Integrating Family Services Payment Reform Implementation Summit Lessons Learned Payment Reform Implementation Summit November 30th, 2018

Integrating Family Services What was the Purpose? IFS was a proposed realignment of the child and family system of care. IFS was designed to bring together the various elements of child and family services into one integrated system.

Integrating Family Services Historical Perspective Children’s Services used to reside across 6 Departments and 11 Divisions within the Agency of Human Services. Each of these “stand alone silos” was developed independently This lack of coordination resulted in a system of care that was fragmented, inefficient, and difficult to navigate.

Before IFS Funding Structure Family Services Division Dept of Mental Health DCF Matched Waivers Individual Services Budgets Intensive Family Based Services Dept of Aging & Ind Living Fee-for-Service Medicaid DMH Matched Waivers Respite Voc Rehab Div DAIL Children’s Waivers Bridges Flex Family Funds Child Development Division Children’s Integrated Services CUPS JOBS Program Dept of Health Substance Abuse

Before IFS Oversight Structure Family Services Division Dept of Mental Health Dept of Aging & Ind Living Billing Systems Data Reporting Documentation Requirements Outcome Requirements Audits Voc Rehab Div Child Development Division Dept of Health

IFS Structure Agency of Human Services Aggregated single funding stream Standardized eligibility requirements Standardized guidelines and operating procedures Agency of Human Services Standardized Billing structure Data Reporting Documentation Requirements Outcome Requirements Oversight and Auditing Structures

Lessons Learned Financial Maintain the ability to manage at the team level while still allowing revenue/expense data to roll up into a common bundle Gauge community needs as compared to targeted / projected need (numbers served). Rates and caps set based on historical averages. Need to be able to reassess based on changing needs.

Lessons Learned Clinical Ability to assess and monitor clinical change over time (Individual, program, and system perspective) Ability to assess community need and adjust clinical service delivery mix to meet that need. Drive to develop preventative programming was difficult given overall funding caps.

Lessons Learned Internal Employees Training to shift from “hours / week” thinking towards “achievement of clinical goals” (in as few hours as possible) Team Dashboards to visually set targets and highlight progress Understanding of some teams will “make money” and others will “loose money”. Manage to targets, not to an even bottom line

Lessons Learned Leadership / Decision Making Clear expectations about the authority to oversee operational details of the bundle (State, local, agency) Data to manage progress towards monthly and annual targets (Team Level and Bundle Level)

Lessons Learned Community Roll Out Training to shift from “hours / week” towards a “achievement of clinical goals” (in as few hours as possible) “Flexibility” allowed for within the bundle created a sense of we can do more. Caused tension within the community as the CAP is finite.