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

1. Today ’s
Agenda

2. >
Who is The Jewish Board?

3. > > Who is The Jewish Board?
What did we learn from the FEGS acquisition?
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4. > > > 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?
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5. > > > > 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
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6. The Jewish Board: Our Mission

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

8. The Jewish Board: Our Scope

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

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

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

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

13. The Jewish Board: Who We Serve Today

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

15. 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

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

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

18. Who was FEGS?

19. >
Federated Employment and Guidance Services

20. > > Federated Employment and Guidance Services
Largest Human Services Agency in New York State
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21. > > > Federated Employment and Guidance Services
Largest Human Services Agency in New York State
Vocational Training, Intellectual/Developmental Disabilities, Behavioral Health
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22. Chronology of a Disaster

23. 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/ / / /16/ /17/ /1/2015

24. What Went
Wrong?

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

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

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

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

29. 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

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
Human Services—A View From New York 30

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
Human Services—A View From New York 31

32. 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

33. Behavioral
Health Portfolio

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

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

36. 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

37. 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

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
Human Services—A View From New York 38

39. 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

40. The
Challenge

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

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

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

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

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

46. Financial
Impact

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

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

49. 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

50. New
Programs

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

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

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

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

55. Why We
Did It

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

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

58. 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

59. 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

60. FEGS Transition:
One Year Later

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

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

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

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

65. 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

66. Lessons Learned
More Expensive Than You Think

67. Lessons Learned
More Time-Consuming Than You Think

68. Lessons Learned
Acquisition Better Than a Merger, in Most Cases

69. Lessons Learned
Complex

70. Lessons Learned
Culture Important

71. Fee-For-Service In New York State

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

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

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
Human Services—A View From New York 74

75. 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

76. Being Successful
In a Fee-For-Service World

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

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

79. 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

80. 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

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
Human Services—A View From New York 81

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
Human Services—A View From New York 82

83. 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

84. Managed Care In New York State

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

86. 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

87. 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

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
Human Services—A View From New York 88

89. 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

90. Being Successful
In a Managed Care World

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

92. 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

93. 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

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
Human Services—A View From New York 94

95. 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

96. Final Thoughts

97. Final Thoughts
Open to Mergers, Alliances

98. Final Thoughts
Transition Funding

99. Questions?

100. 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