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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. 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)

11. 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.