Future directions for consumer directed care · • New legislation mandates consumer directed care...

Future directions

for consumer

directed care

Nicki Doyle

Director, KPMG Australia

2 September 2015

• Consumer-directed care (CDC) is both a philosophy and an orientation to service delivery

where consumers, including care recipients and their carers, can choose and control the

services they get to the extent that they are capable and wish to do so.(1)

• The main objective of CDC is to offer consumers more choice and control than they would

have from traditional and agency directed programs. (2)

• Internationally, the emerging evidence base evidence suggests that CDC approaches lead

to: greater satisfaction; greater continuity of care; fewer unmet needs; more effective use

of scarce public resources (3)

• A review of CDC in community aged care services found:

Even after a short period of operation, CDC appeared to have a positive impact on

participants’ level of satisfaction with various aspects of their life. Participants reported

increased satisfaction with their ability to participate in social and community activities,

their ability to visit family and friends, the quality of their home life and close

relationships, and their health and wellbeing.(4)

(1) Aged and Community Services Australia, Guiding principles for consumer directed care. ACSA 2010

(2) Tilly, J. & Rees, G. Consumer Directed Care: A way to empower consumers? Alzheimer’s Australia, 2007, Paper 11

(3) Bornat & Leece, 2006; Glasby & Littlechild, 2009; Hasler et al., 1999;Social Care Institute for Excellence, 2005

(4) KPMG, Evaluation of the consumer directed care initiative, January 2012

DEFINING CONSUMER DIRECTED CARE

© 2015 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG

International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. The KPMG name, logo and “cutting through

complexity” are registered trademarks or trademarks of KPMG International.1



complexity” are registered trademarks or trademarks of KPMG International.

• New legislation mandates consumer directed care (CDC) in the provision of community

based care. It is anticipated to be extended to residential care in the future.

• In its early days, the focus on CDC is seeing older people make decisions on how to

spend the resources available to them for the care they require to support them in the

community.

• These reforms aim to empower individuals so that they can receive greater value and

more tailored services that are better able to meet their needs

• Consumers experiencing CDC are already having greater satisfaction rates and there is

a stronger focus on wellness and enablement than has previously been seen.

CDC shifts the balance from the aged care system being provider driven to

one where consumers are becoming more empowered and able to shape

market directions

AGED CARE REFORMS: CONSUMER DIRECTED CARE

2

• There will be more choice about the nature and the range of services that are available

• The market will change in response to new and emerging demands from consumers so that

a greater range of services will be available

• The shift in funding control to the individual will encourage the emergence of new

providers increasing competition

• The cost of services will be impacted by market forces – there will be greater pricing

sensitivity improving the cost effectiveness of service provision

• The current regulatory environment will be replaced by a ‘light touch approach’ and a

greater focus on safeguarding so as to maximise the capacity of the market and choice

• There will be greater flexibility and responsiveness from providers: a move away from 9

to 5 to one that is 24/7

• New models of delivery will emerge – new forms of employment, new workforce

requirements, new skills sets.

All of these changes are likely and have been evidenced in settings where

consumer directed approaches have been implemented and have time to mature




KEY ASSUMPTIONS FOR CDC NOW AND FOR 2017

3




Source: SachaChua.com

INITIAL REACTIONS

4

KPMG have worked extensively with government and aged care providers to prepare for the

implementation of consumer directed care (Part one):

• Formative evaluation of Consumer Directed Care (final report under consideration):

- Online survey of all home care providers

- Analysis of retrospective data to demonstrate how CDC consumers were using places

- In depth analysis in 10 aged care planning regions (25 home care providers and 13

ACATs) including interviews with consumers and carers/families

• Support to a range of organisations to: undertake strategic planning, develop new service

models, undertake financial modelling, and support change management, as a basis to re-

orient their organisation in readiness for CDC

• Round-table discussions with residential and home care industry leaders in Victoria and

NSW in March 2015

• Pilot of National Quality Care Indicators, commencing 4 May 2015

Common themes have emerged from across these engagements




EMERGING FINDINGS

5

Providers are at differing points

SPECTRUM OF CONSUMER DIRECTION




Agency Directed Person Centred Consumer Directed

Agencies Consumers Agencies Consumers Agencies Consumers

Agencies

allocate and

ration services

based on

assessment of

consumer need,

and make

decisions about

how to distribute

centrally-pooled

funds

Agreed financial targetsand time frames

Clear non-financial objectives

Both aligned with and part of overall strategic programme

Reflected in senior management targets and incentives

Providers use

individualised

assessment and

planning

approaches

and tailor the

delivery of care

and services

to consumer

preferences

Consumers have choice around the services they can access from a menu of available services, and may have some control over when services are delivered

Providers

facilitate the

planning and

delivery of a

tailored package

to meet a

consumer’s self-

determined

goals within an

individualised

budget.

Consumers have choice of care and services, control over how, when and by whom services are delivered, and control their individualised budgets

Lower HigherSpectrum of consumer-direction

• Undertaken detailed cost modelling to develop new fee structures

(i.e. understand cost of delivery and unit pricing)

• Understand risk, are comfortable with the unknown, and prepared

to “take a hit”

• Involvement of consumers in adapting model of care

• Implementing multi-tiered care coordination models

• Broadening service offerings to better support principles of CDC

• Developing partnerships, relationships and tools to support

provision of CDC

• Taken a whole of organisation approach, with strong CEO and

senior management commitment

• Established strong change management and training for Board and

Staff at all levels

• Refined marketing strategy to best position the organisation

• Adopted a continuous improvement process, recognising it takes

time to embed

1

2 Model of Care

Strategy

Financial Management3

PROVIDERS BEST ADAPTING TO CHANGE ARE / HAVE




• Struggling with changing administrative and case management costs –

with high variability in administration and case management pricing

structures evident

• Reluctance to price services to recoup costs while remaining competitive,

vs. charging what is “fair”

Strategy• Under-estimating the scale of transition and planning required

• Primarily focussed on the financial transparency aspects of CDC

• Thinking beyond program guidelines to move innovative models of care

• Limited focus on models of care including changing role of workforce

• Limited consideration of the continuum of CDC, and choices available to

consumers to engage with their care

• Appetite for innovation, however regulatory/market supply constraints that

have to be overcome

• Under-estimating training, education and change management

requirements

• Culture and practice change yet to be widely observed

• Workforce skill and confidence to “have conversation” with consumers

about purchasing

• Diversifying the workforce and considering differing models – IR constraints

ONGOING CHALLENGES INCLUDE




Model of care

Financial management

Workforce

1

2

3

4

8

ONGOING CHALLENGES INCLUDE




• Managing resourcing to demand is challenging

• Managing access to capital to deal with peaks and troughs in consumer

demand requires new skills and capability

Consumer engagement

• Consumer preferences for face-to-face information provision

• Early planning by consumers – to avoid pressured decision making in times

of crisis

• Information asymmetry regarding costs, purchasing power, and value for

money

• Variable views on purpose and establishment of contingency funds

• Choice is constrained by the market, and opportunities and information

imparted by providers

• It takes time for consumers to assert and exercise control and yet to be

given effect for some special needs groups

• Co-design/co-production is yet to emerge and limited progress in the use of

CDC to support participation, wellness, and re-enablement

Giving effect to CDC

Demand

5

6

7

9

• Redesigning jobs to embody

CDC

• Providing education, training and

support to staff to develop the new

skill sets

• Ensuring staff are fit for purpose for

CDC, and if not, taking necessary action

Consumer

Directed

Care

• Re-design business model to put CDC

framework at the fore

• Developing partnerships with other service

providers to facilitate and support CDC

• Implementing systems to track and

monitor the quality of CDC

being offered e.g. consumer

feedback pathways

• Provision of information and empowering

the consumer to make decisions

• Conducting market research to

determine the types of services

and products desired by your

local community and consumers

• Redesigning ‘back office’

functions to respond to CDC

• Identifying key financial risks and

challenges

• Establishing a risk management strategy to

mitigate the effects of unpredictable cash flow

• Maintaining a competitive advantage in a

client driven environment




IMPLEMENTING CDC – CONSIDERATIONS

10

Approach to implementing CDC has comprised:

• Consulted widely with consumers to identify what they wanted, what worked under

current model, and what could be improved

• Expended considerable time and effort on multiple iterations of training and

change management, at all levels of the organisation

• Experimented with service delivery model options: now have a mixed model with

more than 100 brokerage services as well as in house provision

• Undertook detailed market analysis to establish value proposition and ensure a

competitive edge

Large provider operating in both metropolitan and regional areas




CASE STUDY 1

11

Approach to implementing CDC has comprised:

• Fundamental changes to organisation to shift thinking and support change

• Iterative process to development of new model of care

• Reviewed job titles and descriptions, placing consumer at the centre of roles and

responsibilities, and re-badging case managers as “coaches”

• Developed tools to support behavioural change and take-up of options and

expend care packages: common bundles; case examples; sampler events

• Implemented a self-assessment model: material provided to consumer and

family/carer prior to first meeting with coach

Medium sized provider operating in a metropolitan area




CASE STUDY 2

12

Stand in the shoes of the consumer to understand their experience of

service provision… recognise that consumer expectations have no

boundaries

Stress test some of the core processes from a consumer focus to see how they

work and whether they are delivering as intended

Talk to current and potential consumers to learn about their needs and

wants now and into the future… start by looking outside in not inside out

It will be necessary to establish ways of gathering firsthand data from consumers to

inform an organisation’s focus, products and services.

Consider what internal and external data is being collected, and how it is being used.

Re-orientate services to have a greater focus on consumers, starting by

identifying who the consumers are…

Don’t assume they are a homogenous group – there may be need to segment

the customer base to better understand what different groups require1

2

3




THE PROCESS OF CHANGE – MATURING FOR 2017

13

Train workforce in what it means to be consumer focused: it is a different

way of working with different rules… it is about service and experience

Staff will need to reorient the way they work – if they can’t manage this

transition – their future in the organisation will need to assessed.

Focus all of the organisation on the consumer… the emphasis should be

on ‘consumer life time value’

This will require a behavioural, skills and cultural shift at all levels within the

organisation.

Establish a commitment to becoming a consumer led organisation by

leading from the top

Current ways of working will have to change – the leadership team should

refocus their organisation’s mission, priorities and values to reflect the

importance of the consumer.

4

5

6




THE PROCESS OF CHANGE - MATURING FOR 2017

14

Develop a ‘sense and respond’ capacity to meet changing needs and

expectations…

Expectations of consumers can change rapidly in a competitive market – there is need to

stay close and abreast of what current and future patients/consumers are thinking –

emerging trends need to be identified quickly so providers have an edge – and get new

offerings to the market quickly (it is now weeks not months for new products)

Redesign business processes so they better respond to consumers’

requirements and expectations…

Start with the basics – core processes should be co-designed to make sure that they

work as needed in responding to consumer needs – don’t underestimate the value of

digital strategies as ‘game changers’ for the organisation in the market place

Keep close to consumers to get regular feedback on how they are

tracking… are you delivering on your promise/their expectations?

Only consumers will be able to accurately assess how an organisation is faring

– regular soundings and engagement with the consumers experience will be

essential to provider success

7

8

9





15

Learn from other customer focused industries

Large customer focused industries including banking, insurance, and telcos are

undergoing transformation in their service delivery to be more customer

focused. Whilst differing sizes and target markets, there are many lessons

applicable to aged care industry

Technology is key to engage with consumers

Technology is evolving quickly and can be used to market services, engage with

current and future consumers and deliver services. Develop digital strategies to

engage, enhance and personalize consumer experience.10

12





16

July 1st was the starting line not the finishing line ……




“Success in the market should be driven by consumer interests

not the special interests of suppliers and providers…

[Vulnerable Australians, including special needs groups] too

should enjoy the benefits of choice, where this can reasonably

be exercised, and service providers that respond to their needs

and preferences [across the continuum of care]”

Ian Harper, Competition Policy Review




LOOKING AHEAD: OPPORTUNITIES FOR PROVIDERS

18

Thank you

Nicki Doyle

Director, KPMG Australia

Health, Ageing

and Human Services

T: +61 (03) 9838 4112

E: [email protected]

© 2015 KPMG, an Australian partnership and a member firm of the KPMG

network of independent member firms affiliated with KPMG International

Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

The KPMG name, logo and “cutting through complexity” are registered

trademarks or trademarks of KPMG International.

The KPMG name, logo and “cutting through complexity” are registered

trademarks or trademarks of KPMG International.

Future directions for consumer directed care · • New legislation mandates consumer directed care...

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