How To Develop A New Service Line: Building A ... · the new service line •Financial feasibility analysis Phase II: Final Service Line Development & Launch •Service line design

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www.openminds.com15 Lincoln Square, Gettysburg, Pennsylvania 17325

Phone: 717-334-1329 - Email: [email protected]

#OMInnovation

The 2018 OPEN MINDS Strategy & Innovation Institute

June 5, 2018| 10:15am – 11:30am

Joseph P. Naughton-Travers, EdM, Senior Associate, OPEN MINDS

How To Develop A New Service Line: Building A Diversification Strategy & Conducting A Feasibility Analysis


I. From Concept To Implementation: Your Best Practice Model

For New Service Line Development

II. Case Studies In New Service Line Development

• Uplift Family Services

• SPARC Services & Programs

III. Questions & Discussion

Agenda

From Concept To Implementation: Your Best Practice Model For New Service Line DevelopmentSection Description


Decisions About Service Line Diversification Typically Made In Strategic Planning Process

Develop Detailed Implementation Action Plan & Key Performance Indicators

Develop Budget & Financing Plan

Develop Operational Plans – Marketing and Business Development, Human

Resources & Information Technology

Create Tactical Approach & High-Level Implementation Action Plan & Performance

Indicators For Strategy Implementation

Identify Options for Achieving Objectives & Strategy Scenarios – Develop Strategy

Gather Internal Information/Internal Analysis – Service Portfolio Analysis

Gather External Information/External Analysis – Trends & Competitors

Review/Establish Mission/Vision/Objectives


Revenue Diversification & Risk

New

Customers

Current

Services

Current

Customers

New

Services

Greatest

Risk

Least

Risk

Moderate

Risk

Moderate

Risk


To Address Aging Service Lines & Need For Diversification, What Are Your Options?

“Reformulation”

or “product line

extension” of

current services

Development of

new services


Commonly Used Portfolio Analysis Tools

Bubble Diagrams

Mission vs. Profitability

Matrix

Market Growth vs.

Market Share Matrix

Other Metrics For

Comparing Service

Lines

Service Mix Analysis

Business Unit Profitability

Analysis

Unit Cost Comparison

Payer Distribution By

Service Line

Revenue By Service Line

Revenue By Payer


More Ideas Than Time Or Money

Problem is often there are more ideas for new

service lines than time or money to evaluate and

implement

Recommend metrics-based ranking model to

evaluate new service line ideas – with the goal of

reducing the number that move to service line

feasibility analysis and development process


Where Do New Service Ideas Come From?

Market intelligence – macro-market monitoring, competitor analysis,

formal needs assessments.

Monitoring and analyzing customer (consumer, payer, referral

sources, etc.) needs

Staff experience and ideas

Your strategic planning process and other brainstorming


1. Strategic alignment

2. Synergy and leverage of core competencies (marketing, expertise, delivery, etc.)

3. Existence of market need (minimum size)

4. Market attractiveness (growth, rates, competition)

5. Reasonable likelihood of feasibility

6. Product advantage (unique selling proposition, value equation, etc.)

7. Ability to meet external requirements (accreditation, licensure, legal, etc.)

8. Positive return relative to financial risk

9. Available cash and capital

10. No “killer” variable

“Must Meet” Criteria In New Service Selection


OPEN MINDS Process For Metrics-Based Evaluation Of New Business Opportunities

1

• Develop an itemized list of business development opportunities for

consideration

2

• Develop a list of factors or metrics to be used in evaluating new business

opportunities

3• Develop a scoring scale for each metric

4• Assign weights to each metric – reflecting organizational priorities

5

• Research and score each business opportunity, using the key metrics and

weighting of metrics to rank the business opportunities

6

• Qualitative research and discussion of each of the top-rated opportunities

for final selection for formal feasibility analysis


Moving From An Idea To Implementation Has Two Phases

Phase I: Conducting a

Feasibility Analysis

• Define the new service line

• Analyze market and competition for

the new service line

• Financial feasibility analysis

Phase II: Final Service Line

Development & Launch

• Service line design

• Service line launch preparation

• Service line launch management

• Service line launch and pilot test

Uplift Family Services

Eleanor Castillo Sumi, Ph.D., BCBA-D, Vice President

of Research and Program Development, Uplift

Family Services

How To Develop A New Service Line: Uplift Family Services Case Example

Eleanor Castillo Sumi, Ph.D., BCBA-DVP, Research & Program DevelopmentOpen Minds ConferenceJune 5, 2018

15 Copyright © 2016 EMQFF www.upliftfs.org

Agency overview

Implementation Science: Framework for Executing

Autism Services

Outcomes

Questions and Answers

OBJECTIVES

AGENCY OVERVIEW


17


SERVICES WE PROVIDE

Service Levels Description

Intensive

Behavioral Health

Primarily based on Wraparound principles &

practices (e.g., CFT)

Largely funded by Medi-Cal (SB946) or MHSA

(Full partnership)

High frequency (several days/week) and

intensive (several hours/day)

Multiple systems and staff involvement

Goal: Prevent more restrictive level of care or

step-down from higher level of care


SERVICES WE PROVIDE


Outpatient Services in community and clinic

Largely funded by Medi-Cal (SB946)

Less intensive- lower frequency and intensity (several

hours/day)

Less likely to be involved in multiple systems

Goal: Symptom reduction and increased functioning

within current living situation

Developmental

Disabilities

Services funded by health plans, Education, and

Regional Center

Applied Behavior Analysis, Classroom Consultation

Highly individualized intensive services (6-24 hours

per week depending on an individual’s age and level

of functioning)


SERVICES WE PROVIDE


Community

Wellness

Primarily funded by the private sector and grants.

Community resources- mental health presentations,

trainings, and activities for youth and their families

Crisis Continuum For youth with imminent mental health needs and

may be a danger to themselves or others

Mobile, Crisis Stabilization, Community Transition,

Developmental Disabilities

Educational

Supports

Services delivered in a school setting (most often

within a multi-tiered support system structure)

Funded by Education or Mental/Behavioral Health

Foster Care and

Adoptions

Services funded by the Dept of Social Services

Focused on foster care placements and/or adoptions.

May be independent services of a component of a

larger program


AGENCY ASSOCIATES AND FINANCIAL STATUS

89%

2% 5% 4%

Revenue Distribution

Government Grants

Fee for Service

Fundraising

Other Income

80%

20%

AssociatesN= 1387

Clinical Non-Clinical

WHO WE SERVE

EXECUTION OF A NEW BUSINESS: APPLIED BEHAVIOR ANALYSIS


EXTERNAL CONTEXT

History of Applied Behavior Analysis (ABA) in California

Regional Centers

ABA services NOT new; funding source expanded

2012- California passed SB 946

Required that every health care service plan and health insurance

policy issued, amended, or renewed after January 1, 2012 to shall

provide coverage for behavioral health treatment for autism or PDD

2014- BHT a covered medi-cal benefit for youth with ASD

less than 21 years of age

45% of the population

Transition from Regional Centers to Health Plans


INTERNAL CONTEXT

New business operations and language

150 years legacy- mental health and social services programs

Primarily government-funded programs vs commercial insurance

History of serving “high functioning” youth with ASD, but not the

full spectrum

What is “standard” business process?


Key Performance Indicators (KPI)

Strategic Objectives

Strategic Focus:

Internal Operation, Financial, Market, Foundation

Vision


IMPLEMENTATION SCIENCE FRAMEWORK

Based on the National Implementation Research Network

(NIRN; Fixsen & Blasé, 2008)

Implementation Frameworks help define:

WHAT needs to be done (effective interventions)

HOW to establish what needs to be done in practice

WHO will do the work to accomplish positive outcomes in typical

human service settings (effective implementation)

WHERE effective interventions and effective implementation will

thrive (enabling contexts)

3-5 years- Science “to” (implementation) Service


IMPLEMENTATION SCIENCE FRAMEWORK: EFFECTIVE INTERVENTION

Need a clear description of the intervention

Intervention needs to be teachable, learnable, doable, and readily assessed in practice.

Clear philosophy and principles that are a good fit with the needs and values of the agency and funding source

Clear inclusion and exclusion criteria that define the population for which the program is intended

Program Resources: Program manuals: Caregivers and Staff versionsCARe ExpectationsAcknowledgement/ReinforcementsConsequences


IMPLEMENTATION SCIENCE FRAMEWORK: DRIVERS

Key components of capacity and the functional infrastructure

supports that enable a program’s success.

3 Categories of Drivers :

Competency- Coaching, Training, Selection

Organization- Systems Intervention- Commercial insurance

Facilitation Administration- Internal processes, policies, structures

Decision Support/Data- System for identifying, collecting, and

analyzing reliable data in a timely manner

Leadership- Technical, Adaptive


IMPLEMENTATION SCIENCE FRAMEWORK: TEAMS

Implementation team purpose:

Change agents whose role is to “make (vs let) it happen!”

Actively navigate the complexities, plan, and negotiate the journey

through the stages.

Test, improve, and organize to “quickly” identify/detect “bugs” in

the process and resolve issues using the improvement cycle

Implementation Teams

Project Plans

Project Charters- Sponsor, Business Owner, Core Team, Subject

Matter Experts

Finance, Human Resources, Training, IT, Outcomes, Facilities,

Communications


IMPLEMENTATION SCIENCE FRAMEWORK: CYCLES

Plan-Do-Study-Act Cycles

Rapid-CyclingCatalyst (consumer level)

EHR reports (program level)

Business/ level (drivers)


IMPLEMENTATION SCIENCE FRAMEWORK: FIDELITY ASSESSMENT

The degree to which interventions/practice are used as

designed/intended.

Fidelity data used to “teach” technical clinical skills vs

performance evaluations that should be comprehensive (clinical

and administrative)


IMPLEMENTATION SCIENCE FRAMEWORK: STAGES

Exploration and Adoption– Identifying the need for change, learning about

possible interventions that may provide solutions, learning about what it takes

to implement the innovation effectively, developing stakeholders and

champions, assessing and creating readiness for change, and deciding to

proceed (or not)

Installation/Pre-Implementation – Establishing the resources needed

required to implement the innovation as intended

Initial Implementation – First use of ABA in an organization (and with

individuals) that is just learning how to support the new ways of work

Full Implementation – Skillful use of ABA that is well-integrated into the

repertoire of teachers and routinely and effectively supported by successive

building and district administrations

Sustainability (financial and programmatic) and Innovation


OUR MISSION AND VISION

Mission Vision

We do whatever it takes

to strengthen and

advocate for children,

families, adults, and

communities to realize

their hopes for

behavioral health and

well-being.

To be trusted leaders in

providing innovative

care for complex

behavioral health and

social service needs


PHASE 1: EXPLORATION AND ADOPTION

Involves assessing needs, program/practices to meet the

needs, assessing the fit and feasibility of implementing and

sustaining the program

Mission/Vision Alignment

Education and Social Impact

1:65 (CDC, 2010)

1:59 (CDC, 2018)

Build or Buy?


PHASE 2: INSTALLATION/PRE-IMPLEMENTATION

Establishing the resources required to implement ABA as

intended

Uplift Model: Specialty Applied Behavior AnalysisProgram- Integration of Applied Behavior Analysis WITHIN the

agency’s principles (Wraparound) and services models (Behavioral

Health/Social Services)

Finance- Billable services and billing difference from government

funded programs

Human Resources-Staffing pattern- Full time vs part time vs independent contractors

Highly competitive market: 1 BCBA: 500 individuals with ASD

Training

Electronic Health RecordDifferent documentation requirements from government-funded

programs

Goal tracking documentation

Centralized scheduling



PHASE 3: INITIAL IMPLEMENTATION

First use ABA in environments that are just learning how to support the new

ways of work

Sept 2012 (FY12-13)- Launched our pilot in Inland Empire and Bay Area

Inland Empire was the primary focus

Research analysis showed a significant number of people with commercial

insurance primarily though Stater Brothers, Kaiser, and the Universities

Despite our willingness and experience in traveling throughout the entire

region, our “hub” was in a high medi-cal area

2 youth for “process practice” in the Bay Area (2 staff)

FY13-14- Continued pilot in Inland Empire and Bay Area becomes the

“transformation zone” to develop a sustainable, replicable, and effective

infrastructure

Inland Empire still the primary focus as we start to expand services in

schools, but demand was in Bay Area

Bay Area increased from 2-30 consumers

SyMed contracted for commercial billing


PHASE 4: FULL IMPLEMENTATION

Skillful use of ABA that is well-integrated into the repertoire

of the business and routinely and effectively supported by

successive building and the agency’s leaders

Our program today


PHASE 5: SUSTAINABILITY AND INNOVATION

Integrate a “new” service line (5 years old vs 151 years old) into

current agency-wide initiatives:

Trauma Informed Care

Partnering with Education in Multi-Tiered Service System/School

Wide Positive Behavior Supports

LESSONS LEARNED AND TIPS


SUMMARY

Strong partnership and collaboration between Program and Finance and all Support Services

Pilots/demonstrations can be helpful to start innovations, but be cognizant about the true infrastructure necessary to replicate or sustain the program

E.g., Administrative Assistant can multi-task (intake calls, schedule, file, etc.) but having multiple Administrative Assistants is not sustainable.

Apply the same business process for different payors (e.g., insurance, schools)

Do not underestimate the need for a thorough pre-implementation stage OR overestimate the organization or individual clinicians capacity and skills

This is not just a change in practice- e.g., TBS to ABA

Exploration stage helps to create readiness

QUESTIONS AND ANSWERS

Between the 84 children with Autism that were served in our Specialty Applied Behavior Between the 84 children with Autism that were served in our Specialty Applied Behavior Analysis program (sABA), there are were over 7,460 target skills goals of which 66% were mastered.

82% of families reported their child is better at handling daily life

84% of families report their child gets along better with family members

72% of families report their child is doing better in school

85% of families are satisfied with their life

Commercial Insurance Services include programs that are funded by commercial insurance. The largest percentage of commercial insurance services are for children and youth with Autism. The services reflect our integration of Wraparound Principles and Applied Behavior Analysis (ABA) and are delivered at home, in the community, and our Center. Intensity of services may range from 6-24 hours per week depending on an individual’s age and level of functioning.

Eleanor Castillo Sumi, Ph.D., BCBA-D

[email protected]

408.628.5506

mailto:[email protected]

www.upliftfs.orgHealing families. Strengthening communities.

SPARC Services & Programs

Teri Herrmann, MA, Chief Executive Officer, SPARC

Services & Programs

How To Develop A New Service Line: Building A Diversification Strategy & Conducting A Feasibility Analysis

Teri Herrmann, MA, CEO

SPARC Services & Programs

Who We Are

• SPARC Services and Programs is a Behavioral Health Agency in North Carolina dedicated to the mission of keeping people out of unnecessary and expensive institutionalized care

• Our Owner and Leadership Team have deep and long roots in the NC Behavioral Health Industry and wanted to do something different in our state

• So SPARC Services and Programs was born to meet unmet needs through specialized niche services designed to keep people out of unnecessary institutional care and partner strategically with payers to custom design services to meet their needs

Our Values

SPARC Services & Programs Values

1. Work to keep people out of institutional care

• People who receive our Programs and Services shall develop hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning.

2. Be positive and solution-based

• People who work at SPARC shall maintain a solution-based demeanor and view crisis as opportunities. Negativity ruins company cultures.

3. Give and accept feedback appropriately, and grow

• We believe we must make it ok to give and accept feedback appropriately, and then grow from that experience. Gossip is unfair and hurtful.

Our Values Continued

4. Support the principles of System of Care

• We accept the principles of System of Care. We are family-driven, community-based, and culturally and linguistically competent. Collaboration is critical.

5. Maintain great customer service

• Great customer service will be achieved through genuine, transparent relationships.

6. Record what we do accurately and timely

• We have a responsibility to record accurately, timely, with confidentiality, and in a manner that adheres to local, state and federal standards.

What Makes SPARC Different

• Value Based Purchasing with Shared Risk Contracting

• Strong Agency Culture

• Value Driven, Organically Grown Behavioral Health Organization

• Strong and Experienced Leadership

• Efficient Electronic Referral Process

• Innovative, 100% Paperless Electronic Health Record

• Licensed to Provide Family Centered Treatment ®

• Custom Designed Programs Available

The North Carolina LME/MCO System

NC LME/MCO System Continued

• NC Medicaid Funded Mental Health, I/DD and SUD Services are managed by 7 LME/MCO’s

• The LME/MCO’s are charged with contracting with a provider network, overseeing contractual compliance of the network, authorizing services, paying for services, and providing Care Coordination to members who qualify

• They operate closed provider networks

• Providers who have sites across the state need to have contracts with multiple LME/MCO’s and there are often different processes in place for each

NC Behavioral Health System Transformation

• The NC system has been reforming since 2002 and the system is getting ready for a major overhaul again

• North Carolina is preparing to transition its Medicaid and NC Health Choice programs from a predominantly fee-for-service delivery system to managed care, which will advance high-value care, improve population health, engage and support providers, and promote predictable and sustainable costs. In designing this transition, the goal of the Department of Health and Human Services (the Department) is to improve the health of North Carolinians through an innovative, person-centered and well-coordinated system of care that addresses medical and nonmedical drivers of health. (excerpt from Care

Management Concept Paper 03.09.2018)

NC Behavioral Health System Transformation Continued

• Most Medicaid and NC Health Choice2 enrollees will begin transitioning to prepaid health plans (PHPs), which are integrated managed care products that will provide physical and behavioral health services, long-term services and supports, and pharmacy benefits, and will address health-related resource needs.

• The Department intends to offer different types of PHPs, customized to the populations they serve.

• Standard plans will launch the first year of managed care and will serve the vast majority of Medicaid enrollees.

• Behavioral health and intellectual and developmental disability tailored plans (BH I/DD TPs) will launch in the third year of managed care and focus on specialized needs of individuals with behavioral health disorders, I/DD and traumatic brain injury (TBI). (excerpt from Care Management Concept Paper 03.09.2018)

• Providers will again need to re contract with a new set of payors as this transformation occurs

SPARC Child/Family Services Continuum

Acu

ity

Sca

le

Family Centered Treatment (alternative to residential level

III)

In Home Therapy Services (Home Based Therapy and

Case Management)

Outpatient Therapy

Enhanced Crisis Response

Bridging Team


Family Centered Treatment® (FCT)Family Centered Treatment® (FCT) is an evidence-based practice (EBP) that is currently being provided in various states. FCT has been gradually formalized into a model of home-based treatment that lowers rates of out of home placements. It has been refined based on research, experience and evidence of effectiveness derived from practice. The foundations of the model are from eco-structural family therapy (Minuchin) and emotionally focused therapy (Johnson). FCT is a systemic family systems change model. FCT is also a Trauma Treatment due to the inclusion of Emotionally Focused Therapy components included at key junctures in treatment.

This service is targeted towards:

• Consumers with prior treatment episodes of residential treatment with unsuccessful family reunification

• Consumers at risk for higher levels of residential, such as Level III

• Consumers who have been hospitalized with little prior treatment where hospital is recommending residential services

• Consumers currently in residential treatment where discharge is being prolonged due to lack of family systems work to make this successful

• Consumers with extensive histories of utilizing enhanced services without successful outcomes


Enhanced Crisis Response

The intent of this pilot is to put enhanced supports in place as quickly as possible for youth with behavioral health needs that are at risk for abandonment, crisis episodes, or restrictive levels of care. With timely assessments and supports the intended outcome for youth is to be able to maintain them in their home environment, non-therapeutic foster homes, kinship placements, or minimize needs for long residential treatment stays.

This program operates under the philosophy that children thrive when they can safely remain in or be reunified with the home of their own family, and/or a safe permanent alternative. The program will utilize licensed/associate practitioners who provide an immediate comprehensive clinical assessment (when necessary), along with corresponding 24-7 service delivery. For youth in the emergency department the practitioner will respond within 2 hours of the referral and for other referrals response will be on the same day or by end of the following day.

This program is intended to be short term, with services lasting on average 60-90 days. During this time, the program staff will work with the child, their family, to diffuse the imminent crisis and get the family linked to appropriate community-based services that allow the child to thrive and meet their goals.

SPARC Child/Family Services Continued

In Home Therapy Services (IHTS)

IHTS is a time limited service, approximately 6 months, in which the Therapist and the Case Manager work with the child and their family to meet the therapeutic needs as well as provide linkage to professional and natural supports. The Therapist will provide individual and family therapy to address the child’s mental health needs as well as family systems issues and needs that may complicate traditional outpatient therapy from being successful. The CM will approach the care coordination through the philosophies of System of Care and will work with the various systems involved with the child and family, such as DSS, DJJ, Primary Care, and School System.

Outpatient Therapy

Children can receive home and office based Outpatient Therapy by a licensed therapist. Outpatient Therapy includes Individual and Family Therapy. Outpatient Therapy can be used as a step down for both IHTS and FCT.

SPARC Services For Dually Diagnosed Children & Adults

Bridge Team

Managed by selected LME-MCOs, the Transition Bridging Teams will support identified individuals who experience a dual diagnosis of intellectual and developmental disabilities (I/DD) and serious behavioral challenges and are transitioning out of a PRTF or the state’s Development Center Specialty Programs and into community settings consistent with the Home and Community-Based Services Final Rule. While the level of Bridging Team involvement may vary, the Team will provide intensive, “hands on,” time-limited oversight and technical assistance to community-based support networks.

SPARC Adult Services

Transition Management Services (TMS)

Transition Management Services (TMS) provides services to individuals participating in the Transitions to Community Living Initiative (TCLI). TMS is a rehabilitative service intended to increase and restore and individual’s ability to live successfully in the community by maintaining tenancy (housing in the community). TMS is focused on increasing the individual’s ability to live as independently as possible, managing the illness, and reestablishing his or her community roles related to the following life domains: emotional, social safety, housing, medical and health, educational, vocational, and legal. TST provides structured rehabilitative interventions and works in partnership with the individual’s behavioral health service provider.

Our Keyes To Success

• Commitment to agency values

• Strong relationships with payors and stakeholders

• Assess Business from 3 lenses: 1) is there a community need/desire for the service; 2) is there a payor willing to partner with you, and 3) can you find the right staff to deliver the service

• Strong Commitment to agency culture

• Lean, efficient, and mobile infrastructure

• Electronic Health Record that meets our needs and can be customized

• Willingness to take risk

www.openminds.com n 15 Lincoln Square, Gettysburg, Pennsylvania 17325 n 717-334-1329 n [email protected]

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Documents

How To Develop A New Service Line: Building A ... · the new service line •Financial feasibility analysis Phase II: Final Service Line Development & Launch •Service line design