barrett 1 sandra barrett assistant director. barrett 2 the choice an opportunity to exchange agency...
Post on 27-Dec-2015
228 Views
Preview:
TRANSCRIPT
Barrett 1
An Experiment in Consumer-Direction
Sandra BarrettAssistant Director
Barrett 2
THE CHOICE
An Opportunityto Exchange Agency Personal Care Services for A Monthly Cash Allowance
Barrett 3
THE SOCIAL EXPERIMENT
Classic experimental design with an experimental group receiving the allowance and a control group continuing to receive agency services – both groups are part of the evaluation
Barrett 4
THE SOCIAL MARKETING
Open Enrollment Direct Mail
• Letters from the governor
• Letters to participants requesting referrals
• Notes with copies of news clippings
• Letters from participants with information about their experience
Public Service Announcements• Television• Radio
News Releases
Barrett 5
THE PLAYERS
Need personal care• New to continuing
ratio is 30.5% Willing to participate Able to make
responsible care decisions or have a representative decision-maker• 43% use a
representative
18 Years Old or Older• 72% age 65 or
Older• 64% White/33%
Black/3% Other• 77% female/84%
unmarried• 62% live in rural
area/68% live with others
Receiving Medicaid
Barrett 6
CLOSING THE DEAL
Request information Enter into database Telephone contact
by enrollment staff Enrollment home
visit Completed signed
consent form
Barrett 7
SHOW ME THE MONEY!
Allowance• Based on personal
assistance needs• Approximately
$8.00 per hour• Average
allowance is $405.00 a month
Uses of Cash• To meet personal
care needs• Hire personal care
assistant• Purchase items
and services related to personal Care
Barrett 8
THE PAY OFF
82% of the allowance is used to hire a PSA• 74% hire a family
member• Friend/neighbor
16% of the allowance is used to purchase items traditionally unavailable through Medicaid• Personal care items;
assistive devices; health and safety items
• 2% is saved
Attractive Program Features
Barrett 9
THE SUPPORTING CAST
Bookkeeping• Accept cash
allowance• Disperse cash
according to plan• Serve as employer
agent• Maintain employee
files• Pay payroll• Withhold/pay taxes
Counseling• Training• Reassessments• Monitoring• Support Resource
• Develop cash Plan/answer questions
Barrett 10
THE OBSERVATIONS*Quantitative Evaluation
Participants and family members express a high level of satisfaction with this program.
81% say the Program has improved their lives/No one says they are worse off
99.76% are satisfied with their caregiver relationship
96% would recommend the program to others.
97% are happy with the time help is provided• 50% receive help before
8 AM• 65% receive help after 6
PM• 77% receive help on
weekends Participants have more
unpaid help than paid help*Preliminary Information Provided
by MPR based on 9-month consumer survey – 885 Respondents
Barrett 11
THE OBSERVATIONS*Qualitative Study
Interviews were semi-structured, open-ended, face-to-face with consumers/reps, paid workers, counselors
Cross-cutting themes• Family context of care• Meaning of independence• Community context of care• Skills and qualities of
caregivers• Alternate uses of cash• Previous agency experience
Widely shared values• Flexibility/freedom• Control/responsibility• Getting out more• Securing services from
someone who cares about you
• Securing help that fits the rhythms of life
• Being about to hire family*Preliminary information based on 27 case
studies completed by the University of Maryland Baltimore County
Barrett 12
THE OBSERVATIONS*Cost Evaluation
Arkansas Medicaid has spent no more per month on the Treatment Group than on the Control Group
Based on per hour of care delivered, IndependentChoices costs are nearly 10% lower than traditional agency-delivered services.
A higher percentage of each service dollar pays for direct service rather than administrative costs
Treatment Group receives more of the personal care service ordered by the MD
Control Group Beneficiaries did not receive personal assistance services in 40% of the months in which they were eligible compared to 9% for the Treatment Group
Institutional Costs were 18% higher for the Control Group
*Comparison of Treatment and Control Groups Randomized During the First 2 Years of Operation
Barrett 13
THE LESSONS
Estimating Counseling/Fiscal Agency Reimbursement
Consumers are less interested in cash than previously believed
Consumers want choice and control over who, when and how care is provided
Disenrollments occur in the first few months
Lag time between enrollment and beginning self-direction vary
Consumer-directed models provide better access to authorized service
Consumers in Arkansas have been managing cash budgets responsibly WITHOUT ANY MAJOR INSTANCES OF FRAUD OR ABUSE
Barrett 14
THE VERDICT
• Consumer Direction Works• Consumer Direction is Not For Everyone• This Model Will Not Replace the Traditional
Model• Respect for Preferences Should Be a Major
Consideration in Program Design and Training
Barrett 15
THE FUTURE
Arkansas is currently negotiating with CMS to amend the 1115 demonstration waiver terms and conditions to operate the program without randomization
The Cash and Counseling Program is proposing that CMS modify their definition of personal care to include goods and services in addition to human assistance
Barrett 16
IndependentChoices
Sandra BarrettArkansas Division of Aging and Adult Services
PO Box 1437 Slot 1412Little Rock AR 72203
501/682-2441www.independentchoices.com
top related