MontanaDDpresentatio n060105a

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Published on April 13, 2008

Author: BAWare

Source: authorstream.com

State of Montana When a Field of Dreams Meets a Perfect Storm :  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? :  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:  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:  Win As Much As You Can FORMULA: 4 Y’s = Y wins $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 ROUNDS: RULES SCORE Round #1 No discussion _________ Round #2 2 minute discussion _________ Round #3 2 minute verbal contract _________ Round #4 2 minute signed contract ___2x____ Win As Much As You Can:  Win As Much As You Can Easy to Say All the Time / Tough to Do Most of the Time: JKL Common Understanding, Vision, & Values JKL Communication JKL Trust JKL Commitment to the Cause JKL Personal Values & Needs The Art of Networking: Where to put Crab Pots in a Hurricane :  The Art of Networking: Where to put Crab Pots in a Hurricane What is a Network:  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:  Building & Nurturing a Network INVENTORY & ORGANIZE CONTACTS ASSESS TIMING & QUALITY OF CONTACT MIX PEOPLE & CATEGORIES IDENTIFY FOCUS CREATE OPPORTUNITY EXPAND Inventory & Organize Contacts:  Inventory & Organize Contacts Business Friends Relatives Education Public Figures Web-based Research Assess Timing & Quality of Contacts:  Assess Timing & Quality of Contacts Creating the Opportunity:  Creating the Opportunity Build YOUR Network:  Build YOUR Network Three-Way Contracts:  Three-Way Contracts How Organizations are Supposed to Work: Quicksand, Quagmires, & Quality Assurance:  How Organizations are Supposed to Work: Quicksand, Quagmires, & Quality Assurance Summary:  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:  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:  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 Key Strategies:  Key Strategies Structure Connect accountability with the Regions & State Program Office Systems Implement procurement, rates, utilization controls Culture Empower people & families; recognize limits of public funding Individual Retrain Case Managers, Behavior Providers, & Region staff Change Strategies:  Structure Operations Culture Individual Behavior 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 Change Strategies CHAOS THEORY:  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:  CHAOS THEORY Creativity / Chaos Stability / Stagnation Montana Change Strategies:  Structure Operations Culture Individual Behavior Fill In the Blanks Low stress High Stress Montana Change Strategies State of Montana: Mother Theresa meets Robin Hood:  State of Montana: Mother Theresa meets Robin Hood Social Entrepenurialship: How Can Business be More Like Government:  Social Entrepenurialship: How Can Business be More Like Government BUSINESS GOAL:  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:  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:  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:  ENVIRONMENTAL FORCES DEMOGRAPHIC SOCIOLOGICAL / “PSYCHOGRAPHIC” TECHNOLOGICAL POLITICAL / REGULATORY WHO ARE YOUR SCRUTINIZERS ORGANIZATIONAL SUCCESS FACTORS:  ORGANIZATIONAL SUCCESS FACTORS Definable Program Niche Retain Key Personnel Visible Preserve/Expand Revenue Sources Aggressive Marketing QUANTIFY PEOPLE ISSUES:  QUANTIFY PEOPLE ISSUES What Services support the greatest Number of People with the Greatest Need Slide31:  PEOPLE V. NEED Rating Scale Critical Need 5 points Substantial Need 4 points Needed 3 points Some Need 2 points Little/No Need 1 point PEOPLE V. NEED Rate Level of Need:  PEOPLE V. NEED Rate Level of Need ( Rate each Service Area using the Rating Scale ) PEOPLE V. NEED How does your Business Rate?:  PEOPLE V. NEED How does your Business Rate? Critical Need More than 20 % Substantial Need No more than 80 % Needed No more than 60% Some Need No more than 40% Little/No Need Less than 20% Percentage of Business Efforts “80 / 20” RULE:  “80 / 20” RULE 80% of your energy should be focused on the 20% critical need QUANTIFY MARKET:  1) Total Number of Available Consumers of Services 2) Financial Reimbursement Rate per Consumer 3) TOTAL REVENUE Available in the Market 4) Your Earned Income from your enrolled Consumers receiving your service at your reimbursement rate provides QUANTIFY MARKET multiplied by equals Compared to MARKET SHARE Managing Profit:  Managing Profit MISSION V. MARGIN:  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 Ponder Ponder Ponder Ponder Ponder Ponder Ponder Ponder Ponder GO GO GO GO Ponder STOP GO STOP STOP STOP STOP STOP STOP STOP STOP STOP Yogi Berra Predicts the Future: All Over Again:  Yogi Berra Predicts the Future: All Over Again Age Demographics:  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 = 76 million Gen X (1964-79) = 17 million Gen Y (1979-94) = 60 million Diversity Demographics:  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:  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:  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 = 2.08 Canada Birth Rate = 1.52 Mexico Birth Rate = 2.9 (from 7.0) IMPLICATIONS:  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:  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:  Creating Portfolio Careers for When You Grow Up Portfolio Careers:  Portfolio Careers MULTIPLE INTERESTS MULTIPLE INCOME STREAM MULTIPLE RISK MULTIPLE IDENTITIES MANAGED TIME ORGANIZATION DESIGNING YOUR CAREER:  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 JOBS look like in 3 YEARS Tools:  Tools BRAINSTORMING Straight On Upside Down Inside Out 20,000 feet In your face At an angle From the Outside looking In Tools:  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:  Building THE PLAN: Putting it all together The Plan:  The Plan Managing Change In Chaotic Times: If you draw a line in the sand, make sure the tide is coming in…:  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 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:  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:  The Growth Process of Profound Change INITIATING CHANGE SUSTAINING CHANGE REDESIGNING & RETHINKING CHANGE Initiating Change: Challenges:  Initiating Change: Challenges Not Enough Time No Help Not Relevant Passive Non-Believers Sustaining Change: Challenges:  Sustaining Change: Challenges Managing Fear & Anxiety Finding Relevant Measures Managing Zealots & Cults Finding Relevant Rewards Redesigning Change: Challenges:  Redesigning Change: Challenges Defining Governance Working Group Dynamics Discover Likenesses Discover Differences Reinvent Relationships So…What Do You Do: Manage Time:  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:  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:  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:  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 Consent Managing the Issues:  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:  Search for Successful Strategies FAILURE IS ONLY DEFERRED SUCCESS State of the States: Who’s Having all the Fun:  State of the States: Who’s Having all the Fun Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003):  Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003) Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003):  Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003) Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003):  Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003) Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003):  Estimated State Deficits for FY 2004 (Center for Budget & Policy Benefits 2003) National Expenditure Comparisons:  National Expenditure Comparisons National Expenditures SFY 2003 Annual Per Capita Cost for HCBS:  National Expenditures SFY 2003 Annual Per Capita Cost for HCBS STATE Per Capita Cost Florida $ 24,000 / person California $ 19,100 / person Texas $ 42,900 / person Pennsylvania $ 56,000 / person Florida Financial Investment History:  Florida Financial Investment History Summary:  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:  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 State Strategies:  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:  Face the Nation: The Perfect Storm Issues:  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:  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”:  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:  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:  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:  Field of Dreams: Create some PIN BALL WIZARDS 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 :  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 :  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:  Figure out the Good Guys System Evaluation / Build Capacity Provider Evaluation Outcome Development Quality Assurance system design and implementation Hire Friends and Relatives :  Hire Friends and Relatives Attraction and Recruiting Compensation Planning Benefits Planning Provider Business Planning Slide89:  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 Slide90:  DATA Know Thy Self Know Thy Friends & Relatives Know Thy Assets’ Comings & Goings Know Thy Money Changers DEMOGRAPHICS NEEDS ASSESSMENT SYSTEM MODELING TOOL All of the Parts:  All of the Parts Step 2 Plan, Cost Out & Budget 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 Where’s the Money :  Where’s the Money Distribution of Individual Costs (based upon MMIS Expenditure Data):  Distribution of Individual Costs (based upon MMIS Expenditure Data) COMPARISON OF STANDARD RATES TO CURRENT RESIDENTIAL HABILITATION PROVIDER SFY 02 AVERAGE UNIT COSTS:  COMPARISON OF STANDARD RATES TO CURRENT RESIDENTIAL HABILITATION PROVIDER SFY 02 AVERAGE UNIT COSTS DECREASE INCREASE 0%-5% increase 5%-10% increase 10%+ increase 0%-5% decrease 5%+ decrease 8 % of Providers 10 % of Providers 55 % of Providers 15 % of Providers 12 % of Providers Where’s the Money? :  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:  Where’s the People Slide97:  Example - Washington State DD Enrollment Trends 3% 10% 15% 2% 70% New People Enrolling 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 1 out of 5 drop out People Leaving Potential Enrollment:  Potential Enrollment TOOL BOX: Individual Cost Guidelines :  TOOL BOX: Individual Cost Guidelines Individual Cost Guideline Factors:  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:  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):  Housing Costs - Median Rents & Leases (U.S. Department of Housing and Urban Development - 2002 1st Quarter data) 1 2 3 4 5 ORLANDO $552 $626 $746 $ 979 $1195 MIAMI $498 $626 $781 $1072 $1243 PENSACOLA $450 $492 $558 $ 746 $ 873 JACKSONVILLE $520 $581 $701 $ 975 $1030 TAMPA $484 $576 $713 $ 948 $1148 TALLAHASSEE $459 $510 $670 $ 875 $1055 Number of Beds Location Comparison of Direct Care Staff Hourly Salaries among Other States:  Comparison of Direct Care Staff Hourly Salaries among Other States TOOL BOX: Rate Benchmarks :  TOOL BOX: Rate Benchmarks BENCHMARK: Salary Compensation for Direct Care Workers:  BENCHMARK: Salary Compensation for Direct Care Workers BENCHMARK: Program Related Costs:  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:  BENCHMARK: Employee-Related Expenses BENCHMARK: General & Administration Costs:  BENCHMARK: General & Administration Costs TYPE OF PROVIDER NO FACTOR WITH GEO FACTOR Agency-based 12 % 15% Providers Independent 7 % 7 % Contractors GEOGRAPHIC FACTOR = 3% for Agencies only Cost Center Percentages for various HCBS Services Provided by Agencies:  Cost Center Percentages for various HCBS Services Provided by Agencies Where’s the Hammer :  Where’s the Hammer Liquidity Ratios:  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 :  Where’s the Workers Slide113:  Staff Productivity Variables Back Slide114:  Amount of Pay Increase to Achieve 10% reduction in Staff Turnover Back Richmond $5.20 To achieve a 10% reduction in turnover requires very different amounts of pay increases in different labor markets. Washington Dover Charlotte Charlottesville Baltimore Philadelphia $3.14 $2.85 $2.37 $1.87 $1.63 $1.09 Slide115:  Pay is not always a key driver of Retention: Investing in career programs vs. salary increases reduced turnover by 10% Tools:  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 A Thrilling Time Ahead… Be on Your Guard :  A Thrilling Time Ahead… Be on Your Guard

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