Organisational Readiness for Personal Budgets in Australia

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NDIS & LEARNING FROM THE UK
EXPERIENCE OF
PERSONALISATION:
A PROVIDER PERSPECTIVE
Peter Gianfrancesco
[email protected]
www.galeruconsultancy.com
OVERVIEW
 About
me
 The UK & ‘Personalisation’
 How we prepared
 What we did
 Insights arising from our experience
 Lessons for NDIS providers
 My emphasis is on the long term view of
market engagement
 A provider emphasis and focus
THE INTERNATIONAL PICTURE
 Providing
care through a model of
regulated brokerage and personal
purchasing is not new:
 Examples can be found in ENGLAND,
USA, BELGIUM, SCOTLAND and may or
may not be limited to disability care. The
private insurance and/or managed care
model also fits into this context
 The best current comparator is the UK
Personalisation Model as it has a
uniquely disability focus and is national
in its scope
IN ALL OF THE MODELS, IT IS THE
PROVIDER RESPONSE AND NOT THE
REGULATION THAT WILL DETERMINE THE
SUCCESS OF THE MODEL
THE GREATEST RISK TO ALL MODELS IS IF
PROVIDERS WITHDRAW FROM OR FAIL IN
SUPPLY OR IF THE PROVIDER MARKET
CHANGES TOO QUICKLY
THE EVOLUTION OF A MODEL
Regulator
Provider
Consumer
Phase 1:
Implementation
Helpful
Stimulates Provider Market
Supports existing providers
Optimal inclusiveness
Optimal generosity re Tariff
Separation of Funding
Anxious
Short Term Focus
Collaborative
Re-engineers existing services
Products emerge from existing capability
Workforce modification
Confused
Anxious
Wants more of the same
Chooses familiar supplier
Phase 2:
Embedding
Helpful
Less Market Involvement
Support for struggling providers
Integration of Funding
Less inclusive
Sees a way to make it work
Loss of other funding sources
Starts to subsidise care
More competition
Emerging product innovation
New Partnerships
Emerging new providers
Emerging new workforce
Reassured
Starts to exercise influence
Provider swapping
Still choosing traditional
care
Phase 3:
Market Maturation
Less Helpful
Market Driven
Tariff adjustment as budgetary
control
Model has shaped provider culture
Increasingly innovative products
Competitive Market
Non MH providers
Providers compete on added value
New workforce
Discerning
More recovery orientated
Expects more
UK EXPERIENCE AS A PROVIDER
PERSONALISATION – THE ENGLISH
EXPERIENCE
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A national policy approach with strong political support
Implementation devolved to 250+ UnitaryAuthorities
Introduced on a national scale 5 years ago
Tariffs and products (regulation) determined locally (with some
exceptions) or by provider
Consumers ‘hold’ the budget (reality is different) or get a
‘notional’ budget
Brilliant when it is allowed to be used creatively (the Lathe
example)
It has not worked that well in mental health
Being used to drive price down and eligibility up
Implemented at a time of great financial austerity and loss of
contracted care
UK EXPERIENCE AS A PROVIDER
WHAT WE KNOW IS THAT THE SMALLER
PROVIDERS DEMONSTRATED FASTER
MARKET ENTRY AND GREATER INNOVATION
AND RESPONSIVENESS BUT THE LARGER
PROVIDERS OUTLASTED THEM IN THE
MARKET BECAUSE OF THEIR
INFRASTRUCTURE, CAPACITY AND LOWER
UNIT PRICE
-
IN THIS SCENARIO EVERYONE LOSES
BECAUSE LOCALISM AND INNOVATION
DISAPPEAR
DESPITE THE CHAOS PERCIEVED
BY PROVIDERS, MANY
CUSTOMERS REPORTED:
- BETTER SATISFACTION
- BETTER ENGAGEMENT
- IMPROVED QUALITY OF LIFE
WHAT WOULD HAVE HELPED
CLEAR NATIONAL TARRIFFS
 SUPPORT FOR PROVIDERS
 SUPPORT FOR CUSTOMERS
 INDEPENDENT CARE PLANNING
 MORE GRADUAL REDUCTION IN CONTRACTS
 BETTER PLANNING AND LESS CHAOS
 MORE STRATEGIC AND LESS REACTIVE SUPPLY
 TIME TO UNDERSTAND WHAT WE WERE DOING

WE SURVIVED AND
THRIVED SO WHAT DID
WE DO?
WHY US?
THE 5 C’S
Cultural
confidence and
readiness
Customer service and focus
Capability was understood
Capacity was identified
Costs were known (eventually!)
CULTURAL CONFIDENCE &
READINESS
Who
are we here for?
Is the whole organisation on
board?
What are the cultural barriers?
What values must we preserve?
What can we move on from?
CUSTOMER SERVICE & FOCUS
Who
are our customers?
How do we provide GREAT
customer experience?
What do our customers tell us
about our effort?
What more can we do to add
value?
CAPABILITY
What
is it we ACTUALLY do?
What is it that makes a
difference?
What else are we good at?
Who else might benefit?
How can we develop to match
REAL customer needs?
CAPACITY
How
much can we provide?
How productive do we need to
be?
How can we be more efficient?
What new partnerships
emerge?
What are the markets we are
seeking to appeal to?
COSTS
How
much does it cost us to
supply?
Can we supply within the market
tolerances?
Do we ‘loss lead’?
Do we subsidise care?
What assumptions do we make
about our supply model?
What are the cost pressures we
KEY QUESTIONS WE CONTINUALLY
ASKED….
 Why
are we considering entering this market?
 What are our ambitions as a provider?
 Do we have a duty to supply?
 What happens if we choose not to?
 How does it fit with our organisational purpose?
 Can we afford to do it?
 Do our values limit our market?
 What hidden capability is there?
 What would we do with the profit?
 How would we manage revenue loss?
WHAT WE CAME UP
WITH…..
IN NORFOLK, ENGLAND…
Population of 1 million people
 In any given year:*
 120,000 people experience a mental health
problem requiring help
 65,000 see a GP ONLY and/or use public or
NGO mental health services
 55,000 people need help, get nothing or have no
eligibility but many have a capacity and desire to
purchase
 What are the market opportunities here?

DEVELOPING A PRODUCT RANGE
 Dis-aggregating
current supply into products
 Assessing current product range against the
market opportunity
 Testing the offer and refining it
 Identify new product opportunities
 Assess the supply issues and challenges
 Defining the story associated with the product
offer
 Develop marketing, perhaps JUST for the
product
 Launch and supply
LIFEHELP
Part of Norwich Mind (A$5M)
 New brand and product range developed
 Offered universally
 600+ customers first two years
 25% clients hold a personal budgets
 40% have care purchased for them (notional budget)
 25% self fund
 10% free
 Profit is used to provide free care to 10% of the clients
who would otherwise receive nothing
 Growth is projected at 20% pa
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UNIVERSALITY
The 2011 Australian Census indicated that the incidence
of a mental health problem could be as high as 1 in 3
 Why would we not want to include the whole population
as potential customers for our purchasable care
products?
 The larger the market, the larger the potential revenue,
the more mixed a customer base is, the less stigma is
attributed to any customer
 It IS possible to broaden your market and retain (and
enhance) your offer to your core beneficiaries
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ADVANTAGES OF UNIVERSAL SUPPLY
Larger Market
 Less Stigma
 Less Regulation
 Greater Public Benefit & Impact & Reach
 Customer Expectations Higher
 Better Organisational Profile
 Fewer people excluded from available care
 Larger profit, greater potential to subsidise

WE SUCCEEDED IN SUPPLYING
BUT, MORE IMPORTANTLY, WE
BECAME A MUCH BETTER
ORGANISATION ALONG THE
WAY
LIFEHELP – MAIN LESSONS
Staff are much more productive
 Staff are more flexible and multi-skilled
 Staff have become innovators and promoters
 The workforce is more diverse and more casualised
 Volume matters as does a broad customer base
 Mixed economy of purchasers is critical
 MAXIMISING market size is key
 Financial planning and management is very complex
 Client retention is good
 Clients say the service works and they welcome the
choice
 Staff are satisfied
 The number of NGOs providing has halved.
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10 INSIGHTS THAT ARE RELEVANT HERE
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Our offer is 90% RELATIONAL and 10% technical
There is very little product differentiation on the provider
side in mental health (it’s the people and their lives that
represent difference)
Market the relational promise (the employee profile and
story)
Celebrate and communicate success through stories –
real people, real photos, real narrative
Keep your values and history at the heart of your
message
Continually ask what makes us different
Emphasise localism and cultural relevance
Add delight and value at every opportunity
Provide GREAT customer service
OUR EVIDENCE ON CUSTOMER PRIORITIES
System defaulted to traditional suppliers at start up
(seems to be same in some NDIS launch sites)
 Peer support over-rated by providers (not a factor in
initial purchase but a factor in re-purchase)
 Customers value:
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Responsiveness
Great customer service
Familiarity / low risk / continuity
Help that works (from the customers perspective)
Flexibility
Value
Pleasant surprises
People that they like and who like them
SUPPLY CHALLENGES – WHAT WE HAVE
LEARNED IN THE UK
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Our workforce had to increase productivity by 20%
‘Standing’ liability needs to be minimised
Customers demand different qualities to those that organisations often hold
dear….eg:
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A new paradigm of staff deployment
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Less qualified but experienced in life
Flexible and responsive
Relationally competent
Move away from traditional structural model (teams)
Multi-skilled staff covering full range of client needs are more efficient
Big increase in infrastructure demands
Requires a different understanding of outcome
Workforce has become more casual and/or self employed and generally
operating at a lower level of qualification but with new sought after attributes
Organisational complexity increases
Creativity needed to continually add value
Greater reliance on technology to support distant delivery
Very hard to supply remotely unless additional investment (by provider,
regulator or co-purchasing)
MEASURING SUCCESS
Rewarding staff who are BOTH effective and productive –
how would we do that?
 The Loved One Test
 Market Capture
 Customer Loyalty (a good thing?)
 Health and other client outcomes (QOL, Goals etc)
 Testing value for money
 Financial monitoring – efficiency monitoring
 Practice governance
 Public ratings (Patient Opinion, Whitecoat)
 Matching the promise to reality - stories
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SUMMARY OF KEY POINTS
It’s bloody hard!
 NDIS offers great opportunity
 The implementation approach seems sound
 Providers need to think differently
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In terms of who they supply to
 In terms of brand and marketing
 In terms of supply and productivity
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Early to market is important
 Competition is inevitable (particularly in urban settings)
 Funding will be more complex and chaotic
 Customers will benefit if suppliers adapt
 Preparating for supply will improve your organisation
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FURTHER INFORMATION

www.norwichmind.org.uk

www.personalhealthbudgets.england.nhs.uk

www.mind.org.uk

www.scie.org.uk/topic/keyissues/personalisation

www.thinklocalactpersonal.org.uk

www.whitecoat.com.au

www.patientopinion.org.uk
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