Start where you are. Use what you have. Do what you can . - Ar - PowerPoint PPT Presentation

Start where you are. Use what you have. Do what you can . - Ar Arthur As Ashe Making the Most of Employer Authority: Optimizing Consumer Control & Management of Their Staff Setting Wage Rates & Saving for Bonuses cdChoices.org Facebook.com/CDChoices

Session Agenda Session Goal: To inspire participants to think creatively about even the most restrictive self-direction programs in order to further empower consumers and respond to the ever- changing regulatory and funding environment. 1. Who are we? 2. What is happening in New York State? 3. Revisiting purpose; Looking ahead 4. Getting creative with what you have 5. First Year Results: Survey and data review 6. Challenges and the future 7. First person experience: Cindy & Dan share their experience 8. Q&A

Before we begin… “Yes t they c y can!” !” Do not doubt the capabilities of the consumers (or their representatives) you serve! (…or how the workers they employ will respond)

Part I: “Who are we?”

Consumer Directed Choices, Inc.  Non-profit FMS founded by consumers in 1997  Based in Albany, NY  FMS for approx. 1,000 individuals in 16 Capital Region & Hudson Valley counties  Medicaid: Consumer Directed Personal Assistance (CDPA)  Aging Funds (OAA): Consumer Directed Expanded In- Home Services for the Elderly  NYS Grant: Alzheimer’s Caregivers’ Consumer Directed Respite Program  Board of Directors: Almost 50% are consumers/representatives and other persons with disabilities  Founder, Constance Laymon, served as CEO from beginning until her death in September 2012 – leader in development and growth of CDPA in New York

Part II: What’s Happening in New York?

CDPA in NYS: Structure & Financing  NYS has multiple self-direction programs: Today is focused on Consumer Directed Personal Assistance (CDPA)  Established in state law in 1995  Originally only found under New York’s Medicaid State Plan for Personal Care Services  Included in NYS 1115 Medicaid Waiver for Managed Long Term Care in 2012  Also now part of the Community First Choice Option  Employer Authority only  Division of responsibilities:  County local social services district/managed care plans: determines eligibility, approves individual’s care plan, authorizes services in weekly hour allotments (e.g. 40 hrs./week)  Consumer (or designated representative): responsible for implementing care plan including recruiting, hiring, training, supervising, scheduling, terminating their workers (“Personal Assistants”)  Fiscal Intermediary (“FI”): payroll, benefits coordination, compliance monitoring, employer resources

CDPA in NYS: Structure & Financing (continued)  FI is prohibited by statute from engaging in consumer responsibilities  But responsible for “establishing the amount of wages” for workers  CDPA is currently (changes are anticipated in the future) financed via a single hourly reimbursement to FI for every State Rates 25% hour the consumer uses services Managed Care 74%  Pre-2012: Reimbursement rates determined by state formula  2012: Managed care/Managed Long Term Care (i.e. health plans) negotiated rates introduced  2019: Approximately 74% of CDPA services are paid for by managed care using negotiated reimbursement rates (re: CDChoices)

CDPA in NYS: Structure & Financing (continued)  Impact of managed care on CDPA “system”:  Significant program growth  Significant growth in # of FIs operating as well as # of managed care plans  Greater disparity in reimbursement rates across funders  Other big Medicaid change: Value-Based Purchasing  Health plan premiums impacted by performance on quality measures  Traditional licensed & clinical providers required to participate in value-based contracting with health plans  CDPA is currently exempt from value-based contracting (but not exempt from health plan’s quality measures)

What did all this change mean?.... We needed to change!

Part III: Revisiting Purpose & Looking Ahead

Our Purpose & the Future…  Our Why: CDChoices exists to ensure that people with disabilities have the maximum freedom and control over the care, their lives & their destinies  Mission & Values = Consumer control & freedom:  Consumers in the best position to determine what is best for their care and independence  Dignity of risk – consumers are capable of making informed decisions & accepting the results  Experiencing increased competition (need to differentiate)  Observing increased reimbursement rate differences among managed care plans  Worker wage increases typically pushed during negotiations

Our Purpose & the Future (continued)…  Growing need to control program costs…but don’t want to interfere with consumer responsibilities  Increasing emphasis on value and performance (aka: Value-based Purchasing or VBP)  VBP in Traditional Care: Service provider is incentivized to deliver better quality care in exchange for higher revenues  VBP Challenge in CDPA: FMS providers are not responsible for nor have control over consumers’ care  Theory on how VBP can work in CDPA: consumers given more resources, greater control – and eventually incentives – to achieve better personal health outcomes

Part IV: Getting Creative with What You Have

The Idea…  Build in budget authority  Consumer controlled wages & benefits  Potential to address every challenge  Strengthens missions and purpose  Vision: consumers have full control over their workers’ wages & benefits within the fiscal, legal, programmatic parameters defined by government and health plans  Biggest challenge: How?  Limited flexibility with program & funding  Infrastructure not set up for consumer controlled wage/benefits  Financial risk – needed to minimize  Solutions:  Don’t fight program structure – design around it (KNOW THE REGULATIONS/STATUTES)  Phase in/Test concept – don’t try implementing too much at once

How did we start?  Tested consumer capacity and acceptance of control over compensation  Surplus funds allocated into individual budgets for consumers to distribute to their workers o Individuals’ overtime costs factored into budgets  Consumers given control over funds for wage increases for their workers  Both initiatives were successful, well-received

What came next?  Outlined multi-phased concept  Phase I – basic cash/wage compensation  Phase II – budgeting premium & non-billable pay  Phase III – budgeting nonmandatory benefits & vendor purchases  NOTE: phases & order not set in stone  Currently in Phase I - Spent 3 years planning & preparing for implementation:  Organizational philosophy and values – from board/owners to staff  Financial capacity/feasibility  Informational system capacity  Process & procedural structures

Where are we now?  Consumers are responsible for setting the specific wage rate their PAs’ will earn:  Can change a PA’s wage rate at any time  Can “save” for bonuses for any of their PAs  Each consumer has a per-hour “wage band”  Same concept as a pay range – “minimum” and “maximum” pay rate o “Minimum” is minimum wage o “Maximum” is called a ceiling – the highest pay rate the consumer can set  Wage band ceiling is dependent on the reimbursement rate of the consumer’s payer  Results in consumers having different wage bands, different wage ceiling due to variations in reimbursement levels

Where are we now? (continued)  Consumer can change a worker’s pay rate at any time  Up or down (but if “down,” must follow state regulations)  Consumer can “save” for bonuses for PAs  Set pay rate for one or more workers below the wage band ceiling  Each hour that worker works, a “savings” is accrued  Bonuses can be distributed to any currently employed worker  Started: March 24, 2018

Part V: First Year Results

Consumer Survey Results  Surveymonkey questionnaire – Summer 2018 (Initial Reaction)  Targeted to all consumers – completed online or hard copy  12.3% of all active consumers at the time  Generally representative of consumer population: How many employees? Who are their payers? Self-Directing? Other 3% 3+ Workers 1 Worker 32.1% Non-Self 45.5% Managed Care Directing 69% Self-Directing 45.5% State Rates 54.5% 29% 2 Workers 23.2% Survey respondents’ payers a little off: General consumer population =74% MCO/MLTC, 25% FFS

Consumer Survey Results  What is the relationship between consumers and workers? Consumer-Worker Relationship All 1 Worker 2 Workers 3+ Workers Family member 42.86% 45.10% 30.77% 47.22% Friend(s) 27.68% 15.69% 42.31% 33.33% Boyfriend/Girlfriend 4.46% 1.96% 11.54% 2.78% No relation 53.57% 39.22% 38.46% 86.11% NOTE: Percentages add up to more than 100 due to “select all that apply” question

Consumer Survey Results  Almost 63% of respondents stated they changed workers’ pay rates  11% of respondents stated they did not change workers’ pay rates