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