Staying Ahead of the Budget Shortfall: Serving More Youth

with the Same Amount of Money (or Less)

Monday, March 5, 2012

Shannon Van Deman, CFO

Economic Challenges

• Federal, state, and county budget cuts• Medicaid budget cuts• More families in need of services

Indiana’s Solution

• Focus on youth with the most intensive needs– 20% of youth use 80% of the dollars– Prevent costly out of home placements

• Development of Choices, Inc.

Choices, Inc.

• Non profit care management organization created in 1997

• Developed around a community need: “high cost youth”

• Blended system of care principles with wraparound values and managed care technology.

Hypotheses

• Serve more youth in the community• Reduce expenses for out-of-home

placements• Improve outcomes for youth• Save money

Methodology

• Time period: November 2008 through January 2010

• Data obtained:– Indiana Department of Child Services (DCS)

monthly indicator reports from Region 10– The Clinical Manager (TCM)– Child and Adolescent Needs and Strengths

Assessment (CANS)

Methodology

• Compared outcomes between youth that received services from Choices and those that did not

• Note that DCS data includes Choices youth

• Average monthly census – Choices 122 youth– DCS 3022 youth enrolled as CHINS

Results

In Home Relative Home Foster Home Residential Other0%

10%

20%

30%

40%

50%

60%Monthly Living Arrangement Snapshot

DCS

Choices

Results

DCS Choices0

0.5

1

1.5

2

2.5

3

Average Number of Out of Home Placements

Results

Average Median0

100

200

300

400

500

600

700

Days in Out of Home Placement

DCS

Choices

Clinical Outcomes

Intake Discharge0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

# of CANS Strengths at Intake & Discharge

Not in RTC In RTC

# o

f S

tre

ng

ths

Clinical Outcomes

Intake Discharge0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

# of CANS Needs at Intake & Discharge

Not in RTC In RTC

# o

f N

ee

ds

Fiscal OutcomeService

Cost per day for DCS LOS (Days)

Total Cost Per Youth Episode

Residential $ 293.24 270 $ 79,174.80 Choices Tier 3 $ 126.94 341 $ 43,286.54

In 2009, there were 102 youth referred by DCS that were not in RTC at enrollment. Of those 85 youth remained out of residential treatment.

Savings per Youth= $79,174.80 (cost of residential treatment episode) - $43,286.54 (cost of a Choices episode) = $35,888.26

Savings to DCS = $35,888.26 * 85 youth = $3,050,502.10

Choices saves DCS approximately 3 million dollars for every 100 youth they divert from residential treatment.

Conclusions

• Intensive care coordination models can be used to:• Serve more youth in the community• Reduce expenses for out-of-home

placements• Improve outcomes for youth• Save money

Questions?

www.ChoicesTeam.org

Choices, Inc.

4701 N. Keystone Ave.

Suite 150

Indianapolis, IN 46205

(317) 726-2121