meets a Perfect Storm
Davis Deshaies LLC
I LIKE you I like to HIRE you I like to WORK for you Can I BUY you a beer?
Win As Much As You Can FORMULA: CHOICES 4 Y’s = $1.00 each 1Y / 3X = Y loses $3.00 / X gains $1.00
2Y / 2X = Y loses $2.00 / X gains $2.00
3Y / 1X = Y loses $1.00 / X gains $3.00
4 X’s = X loses $4.00
Win As Much As You Can FORMULA: 4 Y ’s = Y wins $1.00 each 1 2 Y Y / / 3 2 X X = = Y Y loses $3.00 / loses $2.00 / X X gains $1.00
gains $2.00
3 Y / 1 X 4 = Y loses $1.00 / X X ’s = X loses $4.00 gains $3.00 ROUNDS: Round #1 Round #2 Round #3 Round #4 RULES No discussion 2 minute discussion 2 minute verbal contract 2 minute signed contract SCORE _________ _________ _________ ___2x____
Win As Much As You Can Easy to Say All the Time / Tough to Do Most of the Time:
JKL JKL JKL JKL JKL
Common Understanding, Vision, & Values Communication Trust Commitment to the Cause Personal Values & Needs
The Art of Networking: Where to put Crab Pots in a Hurricane
What is a Network
COMPONENTS: PEOPLE YOU KNOW Who have INFORMATION, CONTACTS, &/or INFLUENCE Who share a COMMITMENT To Do WHAT YOU WANT THEM TO DO And will DO IT
Building & Nurturing a Network
INVENTORY & ORGANIZE CONTACTS ASSESS TIMING & QUALITY OF CONTACT MIX PEOPLE & CATEGORIES IDENTIFY FOCUS CREATE OPPORTUNITY EXPAND
J J J J J J
Inventory & Organize Contacts Business Friends Relatives Education Public Figures Web-based Research
Assess Timing & Quality of Contacts
Date of Last Contact Topics Discussed Within Current Year Within 1 to 2 years Within 3 to 4 years After 5 years
Creating the Opportunity IF YES IF NO PERSONAL CAPITAL CHARGE AHEAD FIND OUT WHO DOES THEN WHAT?
NURTURE BROKER
Build YOUR Network
Name Category Frequency of Contact Personal Capital Nurture Strategy
Three-Way Contracts
Purpose Partners Deliverables Timelines Measures
Personal Professional Social
How Organizations are Supposed to Work:
Quicksand, Quagmires, & Quality Assurance
Summary
STATES ARE BROKE
•
STATES ARE GETTING OUT OF THE BUSINESS Cost Shifting to local government & consumers
•
Outsourcing the Uncomfortable stuff
•
Merging DD Services with Medicaid / Long Term Care; Insurers rather than Providers
•
Rationing: Self-directed Service by any other name
Transparency: Naked Organizations EMPLOYEES: Bad News Face – to – Face Lead by Example, Good News in Writing CONSUMERS: Shift Criticism to Competence BUSINESS PARTNERS: Clear & shared risk COMMUNITIES: Connect to local agenda SHAREHOLDERS: Avoid Spin City If you go naked, you better be BUFF…
Provider Structures BEARERS OF RISK
• Risk Corridors, Reserves, and Standard Rates • Just say Goodbye • Federal Whipping Folk • Negotiators
COMMUNITY & CONSUMER NETWORKS
• Community Inclusion • Quality Assurance / Contract Compliance • Eligibility • Consumer Account Executives
•
Structure
•
Systems
•
Culture
•
Individual Behavior
Key Strategies Connect accountability with the Regions & State Program Office Implement procurement, rates, utilization controls Empower people & families; recognize limits of public funding Retrain Case Managers, Providers, & Region staff
Structure Operations Culture Individual Behavior
Change Strategies • • • •
Reorganization Workgroup / task forces New Job Descriptions Strategic Planning
• • • •
MIS re-engineering Contract/purchasing Hiring practices Rate systems
• • •
Staff training CQI “Community review”
• •
Compensation incentives Terminate & replace
Low stress High Stress
CHAOS THEORY
IF MORE THAN 10% OF THE PEOPLE IN AN ORGANIZATION HAVE THEIR TASKS, TIME, OR COLLEAGUES SIGNIFICANTLY CHANGED, THE ORGANIZATION WILL EXPERIENCE CHAOS….
CHAOS THEORY
Creativity / Chaos
Matrix Project Teams Task Forces
Stability / Stagnation
Liaisons Chain of Command
Structure
Montana Change Strategies
Low stress Operations Culture Individual Behavior
Fill In the Blanks
High Stress
State of Montana: Mother Theresa meets Robin Hood
Social Entrepenurialship: How Can Business be More Like Government
BUSINESS GOAL
Pay attention to Market Trends without losing sight of underlying mission
Programs work better for more people
Increase organizational self sufficiency
PRESSURES ON SOCIAL SERVICE AGENCIES
Economic Recession
Continued Federal & State reductions in spending
Decreased Corporate & Individual giving
Increased People needing support Increased Competition Wavering Public Trust
Key Business Planning Factors
• • • •
Environmental factors Organizational Success factors Competitors People - how many & how critical
•
Size & Direction of Market
–
how many dollars
–
source of funding
•
Potential Profitability
ENVIRONMENTAL FORCES
DEMOGRAPHIC SOCIOLOGICAL / “PSYCHOGRAPHIC” TECHNOLOGICAL POLITICAL / REGULATORY WHO ARE YOUR SCRUTINIZERS
ORGANIZATIONAL SUCCESS FACTORS
Definable Program Niche Retain Key Personnel Visible Preserve/Expand Revenue Sources Aggressive Marketing
QUANTIFY PEOPLE ISSUES
What Services support the greatest Greatest Number of People with the Need
• • • • •
PEOPLE V. NEED Rating Scale Critical Need 5 points Substantial Need Needed Some Need Little/No Need 4 3 2 1 points points points point
SERVICE AREA
PEOPLE V. NEED Rate Level of Need
INFANTS PRE-TEEN TEEN ADULT ELDERLY
•
Respite
•
Rehabilitation
•
Family Educ.
•
Day Care
•
Case Mgt.
•
In-home care
•
Assessment
•
Pre-voc.
•
Voc. Training
•
Shelter Empl.
•
Support Empl.
•
Group Home
•
Tenant Suppt.
•
Indep. Lvg.
( Rate each Service Area using the Rating Scale )
PEOPLE V. NEED How does your Business Rate?
Percentage of Business Efforts
•
Critical Need More than 20 %
•
Substantial Need No more than 80 %
•
Needed
•
Some Need
•
Little/No Need No more than 60% No more than 40% Less than 20%
“80 / 20” RULE
80% 20%
of your energy should be focused on the critical need
QUANTIFY MARKET 1) Total Number of Available Consumers of Services
multiplied by
2) Financial Reimbursement Rate per Consumer
equals
3) TOTAL REVENUE Available in the Market
Compared to
4) Your Earned Income from your enrolled Consumers receiving your service at your reimbursement rate
provides
MARKET SHARE
Managing Profit
1) Determine Profitability for Each Service
• •
Operating Cost minus Earned Income equals Margin Margin divided by Earned Income equals Profit Margin
•
High Profit = 5% gain or greater
• •
Medium Profit On the Margin = 2% to 5% gain = 2% loss to 2% gain
• •
Medium Loss High Loss = 2% to 5% loss = 5% loss or greater
2) Determine Market Share 3) Predict Market Direction over Time
MISSION V. MARGIN
Critical Substantial Needed Limited Not Needed Greater than 5 % profit Between 2 % & 5 % profit Covers Cost Between 2 % & 5 % loss Greater than 5 % loss
GO GO GO GO GO Ponder Ponder Ponder Ponder STOP STOP Ponder Ponder STOP STOP Ponder Ponder Ponder Ponder STOP STOP STOP STOP STOP STOP
Yogi Berra Predicts the Future: All Over Again
Age Demographics • • • • •
2/3’s of ALL people who ever lived to 65 are ALIVE TODAY The average LIFE EXPECTANCY age has almost DOUBLED in the past 100 years The MEDIAN age is 35; by 2020 it will be 42 AGE WAVE begins in 2011 when BB’s turn 65 GENERATION GAPS:
–
Baby Boomers =
– –
Gen X (1964-79) = Gen Y (1979-94) = 76 million 17 million 60 million
Diversity Demographics • • • • •
Foreign-born members of US = 10.4%; up from 7.9% in 1990 50% were born in LATIN AMERICA 25% were born in ASIA 54% are living in NINE METRO areas (5+ mil.) Living primarily in SOUTH & WEST
• Revival of Suburban Living
Since 1990, people are LEAVING Northeast, West & South are GROWING, and Mid West is STABLE
•
Move from CENTRAL CITIES and RURAL / REMOTE to SUBURBAN & EXURBAN
•
NEXT TREND: IN 20 YEARS, GROWTH OF “24/7” CITIES WHICH COMBINE WORK AND LEISURE
Population Growth • • • •
Current US Population WILL NOT DOUBLE; will most likely PEAK in 2050 / possibly 2025 Same for WORLD POPULATION Birth Rates are FALLING; 2.1 children/woman to maintain population Current Birth Rates:
–
US Birth Rate
–
Canada Birth Rate
–
Mexico Birth Rate 7.0) = 2.08
= = 1.52
2.9 (from
IMPLICATIONS • • • • • •
Countries are opening immigration laws to greater movement of global workforce Human Service Agencies are having to balance longevity with declining birth rates Businesses are challenged to maintain a growing global economy with fewer buyers Culturally, there are MORE OLD people and FEWER YOUNG people Retirement is REINVENTED All the good jobs are taken… and retaken
IMPLICATIONS •
SO… IF YOU ARE GOING TO WORK UNTIL YOU ARE 75:
–
Do You Intend to Keep Doing What You Are Doing TODAY
–
How do You Intend to BE SMARTER at 75 than You Are Today
Creating Portfolio Careers for When You Grow Up
Portfolio Careers J J J J J
MULTIPLE INTERESTS MULTIPLE INCOME STREAM MULTIPLE RISK MULTIPLE IDENTITIES MANAGED TIME ORGANIZATION
DESIGNING YOUR • • • CAREER
THREE JOB COMPONENTS: What You Do With Whom You Work How Much You Get Paid
• •
EXERCISE: (income, emerging markets, fun) Identify 3 fantasy jobs that you could HOLD for 1 YEAR What would those YEARS JOBS look like in 3
Tools
BRAINSTORMING Straight On Upside Down Inside Out 20,000 feet In your face At an angle From the Outside looking In
Tools
SELF-TALK I LIKE and RESPECT Myself I continuously find Myself making CORRECT DECISIONS I control my SELF-TALK I make my DREAMS come TRUE
Building THE PLAN: Putting it all together
Domain Home Nest Work/Career Family Marriage/Rel.
Health Spiritual Leisure Education Legacy
The Plan
Who What When
Managing Change In Chaotic Times: If you draw a line in the sand, make sure the tide is coming in…
Myth of Hero Chief Executive Officers
MYTH #1: Nothing can happen without TOP MANAGEMENT buy-in MYTH #2: COMPLIANCE and COMMITMENT are the same thing MYTH #3: All Leaders are the SAME
–
The POLITICIAN : Good listener & mind reader, highly disciplined but lacks depth
–
The NARCISSIST : Grand sense of self, manipulative, poor emotional connections
–
The VISIONARY : Zealous & creative, bored with details
–
The EXECUTIONER : Workaholic w/an attitude, misreads people
Required Leadership •
LINE LEADERS: Production (Labor & Products)
•
EXECUTIVE LEADERS: Marketing (Political Capital & Financial Resources)
•
EXPEDITORS: Sales (Cross Organizational Alliances)
The Growth Process of Profound Change •
INITIATING CHANGE
•
SUSTAINING CHANGE
•
REDESIGNING & RETHINKING CHANGE
Initiating Change: Challenges • • • •
Not Enough Time No Help Not Relevant Passive Non-Believers
Sustaining Change: Challenges • • • •
Managing Fear & Anxiety Finding Relevant Measures Managing Zealots & Cults Finding Relevant Rewards
Redesigning Change: Challenges • •
Defining Governance Working Group Dynamics
– – –
Discover Likenesses Discover Differences Reinvent Relationships
So…What Do You Do: Manage Time
Organize Work :
–
Trust People to control OWN use of Time
–
Value UNSTRUCTURED Time
–
Create “SAFE” Time (Sacred Hours)
–
Push back on NON-ESSENTIAL DEMANDS
–
Integrate & Diversify
So…What Do You Do: Manage Time
Clear Decision-making :
– – – – –
TELLING: here’s problem, here’s solution, charge SELLING: here’s problem, here’s MY solution, here is why… now charge TESTING: here’s problem, here’s MY solution, what do you think?
CONSULTING: here’s problem, don’t know solution, give me a list of options & I will let you know when I hear the right one CREATING: don’t know problem, no clue of solution, let’s discover & consensus build
Meeting Fear & Anxiety • • • • • • •
Start Small Avoid Frontal Assaults Set Examples Reward Diversity Reinforce Choice Reinforce Skills Create a Safe Place for Not Knowing
• Search for Successful Strategies
Find Enough People who have Enough Time
• • •
Identify Successful Strategies
– – – –
Critical & Urgent Skills are in place Authority & Autonomy are clear Organizational Visibility & Leverage Inventory Personal Strength Be CONSTANT, COURAGEOUS, & PATIENT
Informed Consent
Informed Knowledge Enough People Know & Talk Enough People Change In Time Not Enough People Change In Time
Full Steam Ahead Get out the Life Boats
Not Enough People Know & Talk
Pockets of Success Finding Captain Bligh
Managing the Issues • • •
MANAGE THE DOG POUND: Barking Dogs: important & urgent Non-Barking Dogs: strategic importance, but not urgent Sleeping Dogs: non-discussable sacred items that BITE!!
Search for Successful Strategies
FAILURE IS ONLY DEFERRED SUCCESS
State of the States: Who’s Having all the Fun
Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits
Region Percent of Total State Budget East
Connecticut Delaware Maryland Massachusetts New Jersey New York Pennsylvania $ 1. 5 billion $ 300 million $ 1.2 billion $ 1.4 – $2.0 billion $ 4.0 billion $ 10 - $12 billion $ 500 million – $2.0 billion 12.9 % 12.2 % 11.0 % 6 % – 8.8 % 19.0 % 24 % – 29 % 2 % - 9 %
Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits
Region
2003)
Projected Deficit Percent of Total State Budget North
Illinois Indiana Kansas Michigan Ohio Wisconsin $ 3.6 billion $ 850 million $ 700 million $ 1.6 billion $ 2.0 billion $ 2.0 billion 14.8 % 8.8 % 15.7 % 17.5 % 9.2 % 17.6 %
Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits
Region West
Arizona California Colorado Oregon Texas Washington 2003)
Projected Deficit
$ 967 million $ 18 - $26 billion $ 900 million $ 1.0 - $1.3 billion $ 4.0 - $7.8 billion $ 1.0 - $1.3 billion
Percent of Total State Budget
15.3 % 23 % - 34 % 13.4 % 20 % - 27 % 13 % - 25 % 9 % - 12 %
Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003)
Region Projected Deficit Percent of Total State Budget South
Alabama Florida Georgia Kentucky $ 500 million $ 2.0 billion $ 900 million $ 360 million 9.3 % 10.1 % 5.8 % 5.1 %
National Expenditure Comparisons
National Expenditures SFY 2003 Annual Per Capita Cost for HCBS
STATE
Florida California person Texas Pennsylvania
Per Capita Cost
$ 24,000 / person $ 19,100 / $ 42,900 / person $ 56,000 / person
Florida Financial Investment History
Total Expe nditure s for the DS Me dicaid Waive r Program for Florida by State Fiscal Ye ar
$400,000,000 $350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Summary
Managing Debt by credit cards Increasing Independent contractors Outsourcing tough decisions Managing Noise: Merging LTC & DD
operations Closing Institutions From Providers of Service to Insurers of
Risk Shift to Self-Directed Care; Independence Plus
Key National Trends • • • • • • • • •
Living Arrangements continue to shrink More in-home support More supported employment Aging care givers State as purchaser rather than provider of service Shift administrative burden and risk to Community Boards Shift from Categorical to Integrated Services “Managed” entitlements/functional analysis Cost shifting to Welfare Reform
4/30/2020
State Strategies
Facility Closures
• Wisconsin, Mass., Texas, Washington, Louisiana
Reorganization
• Massachusetts, Washington, Oregon, Alaska, Indiana, North Carolina
Administration
• Outsourcing the Uncomfortable stuff • Cost Shift to Communities
HCBS Growth
• Rationing / Self-Directed Service / Flexibility
Face the Nation: The Perfect Storm
Issues •
PAC MAN SYNDROME
•
FRANK SINATRA APPROACH
•
TAKE THIS JOB AND SHOVE IT
•
IF MAMA AIN’T HAPPY AIN’T NOBODY HAPPY
•
MY HOUSE IS A MIGHTY FINE HOUSE
• The PAC MAN of MEDICAID
Disproportionate consumption of Medicaid funds
•
Average length of enrollment in LONG TERM CARE system is 45 disability years
•
CMS Quality Assurance / Audit has built -in cost escalators
•
Will consume Welfare Reform if given a chance
Frank Sinatra “MY WAY” •
ALL States are modeling Self Determination
•
Personal Choice
•
Provider Selection
•
Customized Supports
•
Non-traditional Providers
•
One size fits all except extra-large
You can take this JOB and Shove It •
High staff turn over
•
Low wages
•
Hard work
•
No career
• MY HOUSE is a mighty fine House with two cats in the Yard
Shift from Facility-based / congregate care settings to home ownership
•
In-home support services
•
Tenant support v. group home management
•
Roommate management v. vacancy management
Field of Dreams: Create some PIN BALL WIZARDS
Pin Ball Wizards
•
Connect Dollars and Deliverables
•
Do your Taxes
•
Figure out the Good Guys
•
Hire Friends and Relatives
•
See Forever
Connect Dollars & Deliverables •
Individual / Family Budgeting
•
Life Events Cost Profiling
•
Rate Setting / Rate Modeling
•
Performance / Workload Standards
•
Budget Trending & Forecasting
•
Contract & Procurement Management
Do Your Taxes •
Home and Community-based Waiver planning and management
•
FFP planning and management
•
SSI planning and management
•
CMS negotiations
Figure out the Good Guys •
System Evaluation / Build Capacity
•
Provider Evaluation
•
Outcome Development
•
Quality Assurance system design and implementation
Hire Friends and Relatives •
Attraction and Recruiting
•
Compensation Planning
•
Benefits Planning
•
Provider Business Planning
FOUNDATION FOR CHANGE
Data, data, data Mandate for Change Clear and immediate Fiscal Limits Clear values and beliefs Ambiguous Organizational structure Changing Service Demands Community Activism
DATA
• • • •
Know Thy Self Know Thy Friends & Relatives Know Thy Assets’ Comings & Goings Know Thy Money Changers
DEMOGRAPHICS NEEDS ASSESSMENT SYSTEM MODELING TOOL
Step 1 Determine Individual Cost Guidelines Step 2 Plan, Cost Out & Budget All of the Parts Step 4 Apply Standard Rates $ Step 5 Utilization Review if Needed Step 6 Select Provider & Implement Plan Step 7 Measure personal outcomes Appropriate services and supports at a fair rate Step 3 Test for Fairness
Where’s the Money
Distribution of Individual Costs (based upon MMIS Expenditure Annual Cost Group Less than $25,000 $25,000 to $49,000 $50,000 to $74,000 $75,000 to $100,000 $100,000 and above TOTAL Unique Consumers Data) Median % of Total Consumers 19,400 $ 7,859
79.7%
3,491 1,201 190 90
14.3%
4.9% 0.8% $ 35,776 $ 58,561 $ 84,711 Minimum
$ 136
$ 25,007 $ 50,004 $75,147 Maximum $ 24,999 $ 49,996 $ 74,957 $ 99,914 24,352 0.4% $ 126,188 $ 100,067
$ 274,749
100%
COMPARISON OF STANDARD RATES TO CURRENT RESIDENTIAL HABILITATION PROVIDER SFY 02 AVERAGE 5%+ decrease UNIT COSTS decrease increase 5%-10% increase 10%+ increase
DECREASE INCREASE 8 % of Providers 10 % of Providers 55 % of Providers 15 % of Providers 12 % of Providers
• • • • • • Where’s the Money?
PROFIT
Personal Care Assistance (specialized) Supported Living & Supported Employment
LOSS
Room & Board Liability Insurance Administration Facility Costs
Where’s the People
Example - Washington State DD Enrollment Trends
New People Enrolling
70% 3% 15% 2% 10%
Children Birth to 6 years Children 7 yrs.
to 18 yrs Adults 19 yrs.
to 21 yrs .
Adults 22 yrs.
to 44 yrs. Adults 45 yrs.
to Death
1 out of 4 drop out
1 out of 10 drop out 1 out of 12 drop out 1 out of 7 drop out
People Leaving 1 out of 5 drop out
FY 00
Potential Enrollment
FY 01 FY 02 FY 03 Population Forecasts Florida General Population (in 1,000s) Estimated DD population (1.3% of total) 4 DDP Enrollment (HCBS only) 5 Percentage of People Actually Served by HCBS compared to Potential Eligible People 15,982 1 207,766 21,747 10% 16,041 2 208,534 24,352 12% 16,101 2 209,313 25,888 12% 16, 160 2 210,080 28,888 14% FY 04 16,220 2 210,860 31,888 FY 05 16,279 3 211,627 34,888 15% 16%
1 U.S. Census Bureau, Census 2000.
2 Estimates are based on Mercer’s interpolations of population growth by year between the 2000 census figure and the 2005 projection. U.S. Census Bureau, Projections of the Total Population of States: 1995 to 2025, Series A.
3 U.S. Census Bureau, Projections of the Total Population of States: 1995 to 2025, Series A.
4 Estimated prevalence of DD and/or MR (1.58% of population) from Prevalence of Mental Retardation and/or Developmental Disabilities: Analysis of the 1994/1995 NHIS-D in Data Brief, April 2000, Vol. 2, No. 1., Research and Training Center on Community Living, Institute on Community Integration (VAP), The College of Education and Human Development, University of Minnesota.
5 Fiscal year 2003, 2004 and 2005 enrollments have been estimated assuming a 3,500 increase per year.
TOOL BOX: Individual Cost Guidelines
Individual Cost Guideline Factors • • •
Age and Family Living Situation Community of Residence Personal Cost Factors
– Community Inclusion – Behavior Supports – Health and Wellness Supports – Current Abilities
Desired Outcomes for Rates • • • • • • •
Equitable among Agencies Equitable Access for People Stability & Predictability Financial Viability Incentives for Change Emphasis on Quality Self-Directed
Housing Costs Median Rents & Leases (U.S. Department of Housing and Urban Development - 2002 1st Quarter data)
Location Number of Beds ORLANDO MIAMI PENSACOLA JACKSONVILLE TAMPA TALLAHASSEE 1 $552 $498 $450 $520 $484 $459 2 $626 $626 $492 $581 $576 $510 3 $746 $781 $558 $701 $713 $670 4 5 $ 979 $1195 $1072 $1243 $ 746 $ 873 $ 975 $1030 $ 948 $1148 $ 875 $1055
Comparison of Direct Care Staff Hourly Salaries among Other States
TOOL BOX: Rate Benchmarks
BENCHMARK: Salary Compensation for Direct Care Workers
Position 25th Percentile 50th Percentile 75th Percentile
Personal Care Workers $ 9.17 per hour $ 9.68 per hour $ 9.96 per hour Habilitation Workers $ 8.68 per hour $ 9.42 per hour $ 10.09 per hour
BENCHMARK: Program Related Costs
Base for Agencies = 27% of Total (Gross) Costs Economy of Scale Factor = 2% reduction at 6 &15 sites Geographical Factor = 12% increase for high cost areas
BENCHMARK: Employee-Related Expenses
Cost Item
FICA Unemployment Compensation Workers Comp. Insurance Medical Coverage Paid Time-Off Retirement
Agency Providers
7.65% 1.9%
$7.48 / $100 of salary 13.3%
5.0% 0.2%
BENCHMARK: General & Administration Costs
TYPE OF PROVIDER NO FACTOR FACTOR WITH GEO Agency-based 15% Providers 12 % Independent 7 % Contractors 7 % GEOGRAPHIC FACTOR = 3% for Agencies only
Cost Center Percentages for various HCBS Services Provided Cost Center Direct Care Program Related General & Admin.
Total by Agencies Residential Habilitation Personal Care Behavior Services 61% 27% 12% 100% 72% 21% 7% 100% 65% 28% 7% 100% Adult Day Program 66% 22% 12% 100%
Where’s the Hammer
Liquidity Ratios •
Current Assets to Current Liabilities
•
Debt to Net Assets
•
Net Cash from Operations to Operating Expenses
•
Cash to Operating Expenses
Where’s the Workers
Staff Productivity Variables Back
Richmond Amount of Pay Increase to Achieve 10% reduction in Staff Turnover Washington Dover $3.14
$2.85
Charlotte Charlottesville Baltimore Philadelphia $5.20
$1.09
$1.87
$2.37
$1.63
To achieve a 10% reduction in turnover requires very different amounts of pay increases in different labor markets.
Back
Pay is not always a key driver of Retention: Investing in career programs vs. salary increases reduced turnover by 10%
Tools
SELF-TALK I LIKE and RESPECT Myself I continuously find Myself making CORRECT DECISIONS I control my SELF-TALK I make my DREAMS come TRUE