joan o’connell, phd circles of care evaluation technical assistance center american indian and...
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Joan O’Connell, PhDCircles of Care Evaluation Technical Assistance Center
American Indian and Alaska Native Programs
University of Colorado at Denver and Health Sciences Center
Circles of Care August 2007
Feasibility Assessment:Using Resources Wisely
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Feasibility Assessment
Specific Components
I. Model Description II. Needs Assessment
III. Human Resources/Other Inputs Analysis IV. Management Analysis V. Financial Analysis
VI. Economic Analysis
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I. Model Description
Target PopulationDefinition of SEBDNumber of youth and locationHow they are identified?
Model for a System of Care
Programs Elements/ServicesNew program elementsModification of an existing program(s)
Add elements Expand existing services
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Using Resources Wisely
• Financial Analysis: Is the program practical and fiscally sound? Is the program sustainable?
• Economic Analysis: Does this program providing value when compared to other programs?
• Why Conduct Both Types of Analyses?
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Using Resources Wisely
• Obtain support for the proposed program.
• Promote discussions of financial sustainability
• Resources are limited and resources could be used for other valuable programs.
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V. Financial Analysis - QuestionsV. Financial Analysis - Questions
1. How are program resources utilized?1. How are program resources utilized?
2. Are there sufficient resources to meet 2. Are there sufficient resources to meet the needs of the target population?the needs of the target population?
3. How does the average program cost per 3. How does the average program cost per child served compare to costs of other child served compare to costs of other health programs?health programs?
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V. Financial Analysis - QuestionsV. Financial Analysis - Questions
4. How do program costs change overtime?4. How do program costs change overtime?
5. Is the program fiscally sound? Do 5. Is the program fiscally sound? Do program revenues cover program costs?program revenues cover program costs?
6. How do program revenues change 6. How do program revenues change overtime? Is the program sustainable?overtime? Is the program sustainable?
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Financial Analysis – Resource NeedsFinancial Analysis – Resource Needs
• Building Space• Outdoor Space• Office Supplies• Program Supplies• Computers, Software• Utilities• Travel• Training
• Human Resources– People with human
service knowledge and skills
– People with cultural knowledge and skills
– People with compassion & people skills
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Financial Analysis – Resource Allocation
Model 4 Model 5 Model 6
Equipment, machinery, and other capital 5% 1% 1%
Personnel (salary and benefits) 62% 61% 73%
Rental, utilities, supplies, and materials 3% 3% 9%
Consultants 17% 11% 1%
Travel (for staff, family, and board) 4% 5% 3%
Other (including organization indirect costs) 10% 18% 13%
Total program spending $1,342,584 $1,948,939 $2,530,524
COC Grantee Model Budget Summaries. Program Annual Expenditure Estimates.
Percent of Annual Expenditures
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Financial Analysis – Human Resources
Job Responsibilities Model 1 Model 2 Model 3
Management and Supervisory 3 2 3
Service Provision Clinical (mental health, substance use, etc.) 1 2 13.5 Case management 5 9 6.2
Administrative (administrative, financial, etc.) 4 3 7.5
Cultural Activities and Traditional Healing 2 Traditional Healing Services 11 Training -- 0.2 0.1
Community Outreach, Marketing, Education 1 -- -- Youth Coordinator 1 1 1
Data and evaluation -- 1 Other 2 3 1
Total number of clinical and case management staff 6 11 19.7
COC Model Summaries. Number of Full-time Equivalent (FTE) Positions.
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Financial Analysis Staff per Youth Served
Model 1 Model 2 Model 3
Service Provision Clinical (mental health, substance use, etc.) 1 2 13.5 Case management 5 9 6.2
Total number of clinical and case management staff 6 11 19.7
Number of youth/adults served 50 45 144
8.3 4.1 7.3
COC Model Summaries. Number of Full-time Equivalent (FTE) Positions.
Number of youth/adults per clinical and case management position
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Financial AnalysisEstimated Costs per Child Served
Model 4 Model 5 Model 6
Total program spending $1,342,584 $1,948,939 $2,530,524
Number of youth/adults served 50 45 144
Cost per youth/adults served $26,852 $38,979 $17,573
COC Grantee Model Budget Summaries.
Program Annual Expenditure Estimates.
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Financial AnalysisEstimated Costs per Visit
Service related Total annual expenditures $327,968
Number of day treatment sessions 5000Cost per serivce hour $66
Non-service related
Expenditures not related to the provision of services Evaluation and Research $100,000 Year 1 community awareness activities $6,000
Feasibility
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Financial AnalysisProgram Phases
Planning
Year 1
Ongoing
Planning or pre-implementation phase
Year 1: May include a start-up or pilot phase
Ongoing: Years 2-4
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Financial Analysis
Planning
Year 1
Ongoing
The planning or pre-implementation phase includes:
Recruit and train staff
Data collection
Develop relationships other
organizations (in-kind support)
Establish revenue sources
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Financial Analysis - SpendingPre-implementation Phase
OngoingList services and items provided by sponsors, etc. to quantify the amount of matching funds.
Items / Services Expenditures
Estimates for Sponsored/
Donated Goods & Services Total Value
Office space $16,800 $16,800Office equipment $3,000 $2,000 $5,000Personnel $180,000 $50,000 $230,000Utilities $1,000 $2,000 $3,000Supplies $4,000 $3,200 $7,200Consultants $5,000 $5,000Total $193,000 $74,000 $267,000
Planning
Year 1
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Financial Analysis
Planning
Year 1
Ongoing
The planning or pre-implementation phase questions:
Are there sufficient resources for the proposed work?
Are the cost estimates (or value of donations/in-kind support) correct?
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Financial Analysis
Planning
Year 1
Ongoing
Other questions:
Are sufficient resources allocated to staff recruitment and training?
Are sufficient resources allocated to youth identification and assessment?
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Financial Analysis - Revenue Pre-implementation Phase
Ongoing
Revenue Source Amount
Estimates for Sponsored/
Donated Goods & Services
Total Value
Service provision $33,000 $0 $33,000 Medicaid $25,000 $25,000 Third party $6,000 $6,000 Patient fees $2,000 $2,000Grants/ Other $160,000 $74,000 $234,000 SAMHSA $100,000 $100,000 I H S $40,000 $40,000
Tribe $20,000 $74,000 $94,000Total $193,000 $74,000 $267,000
List services and items provided by sponsors, etc. to quantify the amount of matching funds.
Planning
Year 1
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Financial Analysis – Year 1Spending
Planning
Year 1
Ongoing
Services are provided.Services are provided.
Provision of services may be limited:Provision of services may be limited:
• A pilot or start-up phase may serve fewer A pilot or start-up phase may serve fewer patients or provide limited servicespatients or provide limited services
• Staff planning and training time may be Staff planning and training time may be greater during the first yeargreater during the first year
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Financial Analysis Ongoing Phase: Year 1
Program Costs = Revenues
Salaries Grants
Supplies Reimbursement
Utilities Matching funds
Travel Service fees
Training
Is the Program Fiscally Sound?
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Financial Analysis – Year 1Revenue
Planning
Year 1
Ongoing
There may be several sources.There may be several sources.
Some revenue sources may depend upon Some revenue sources may depend upon the volume of services.the volume of services.
With a pilot project and the provision of With a pilot project and the provision of fewer services, revenues may differ from fewer services, revenues may differ from program operation during later years.program operation during later years.
Example: Medicaid funds home visits and travel Example: Medicaid funds home visits and travel costs but only if service is provided.costs but only if service is provided.
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Financial AnalysisOngoing Phase: Years 2-4
Planning
Year 1
Ongoing
Service provision increases.Service provision increases.
• Additional staff are hired to provide Additional staff are hired to provide servicesservices
• Expenditures increase with the Expenditures increase with the increase in services increase in services
• Service revenues increaseService revenues increase
How do expenses and revenue change How do expenses and revenue change overtime?overtime?
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Financial AnalysisOngoing Phase: Years 2-4
Planning
Year 1
Ongoing
Costs: ? Office space (rent, mortgage)
Salaries and training
Utilities, supplies, travel
Program operations
Revenues:
Grants
Sponsor donations, in-kind support
Revenue from service fees
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Financial AnalysisOngoing Operational Phase: Years 2-4
Planning
Year 1
Ongoing
The best time to answer questions:
•How does the average cost per service compare to service fees and
reimbursement?
• How does the average cost per child served compare to alternative
programs such as residential treatment programs?
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Financial AnalysisGrantee Work Session
Goal: To identify human resource needs for the program component(s) addressed in the feasibility assessment - service provision only
Group: Grantee community
Time: 30 minutes
Report Back: approximately 5 minutes each on Wednesdaymorning
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CircleOf
Life