OASIS: District 4 forums

Davis Deshaies LLCDavis Deshaies LLC

eshaiesDavis LLCdeshaiesDavis LLCd Indiana Department of Family and Social

Services Administration

What’s What’s the PROBLEM? PROBLEM?

PEOPLE WITH SIMILAR NEEDS HAVE VARIED ACCESS TO SERVICES BECAUSE THE AMOUNT OF SERVICE YOU GET DEPENDS ON:

1.1. WHENWHEN you requested service

2.2. HOW MUCHHOW MUCH money was available

3.3. WHATWHAT services were available

What’s the SOLUTION?

FAIRNESS & EQUITYFAIRNESS & EQUITY Refine Individual Resource Allocation process Connect to Provider Reimbursement & Outcomes

PRINCIPLES & VALUESPRINCIPLES & VALUES Person - Centered Planning Self - Directed Choice

PREDICTABLE AND STABLE FUNDINGPREDICTABLE AND STABLE FUNDING Balance quality, utilization, cost, and access

Design anDesign an INDIVIDUAL RESOURCE INDIVIDUAL RESOURCE ALLOCATION ALLOCATION systemsystem

DetermineDetermine FAIR PROVIDER FAIR PROVIDER REIMBURSEMENT RATESREIMBURSEMENT RATES

Connect both to Connect both to PERSONAL & SYSTEM PERSONAL & SYSTEM OUTCOMESOUTCOMES

Assure Assure QUALITYQUALITY

APPROACH

Overview of ApproachOverview of Approach

FIVE STEPSFIVE STEPS:1. Collect InformationInformation

Build data & policy BASELINEBASELINE (3 months)

2. Figure out HowHow MuchMuch people need Define BEST PRACTICESBEST PRACTICES (3 months)

3. See if the BEST PRACTICES Make SenseMake Sense SHADOWSHADOW in District 4 (6 months)

4. See if OASIS WORKSOASIS WORKS PILOTPILOT rates and individual allocations (6 months)

5.5. IMPLEMENTIMPLEMENT (18 months)

Implementation Schedule for OASIS

TA

SKS

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th

Connect Best Practice to Cost Drivers

Implement OASIS StatewideShadow Test In District 4

Determine Best Practice & Cost Drivers

Pilot OASIS in District 4

ImplementationComplete

2007 Quarters 2008 Quarters 2009 Quarters

Determine Standard Price for Service

OASIS - BIG PICTURE

All of the Parts

Step 1Determine Individual

Cost Guidelines

Step 2Plan,

Cost Out &

Budget

Step 3Test forFairness

Step 4Apply Standard Rates

Step 5Utilization Review if Needed

Step 6

Select Provider & Implement Plan

Step 7

Measure personal outcomes

$

Appropriate services and supports

at a fair rate

Number Number of Units of Units

of of ServiceService

Building the OASIS Allocation Building the OASIS Allocation

Cost Per Unit of ServiceX =

OASISAllocation

Cost Drivers

(age, life

events)

X

IndividualNeeds

Assessment

StandardRate

MarketAnalysis

OASIS: The Pieces

AssumptionsAssumptions

People use similar amountssimilar amounts of services in very different waysdifferent ways

Determining how muchhow much paid staff support is needed is more importantmore important than whythan why it is needed.

People and families are the best predictorsbest predictors of the amount of service needed.

HistoricalHistorical costs don’t always predictpredict need.

WHAT DOES OASIS GIVE YOU?WHAT DOES OASIS GIVE YOU?(Objective Assessment System for (Objective Assessment System for Individual Supports)Individual Supports)

1.1. SINGLE ANNUAL AMOUNT:SINGLE ANNUAL AMOUNT: Total for YearTotal for Year

2.2. RANGERANGE: Gives a view of typical costs and services for people with similar needs

3.3. GUIDELINESGUIDELINES for planning rather than ultimatums

4. Connected to BEST PRACTICESBEST PRACTICES

What INDIANA Cost Drivers What INDIANA Cost Drivers will be CONSIDERED?will be CONSIDERED?

Other States found:Other States found: Primary Cost Drivers:Primary Cost Drivers:

– AgeAge– Family Living SituationFamily Living Situation– Work SituationWork Situation– Life EventsLife Events– Geography & TransportationGeography & Transportation

Secondary Cost Factors:Secondary Cost Factors:– Functional AbilitiesFunctional Abilities– Behavior & Health SupportsBehavior & Health Supports

Needs Assessments do not predict cost forNeeds Assessments do not predict cost for OUTLIER consumers OUTLIER consumers

Indiana Work Group potential factors:Indiana Work Group potential factors: Other FactorsOther Factors (natural supports, employment, forensic and (natural supports, employment, forensic and

behavioral health issues)behavioral health issues)

What’s the BOTTOM Line?What’s the BOTTOM Line?

How OLD are you?How OLD are you?

Where do you LIVE?Where do you LIVE?

With WHOM do you LIVE?With WHOM do you LIVE?

Any Significant Life Events?Any Significant Life Events?

How’s your HEALTH & BEHAVIOR?How’s your HEALTH & BEHAVIOR?

UPPER LIMITUPPER LIMIT1.1. People who need People who need full-time 1:1full-time 1:1 direct care support or more on a direct care support or more on a 24 hour / 724 hour / 7

day per week basis day per week basis 2.2. People who have People who have court-orderedcourt-ordered care care

LOWER LIMITLOWER LIMIT1.1. People who require People who require less than $(?)less than $(?) per year of supports per year of supports2.2. People who require People who require only support coordinationonly support coordination

What are the PREDICTIVE LIMITS What are the PREDICTIVE LIMITS of OASIS?of OASIS?

SHADOW & PILOT TEST

How Should We TEST our IDEAS?How Should We TEST our IDEAS?

Statistical ValidationStatistical Validation– Face– Content– Construct– Convergent / Criteria

Focus GroupsFocus Groups – Frequent consumer / family discussions– Frequent provider / case manager discussions

Best Practice GroupsBest Practice Groups– Consumer Outcomes– Provider Outcomes– Case Management Outcomes

Test & RefineTest & Refine– Simulate with People, Families, Providers, Case Managers

What are BEST PRACTICES?What are BEST PRACTICES?

Health & WellnessHealth & Wellness

Safety & Freedom from HarmSafety & Freedom from Harm

Stable HomeStable Home

Sufficient Personal IncomeSufficient Personal Income

Satisfaction & InclusionSatisfaction & Inclusion

Key Tasks – Pilot PhasesKey Tasks – Pilot Phases

SHADOW (July ’07 to December ’07)• Compare current rates and allocations to proposed• “What would happen IF”

TESTTEST (January ’08 to June ‘08)• Best Practices consumer group • Sample of Providers

Phased IMPLEMENTATIONIMPLEMENTATION (July ’08 to Dec ’09)• By District• Constant modification and adjustment

Evaluate & MODIFYMODIFY (On-going)

Receive Individual Resource AllocationsReceive Individual Resource Allocations Using Person-Centered Planning, build an Individual Using Person-Centered Planning, build an Individual

Budget Plan and Key Personal OutcomesBudget Plan and Key Personal Outcomes Receive technical assistance as needed from Pilot TeamReceive technical assistance as needed from Pilot Team Select provider and Case Manager initiates individual’s Select provider and Case Manager initiates individual’s

budget.budget. Participate in Outcome StudyParticipate in Outcome Study

People in the PilotPeople in the Pilot

Receive Business Development AssistanceReceive Business Development Assistance– Market AnalysisMarket Analysis– Cash Flow ManagementCash Flow Management– Human Resource ManagementHuman Resource Management– Strategic PlanningStrategic Planning

Receive Technical Assistance on Implementing Self-Receive Technical Assistance on Implementing Self-Directed SupportsDirected Supports– Choice & EmpowermentChoice & Empowerment

Providers in the PilotProviders in the Pilot

PROVIDER RATE SETTING

What DO People BUY?What DO People BUY?

People purchase staff timestaff time– Personal Support– Training & Guidance– Therapies & Nursing

People purchase transportationtransportation People purchase housinghousing People purchase equipmentequipment

Why does Indiana need Why does Indiana need NEW RATES?NEW RATES?

CMS Requires “Transparency”CMS Requires “Transparency”– Must be able to measure by “unit of service”– Must differentiate between services– Must reflect Individual Consumer need– Reward success

CMS Requires “Standardization”CMS Requires “Standardization” – Consumer Portability– Public Transparency

Historically negotiated RatesHistorically negotiated Rates– Dependent upon timing & funds available– Advocacy Driven

Public financing is not able to keep up with Provider Public financing is not able to keep up with Provider CostsCosts

What should rates What should rates ACCOMPLISH?ACCOMPLISH?

Pay a FAIR PRICE for FAIR WORKPay a FAIR PRICE for FAIR WORK– Create stable provider network– Attract and retain qualified staff– Encourage research & development– Reward success

Connect to OASIS AllocationsConnect to OASIS Allocations – Consumer Portability– Public Transparency

Guarantee Quality ServicesGuarantee Quality Services– Consumer Outcomes– Provider Outcomes– Case Management Outcomes

Other ReasonsOther Reasons

How much VARIATION in the How much VARIATION in the RATE FACTORS?RATE FACTORS?

Geographical factorsGeographical factors can vary up to 30% between communities in Indiana

– Wages & Unemployment– Housing & Cost of Living– Available Skilled Labor Force– Competing Employers

Transportation costsTransportation costs are influenced by diverse factors:– Urban density– Rural remote access

What are STANDARD RATES?What are STANDARD RATES?

Rates are the AMOUNT OF MONEY PER UNIT OF AMOUNT OF MONEY PER UNIT OF SERVICESERVICE which is paid to a PROVIDER

The RATE AMOUNT is based upon STANDARDIZED STANDARDIZED COSTSCOSTS for – Wages and Salaries– Employee-related Expenses such as BENEFITS & Paid Time Off– Program Indirect Costs such as supervision, materials, utilities– General & Administrative Costs

A PROVIDER may SPEND FUNDS DIFFERENTLYSPEND FUNDS DIFFERENTLY than the RATE ASSUMPTIONS.

Rate Building APPROACHRate Building APPROACH

Examine Direct Care Staff Salaries Examine Direct Care Staff Salaries

Compute Employee - Related Expenses / Compute Employee - Related Expenses / Benefit CostsBenefit Costs

Survey Program - Related / Clinical Survey Program - Related / Clinical Supervision CostsSupervision Costs

Establish General & Administrative Costs Establish General & Administrative Costs

Rate Building APPROACH Rate Building APPROACH (continued) (continued)

Wage ParityWage Parity across all services and employer type.

Employee-Related ExpensesEmployee-Related Expenses are reflecting actual Workers’ Compensation, FICA experience, and geographical differences.

Program-Related CostsProgram-Related Costs have the highest variability.

General and Administrative CostsGeneral and Administrative Costs will be established by policy.