Redesign Informational Meeting Staff 3-26-12 · Operating Model Overview Central and FieldCentral and Field In analyzing the opportunities to shift soci al services programs and administration

Redesign Informational Meeting

Copyright © 2012 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.Copyright © 2012 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

March 26, 2012

Why Are We Considering This Option?


p

Federal IssuesFederal Issues

• Multi-trillion dollar deficit. – Bi-partisan committee will resume its work after the

elections to make recommendations for cuts.

– Human Services will not be spared.

• We rely heavily on Medicaid (TCM, Waiver CM, Care Coordination, etc)

Copyright © 2012 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

State IssuesState Issues• Projected $1billion - $1.5B deficit for next biennium

R id th f M di id t ti l d l– Rapid growth of Medicaid costs eating up larger and larger portion of the state budget

• Bi-partisan interest in changing human servicesp g g• Previous attempts to consolidate county human services

- Governor Pawlenty’s 15 regions• Service Delivery Authority Language

– outcome expectations– variance possibilities– variance possibilities – consequences for counties not meeting outcomes

• Strong belief that if counties can’t do it, then the State


will compel change• Reform 2.0

County IssuesCounty Issues• Cost Shift – Used to have 70% of budget from state

d f d N t 50%and feds. Now at 50%.

• Constant cuts since 2003.

• Highest per capita cost in the state. Concerns of administration and board we are too expensive.

• Elections – all 7 board members likely will be running this year. A change in our board could make us

l blmore vulnerable.

• Changing demographics – growing number of


elderly.

Some Positives About This Potential ChangePotential Change

• Larger organization reduces costs Olmsted CountyLarger organization reduces costs. Olmsted County costs spread over larger organization.

• We get to build an organization from the ground upWe get to build an organization from the ground up.

• Systems of Care model would enhance our services to clients.services to clients.

• A larger organization should make us more resilient to cuts.to cuts.

• Being a leader on government reform will allow us to attract funding and support.


to att act u d g a d suppo t

Some Concerns About This Potential ChangePotential Change

• Governance – depending on how this is structured b d ld t h t l d i iour board would not have control over decisions

regarding the levy they invest in human services ($24 million).($24 million).

• Are counties going into this just to save money or are they also interested in a better human services ysystem?

• There are impacts to the county organization left p y gbehind when the largest department moves on.

• How will the staffing of the new organization impact


g g peach of us?

Background and ContextFrom Blueprint to ImplementationFrom Blueprint to ImplementationFollowing the development of the Human Services Redesign Blueprint in March 2011, we are entering the second phase of co-op design and development.

Blueprint Design Implementation

1. Establish strategicintent and scope of co-

op

2. Define operating model and business

case

3. Develop implementation plan

and change approach

• What is the strategic intent of establishing the co-op? Cut costs? Deliver better service?

• How do we regionalize the administration and delivery of human services?

• What is the portfolio of initiatives required to implement co-op? How should they be prioritized? How should we organize the program?

• What is the right scope of the co-op? Which processes? Which operating organizations?

• How should we redesign our service delivery to deliver a better System of Care?

should we organize the program?

• How should the change be managed to ensure that goals are achieved - securing buy-in and creating a new high performing

Copyright © 2012 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 7

creating a new high performing operating model?

Operating Model OverviewCentral and FieldCentral and FieldIn analyzing the opportunities to shift social services programs and administration into a regional cooperative, there were minimal barriers identified that would require

ti t i t i ibilitOperations Service Delivery

• Processing collateral (incl. document scanning) that come into local office

• Case managementA t / i ti ti

High Touch

counties to maintain responsibility.

Field

scanning) that come into local office• Employee workspace • Meeting space for public• Maintenance of local relationships

( li fi t id h l

• Assessment / investigation• Treatment services• Care coordination, including

interfaces with other entities (e.g., t DPH t )

• Most business functions• Training

(police, fire, courts, providers, schools, hospitals, public health, etc.)

• Management and dispatch of local workforce

courts, DPH, etc)• Information and referral (front door)

L T h• IT (including helpdesk)• HR• Contracting/procurement• Program evaluation

C i ti

Central

• Specialized, low-volume clinical expertise• Information and referral (hotline, 2-1-1, etc.)• Outreach and education• Quality assurance

Low Touch


• Communications• Grants• Waivers (to be confirmed)

Q y• Provider relationship management

8

Operating Model OverviewSystems of CareSystems of Care

Principles:1. Comprehensive array of services and supports

2. Individualized services and supports / individualized plan

3. Community-based - Least restrictive, most appropriate environment, utilize natural supports

4. Person-centered – Consumers participate in all aspects of the4. Person centered Consumers participate in all aspects of the planning and delivery of services and supports

5. Integrated services and supports across systems and providers

6. Collaboration/Coordination across multiple systems

7. Strengths-based – not deficit driven

8 C l ll d li i i ll i


8. Culturally and linguistically responsive

9

Operating Model OverviewOperating Model ElementsOperating Model Elements

To realize full benefits and capabilities, all dimensions of an operating p , p gmodel have to be addressed adequately and implemented thoroughly.

Operating Model Components

Vision for the future

Practices and processes

People

Metrics

12

6

7

Organizational model

Technology

Infrastructure and

Enabling Legal Framework

Funding Model

3

4

5

8

9

Facilities5


Organizational ModelOrganizational ChartOrganizational Chart

Executive Deputy • Planning and E l tiDeputy• IT Liaison • Legal Executive

DirectorDeputy Director

Evaluation• Operations Support• Communications

Deputy Director

IT Liaison• HR Liaison• Insurance Liaison

Legal• Finance

Consumer Contact Services

Director

Children, Youth, & Family Services

Director

Information and Referral / Call

Child Protective Services / Child Welfare / Foster

Adult and Family Services Director

APS / Adult Foster Care

Support Services Director

Financial Assistance and Food Support

DivisionDirectors

Waiver Management

Director

CAC, CADI, DD, TBICenter Care Licensing

Children’s Behavioral Health

Adolescent Unit

Intake for Low Intensity Cases

Adult Mental Health / Chemical Dependency

S / du t oste Ca e

Developmental DelaysAging / Elderly Early Intervention

and Food Support

Medical Assistance

Child Support

Child Care Licensing

Managers

Outreach

EW, AC

Children with Disabilities

Aging / Elderly yg

Supervisors*


Staff*

*FTE numbers for supervisors and staff will be based on program-specific span of control and caseloads

Administrative OrganizationImplementation OptionsImplementation OptionsImplementation of the co-operative’s administrative functions can be accomplished in a number of ways. During implementation of the co-op, we recommend pros and cons of each option be thoroughly evaluated for each

Pros Cons

recommend pros and cons of each option be thoroughly evaluated for each capability within the organization.

Contract withone of the counties

• Systems/Processes already exist• Start-up effort lowest• Some staff already familiar

• Least customizable• May not be able to handle volume• Negotiating costs with host county• Lowest ‘control’ option – will be

prioritized with other County needs

Contract witha 3rd party

i

• Long-term lower costs• Generally somewhat customizable• Start up effort relatively low

• Short-term investment• Staff will have to learn new processes

& systemsservice provider

• Start-up effort relatively low & systems• Contract management overhead

Build your • Most customizable• Most easily modified as needed in the

• Highest cost option• Significant start-up costs


own co-opspecific model

yfuture

g p• Responsible for own maintenance &

associated costs

12

Administrative OrganizationImplementation OptionsImplementation OptionsBased on county input and leading practices, initial options for implementation of administrative functions are identified below. This analysis will be used in developing the business case and will be refined and revised during implementation to reflect more detailed analysis of all options.

Functions Staff IT Systems Benefits

Human Resources Staffed in the Co-

Op Contracted with a member

county (use Olmsted for estimating purposes)

Likely easiest start-up System already established to support HS needs

g p y p

estimating purposes)

InformationTechnology

Contracted with 3rd

party service provider

Contracted with 3rd party service provider

Easier start-up, better able to keep up with technology change Customizable, better support, help-desk

capabilities

Finance Staffed in the Co-

Op Contracted with a member

county (use Olmsted for estimating purposes)

Human Services specialization with systems designed to support work

Legal Staffed in the Co-

Op Contracted with (some) member

counties Human Services specialization to deal with

cadre of recurring issuesg Op counties cadre of recurring issues

Strategic Planning & Delivery Support

Staffed in the Co-Op

Built for the Co-Op Human Services specialization required with systems custom built for desired outcomes

O ti Contracted with Contracted with member county Strictly support – no specialization required;


OperationsSupport Services

Contracted with most member counties

Contracted with member county Strictly support no specialization required;most economies of scale

Insurance Staffed in the Co-

Op Contracted with 3rd party

provider Assume a single Risk Manager on staff

overseeing contract with MCIT

Infrastructure and FacilitiesHub and Field ModelHub and Field Model

The Co-Op will consist of a region-wide network of people, resources, and services, organized in hubs and a field presence, to optimize capacity and bring service delivery closer to the consumer.

Central‘Hub’

Southeast Minnesota Regional Cooperative

Services Centers


PeopleTypes of CareTypes of Care

Short-term services or supports

• Circle of Support• Navigators• Informal Coordination

Intermediate level of services or supports

• Service Coordinators• Larger ratio of families services or supports

Intensive and

to staff

• Care Managersextended level of

services and supports• Very small ratio of

families to staff


MetricsOverviewOverviewMeasuring outcomes and the return on taxpayer investment is an important part of the SE Minnesota Counties Human Services Redesign project.

Type of Metric Examples Source

Human • Children’s Services SDA Steering Committee on services outcomes

• Income Supports• Adults’ Services

Performance and Outcomes Reforms

Stakeholder • Consumer satisfaction levels• Workforce satisfaction levels

Co-op-specific

• Community engagement

Return on taxpayer investment

• Impact to HS and to county budget of programs and services

Co-op-specific (pulling analysis from counties and other sources)investment other sources)

Operational • Service levels for internal HR, IT, Finance, and other functions

• Service levels for external-facing functions,

Co-op-specific


Service levels for external facing functions, including call centers, customer services

Enabling Legal FrameworkSDA LegislationSDA Legislation

Minnesota Statutes Chapter 402A, Essential Human Services; County Delivery provides enabling legislation for the formation of a Service Delivery Authority (SDA)

Overview• Voluntary county governance/management structure certified by Redesign Council (approved by DHS

Commissioner)

(SDA).

Commissioner)• Passed in 2009 HHS omnibus budget bill (Chapter 402A)• SDAs utilize already existing models of community partnerships, build on innovations, and streamline

the human services system to best meet the needs of communities, clients, and taxpayers.

How It Works• Must meet minimum population thresholds (55,000 minimum) via’ single or multicounty structure (with

certain exceptions)certain exceptions)• Can serve as single county SDA if minimum population threshold is met• Can combine with other counties in ‘reasonable geographic proximity ‘ as an SDA to deliver a service,

some services, or all services• Must designate a single administrative agent to communicate with DHS

M b t d i f t t l ti t hi b tt lt


• May be granted waivers from state regulations to achieve better results• No structure specified in law

Funding ModelOperational Funding Flow ChartOperational Funding Flow ChartCounties will pay in to the SDA, combining with State and Federal grants, to make up the revenue base the SDA will utilize to provide b tt i tbetter services outcomes.

Social Services

Inputs Outputs

Federal / State Funding

SDA

Social Services, Support Services,

Administration

$Other Funding SDA

County Specific Accountability

$County

Operational Accountability Reports

Operational Funding


Operational Funding serves as the buy-in each county makes yearly to support the services provided by the SDA.

Funding ModelOperational Funding ConsiderationsOperational Funding ConsiderationsOngoing county contributions to SDA operations should be reflective of each county’s ability to pay and its demand for human services.

Formula Component Ability to Pay (X%) Demand for HS (X%) Historical Spend (X%)

C did t • Tax capacity P l ti • Average of past three Candidate Metrics

p y• Tax valuation• Total county budget

• Population• Poverty rate

g pyear spend on human services

Funding Model ConsiderationsFunding Model Considerations

• Initial years would heavily weight historical spend, but this would trend downwards over time.

• Other updates to funding model would be announced in advance, and would not occur O e upda es o u d g ode ou d be a ou ced ad a ce, a d ou d o occuannually.

• Any cost savings would be used to build cash reserves, and then to pay back any county or non-profit investors. Some portion of future savings would be returned to counties as a ‘dividend’ on a TBD basis This would not be annual and would align with


counties as a dividend on a TBD basis. This would not be annual, and would align with any recalculations of the funding formula.

GovernanceOverview Board of DirectorsOverview – Board of DirectorsWhen designing the governance for a SDA model, consider key stakeholders as well as forums for discussion and decision-making.

RegionalForum

Role/Focus Membership Additional Considerations

Board of • Policy-level • Voting: 1 representative • Attendance is required for both Directors direction to

organization(elected official) and 1 alternate (elected or appointed) from every county

• Non-voting: DHS,

representatives and alternates• Alternates may only vote when their

representative is not present• Board annually elects a Chair, Vice-Chair, and

At-Large Member to Executive BoardNon voting: DHS, Executive Director of SDA (ex-officio), others?

At Large Member to Executive Board• Term limits are staggered• Ad hoc committees may be commissioned by

the Board for specific topics

Executive Board

• Policy-level direction to organization

• Board Chair, Vice-Chair, At-Large Member, and Executive Director of SDA ( ffi i b )

• Meets more frequently than Board to address the line between policy and administration

• Sets agenda for Board meetings


SDA (ex officio member)

GovernanceOverview Advisory CommitteesOverview – Advisory CommitteesRegional Forum

Role/Focus Membership Additional Considerations

Advisory Committee

• Advise on co-op direction and operations

• Consumers• Advocates• General citizens

• The Committee will designate a certain percentage of seats to each stakeholder group

• Interested individuals may apply to theoperations • Interested individuals may apply to the Executive Director of the Co-Op, who then presents a recommended slate to the Board of Directors for approval

• Provide advice and perspective on• Provide advice and perspective on impact of policies and practices to target community – no decision-making authority or role in approval processes

Sub-Advisory Committees

• Advise on co-opdirection and operations

• Consumers• Advocates• General Citizens

• Sub-advisory committees may be established around types of service(e.g., mental health) and/or around populations (e.g., children) as


on specific topics and/or populations

appropriate by statute and demand• These groups provide more specific

forums to inform overall Advisory Committee positions

Q tiQuestions


Documents

Redesign Informational Meeting Staff 3-26-12 · Operating Model Overview Central and FieldCentral and Field In analyzing the opportunities to shift soci al services programs and administration