Human Services—A View From New York David Rivel Chief Executive Officer, The Jewish Board

Today ’s Agenda

> Who is The Jewish Board?

> > Who is The Jewish Board? What did we learn from the FEGS acquisition? >

> > > Who is The Jewish Board? What did we learn from the FEGS acquisition? What is it like to live in a fee-for-service world? > >

> > > > Who is The Jewish Board? What did we learn from the FEGS acquisition? What is it like to live in a fee-for-service world? Questions > > >

The Jewish Board: Our Mission

We help individuals... ...realize their potential and live as independently as possible, guided by the principles of hope, recovery and resilience.

The Jewish Board: Our Scope

An unmatched reach and impact in behavioral health, children’s services, trauma, and recovery... $250 million annual budget

An unmatched reach and impact in behavioral health, children’s services, trauma, and recovery... 3,000 employees

An unmatched reach and impact in behavioral health, children’s services, trauma, and recovery... 75 locations across NYC and Westchester

An unmatched reach and impact in behavioral health, children’s services, trauma, and recovery... Network of 50 mental health clinics

The Jewish Board: Who We Serve Today

Community Services Largest network of community mental health clinics Early childhood centers Care management Preventive services Jewish community services

Adult and Family Residential 1,500 beds through congregate residences in the community and scattered-site apartments in all five boroughs Four domestic violence shelters for survivors and their families

Children’s Residential Largest provider of children’s residential mental health services in New York State Residential facilities serving a total of 400 children

People With Intellectual/ Developmental Disabilities Network of residences with varying support levels and approaches Serves the Orthodox community

Who was FEGS?

> Federated Employment and Guidance Services

> > Federated Employment and Guidance Services   Largest Human Services Agency in New York State >

> > > Federated Employment and Guidance Services   Largest Human Services Agency in New York State Vocational Training, Intellectual/Developmental Disabilities, Behavioral Health > >

Chronology of a Disaster

CEO Announces Retirement—Successor Named $19 Million Deficit—CEO and Successor Leave Vocational and I/DD Process New York State Calls New York City Calls Programs Transfer 11/2014 12/2014 1/2015 1/16/2015 1/17/2015 6/1/2015

What Went Wrong?

What Went Wrong? $19 million deficit Human Services—A View From New York 25

What Went Wrong? $19 million deficit Unusually high overhead Human Services—A View From New York 26

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Human Services—A View From New York 27

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Insufficient cash reserves Human Services—A View From New York 28

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Insufficient cash reserves Significant cash needs (COPS, OMIG Audit) Human Services—A View From New York 29

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Insufficient cash reserves Significant cash needs (COPS, OMIG Audit) Antiquated or non-existent financial and IT systems Human Services—A View From New York 30

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Insufficient cash reserves Significant cash needs (COPS, OMIG Audit) Antiquated or non-existent financial and IT systems Focus on growth, not bottom-line stability Human Services—A View From New York 31

What Went Wrong? $19 million deficit Unusually high overhead Insufficient endowment Insufficient cash reserves Significant cash needs (COPS, OMIG Audit) Antiquated or non-existent financial and IT systems Focus on growth, not bottom-line stability No culture of transparency Human Services—A View From New York 32

Behavioral Health Portfolio

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing Human Services—A View From New York 34

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing New York City and Long Island Human Services—A View From New York 35

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing New York City and Long Island $75 million Human Services—A View From New York 36

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing New York City and Long Island $75 million 800 staff Human Services—A View From New York 37

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing New York City and Long Island $75 million 800 staff 25 facilities and 400 scattered-site beds Human Services—A View From New York 38

Behavioral Health Portfolio Clinics, PROS, care management, supportive housing New York City and Long Island $75 million 800 staff 25 facilities and 400 scattered-site beds 9,000 clients Human Services—A View From New York 39

The Challenge

The Challenge People Human Services—A View From New York 41

The Challenge People Vacancies Human Services—A View From New York 42

The Challenge People Vacancies Information Technology Human Services—A View From New York 43

The Challenge People Vacancies Information Technology Real Estate Human Services—A View From New York 44

The Challenge People Vacancies Information Technology Real Estate Financial Human Services—A View From New York 45

Financial Impact

Financial Impact Cash flow ($200,000 * 5 months) Human Services—A View From New York 47

Financial Impact Cash flow ($200,000 * 5 months) Year 1 revenue loss ($75 million * 12%) Human Services—A View From New York 48

Financial Impact Cash flow ($200,000 * 5 months) Year 1 revenue loss ($75 million * 12%) Billing and accounting staff Human Services—A View From New York 49

New Programs

New Programs Three mental health clinics Human Services—A View From New York 51

New Programs Three mental health clinics Two PROS programs Human Services—A View From New York 52

New Programs Three mental health clinics Two PROS programs 830 supportive housing beds Human Services—A View From New York 53

New Programs Three mental health clinics Two PROS programs 830 supportive housing beds Care management services Human Services—A View From New York 54

Why We Did It

Why We Did It Size matters Human Services—A View From New York 56

Why We Did It Size matters Continuum of care for clients Human Services—A View From New York 57

Why We Did It Size matters Continuum of care for clients Leverage with city, state and UJA-Federation Human Services—A View From New York 58

Why We Did It Size matters Continuum of care for clients Leverage with city, state and UJA-Federation Learn something new Human Services—A View From New York 59

FEGS Transition: One Year Later

FEGS Transition: One Year Later 93% clients served Human Services—A View From New York 61

FEGS Transition: One Year Later 93% clients served Consolidated clinic Human Services—A View From New York 62

FEGS Transition: One Year Later 93% clients served Consolidated clinic Added senior management Human Services—A View From New York 63

FEGS Transition: One Year Later 93% clients served Consolidated clinic Added senior management Consolidated operations, branding Human Services—A View From New York 64

FEGS Transition: One Year Later 93% clients served Consolidated clinic Added senior management Consolidated operations, branding Staff culture Human Services—A View From New York 65

Lessons Learned More Expensive Than You Think

Lessons Learned More Time-Consuming Than You Think

Lessons Learned Acquisition Better Than a Merger, in Most Cases

Lessons Learned Complex

Lessons Learned Culture Important

Fee-For-Service In New York State

Fee-For-Service In New York State Covered clinics and PROS Human Services—A View From New York 72

Fee-For-Service In New York State Covered clinics and PROS Adults until October 1, 2015 Human Services—A View From New York 73

Fee-For-Service In New York State Covered clinics and PROS Adults until October 1, 2015 Provide service, then submit bill to state or managed care plans Human Services—A View From New York 74

Fee-For-Service In New York State Covered clinics and PROS Adults until October 1, 2015 Provide service, then submit bill to state or managed care plans State paid within a few weeks, with minimal denials Human Services—A View From New York 75

Being Successful In a Fee-For-Service World

Being Successful In a Fee-For-Service World Premium on information technology and billing Human Services—A View From New York 77

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Human Services—A View From New York 78

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Inclusionary budgeting process, productivity standards Human Services—A View From New York 79

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Inclusionary budgeting process, productivity standards Staff training Human Services—A View From New York 80

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Inclusionary budgeting process, productivity standards Staff training Customer service Human Services—A View From New York 81

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Inclusionary budgeting process, productivity standards Staff training Customer service Cash flow Human Services—A View From New York 82

Being Successful In a Fee-For-Service World Premium on information technology and billing Organizational accountability Inclusionary budgeting process, productivity standards Staff training Customer service Cash flow Transition funds Human Services—A View From New York 83

Managed Care In New York State

Managed Care In New York State Started for adults October 1, 2015 Human Services—A View From New York 85

Managed Care In New York State Started for adults October 1, 2015 Interim step of health homes Human Services—A View From New York 86

Managed Care In New York State Started for adults October 1, 2015 Interim step of health homes Children scheduled July, 2017 Human Services—A View From New York 87

Managed Care In New York State Started for adults October 1, 2015 Interim step of health homes Children scheduled July, 2017 Provide service, then submit bill to managed care plans Human Services—A View From New York 88

Managed Care In New York State Started for adults October 1, 2015 Interim step of health homes Children scheduled July, 2017 Provide service, then submit bill to managed care plans Managed care pays in four weeks, with higher denial rates Human Services—A View From New York 89

Being Successful In a Managed Care World

Being Successful In a Managed Care World Tremendous premium on IT and billing Human Services—A View From New York 91

Being Successful In a Managed Care World Tremendous premium on IT and billing Additional staff/time for credentialing, eligibility Human Services—A View From New York 92

Being Successful In a Managed Care World Tremendous premium on IT and billing Additional staff/time for credentialing, eligibility Greater cash reserves Human Services—A View From New York 93

Being Successful In a Managed Care World Tremendous premium on IT and billing Additional staff/time for credentialing, eligibility Greater cash reserves Focus on client outcomes Human Services—A View From New York 94

Being Successful In a Managed Care World Tremendous premium on IT and billing Additional staff/time for credentialing, eligibility Greater cash reserves Focus on client outcomes Transition funding Human Services—A View From New York 95

Final Thoughts

Final Thoughts Open to Mergers, Alliances

Final Thoughts Transition Funding

Questions?

The Jewish Board of Family and Children’s Services strengthens families and communities throughout New York City by helping individuals of all backgrounds realize their potential and live as independently as possible. For more information, visit JewishBoard.org