1. Company LOGO Successful Strategies, Innovative Partnerships, Futures Planning Alaska AT Reuse Summit 31 July 2012 Anchorage, Alaska Carolyn Phillips Pass It On Center www.passitoncenter.org

2. Company LOGO Successful Strategies, Innovative Partnerships, Futures Planning We are Glad You are Here.

3. Company LOGO “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." -- Margaret Mead

4. Company LOGO Meeting Goals Why We Are Here: Learn about national and state reuse initiatives, best practices and resources. Identify ideas to increase collaboration between Alaska’s AT Act Program, the Pass It On Center and reuse programs for delivering refurbished assistive technology devices and services to meet the needs of Washington programs and consumers. Develop achievable action steps to continue this conversation.

5. Company LOGO Tuesday, July 31 8:00 Registration, Networking and Breakfast 8:30 Welcome, Overview, Expectations for the Summit Speakers: Mystie Rail, Carolyn Phillips, Director, Pass It On Center 8:45 The National AT Reuse Scene & Your Pass It On Center We will define AT Reuse, look at various program models, examine national AT Reuse data and explore helpful resources and tools for AT Reuse. Presenter: Carolyn Phillips 10:30 Break 10:45 Peer-to-Peer Sharing: Exploring AT Reuse Programs – Overview, Key Elements & Issues We will hear directly from AT Reuse Summit Participants about their AT Reuse Programs. Participants will share their experiences with AT Reuse, populations served, service areas, what works & lessons they have learned along the way. Moderator: Carolyn Phillips 12:00 Networking Lunch 1:00 What does Alaska Need? Alaska AT Reuse: Overview, Key Elements & Issues We will have a facilitated discussion on exploring what AT and Reused AT Alaskans need and how we can work together to provide these services. We will hear directly from individuals about their vision for this concept, including: sustainability, data collection, logistics, liability issues, communication concepts, marketing and potential strategic partnerships. Facilitator: Carolyn Phillips 2:45 Break 3:00 Continue Defining: What does Alaska Need? Alaska AT Reuse: Overview, Key Elements & Issues 4:45 Wrap Up and Closing Thoughts 5:00 Adjourn

6. Company LOGO Wednesday, August 1 8:00 Networking and Breakfast 8:30 Welcome, Recap & Expectations for today’s session 8:45 Exploring Alaska AT Reuse Strategies and Solutions: We will revisit yesterday's discussion points and build on the concepts to find solutions to support the AT Reuse needs of Alaskans. We will have a facilitated discussion on concrete strategies and solutions for AT Reuse in the areas of sustainability, data collection, logistics, liability issues, communication concepts, marketing and potential strategic partnerships. Facilitator: Carolyn Phillips 10:00 Break 10:15 Planning for the Future: Identifying Next Steps and Recommendations During this session, attendees will discuss directions for the future, challenges and opportunities. We will also discuss strategic Partners, who we need at the table, and next steps for success. Facilitators: Carolyn Phillips & Mystie Rail 12:30 Working Lunch – Strategic Future Directions - Recommendations & Discussions Facilitators: Carolyn Phillips 1:30 Wrap-Up Summit; Questions and Comments; Evaluation of the Workshop Facilitator: Mystie Rail & Carolyn Phillips 2:00 Adjourn Safe Travels Home

7. Company LOGO Purpose of the Summit: Meeting Goals 1. Identify points of collaboration to build an intrastate system for delivering reused assistive technology devices and services to meet the needs of people with disabilities in Alaska. 2. Identify common barriers to AT Reuse (transportation, marketing, liability, space, and communication) and collectively explore solutions to these barriers. 3. Develop achievable action steps (short-term; long term) for participants and other key entities. 4. Develop a sustainable national network to continue implementation of efforts to address the AT needs of people with functional needs in disaster preparedness, response, recovery, and mitigation.

8. Company LOGO MITIGATION PREPARATION RESPONSE RECOVERY Fall 2012 Preparedness Conference - Alaska Summit on Emergency Management and AT Reuse Anchorage, Alaska October 2-4, 2012 Successful Strategies, Innovative Partnerships, Futures Planning

9. Company LOGO Guiding Principles  We – Collectively – are Brilliant & Can find an Innovative Path and Create Brighter Futures  We must Think, Live, Work and Act from a place of Abundance – We Have enough time, money, resources…  AT Reuse has a Positive Impact in the Lives of people with disAbilities  We Must Focus on Abilities and Promote Informed Choice!  YOU have the Power to make the Difference!  Change vs. Progress (Bob Phillips)  Recognizing Amazing Opportunities - TY

10. Company LOGO Guiding Principles  This is the Right Time, the Right Place and You are the Right People to Create Positive Change  We need You. You are the pioneers.  This meeting is designed to be an Exchange of Ideas, a Dialogue and a Conversation that continues to Grow after we leave here.  If you build it…

11. Company LOGO Guiding Principles To be Successful –  We need to move from Transactional Relationships to developing Transformational Relationships.  We need to moved from Independent to Intradependent.

12. Company LOGO Progress Diagram Present/Exchange Discuss/Explore Plan/Act What we will do today and in the Future… We will share information, ideas and experiences in the key areas AT Reuse We will discuss & explore the possibilities - Who, What, When, Where & How We will, collectively, start developing an effective, inclusive & responsive Action Plan

13. Company LOGO Marketing Diagram TEXT TET TEXT  Pass It On Center: Who we are, what we do  Knowledge Base  Indicators of Quality for AT Reuse  State Summits to Grow AT Reuse Collaborations  National AT Reuse & CIL – @ ParaQuad in St. Louis October 2012  Webinars….and More! We are Here to Help!

14. Company LOGO Why Reuse AT?  Assistive Technology (AT) reutilization is a concept that was born out of need.  From local grassroots efforts, it has grown to become a nationally recognized response to providing AT to those people who would otherwise “go without”.

15. Company LOGO What is Assistive Technology (AT)?  ASSISTIVE TECHNOLOGY DEVICE - The term `assistive technology device' means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.  This includes, but is broader than, durable medical equipment (DME).

16. Company LOGO Reauthorization of the Assistive Technology Act New Freedom Initiative Interest from OSERS’ leadership Hurricane Katrina Was born of ‘the perfect storm’

17. Company LOGO  The Pass It On Center is creating national and state resources to foster the appropriate reuse of AT so that people with disabilities can get the affordable AT they need in order to live, learn, work and play more independently. www.passitoncenter.org

18. Company LOGO  We are developing an emergency response system based on an existing network of Assistive Technology (AT) Centers across the United States. www.passitoncenter.org

19. Company LOGO The Pass It On Center is Actively  Providing Technical Assistance about AT Reuse  Identifying and Educating about Successful Practices & Indicators of Quality for AT Reuse (IQ-ATR)  Establishing and Coordinating a National Collaborative  Including a coordinated plan to respond to natural disasters www.passitoncenter.org

20. Company LOGO Goal of Reuse Initiative To increase the availability of assistive technology (AT) through promoting and supporting the appropriate, effective reuse of AT devices at the state and local level.

21. Company LOGO What Is ‘Appropriate’ Reuse?  Appropriate reuse: Is safe for consumers and reusers Is safe for consumers and reusers Results in positive outcomes for consumers Results in positive outcomes for consumers Is environmentally friendly Is environmentally friendly

22. Company LOGO What Is ‘Effective’ Reuse?  Effective reuse: Meets the needs of consumers Meets the needs of consumers Produces cost savings Produces cost savings Is sustainable Is sustainable Has a positive or neutral effect on the AT field Has a positive or neutral effect on the AT field

23.  AT Reuse activities include:  Device exchange  Device loan  Reassignment  Refurbishment  Remanufacturing (NO, NO, NO!)  Recycling www.passitoncenter.org

24.  Device exchange: Matching donors to users without intervention (e.g., “classifieds” and on- line auctions)  Device loan: Providing a device on loan for some period of time or indefinitely, usually to help user make informed choice or to provide interim solution Program web sites and E-Bay, Craig’s List, Newspaper ads, et al. www.passitoncenter.org

25.  Reassignment: Making donated devices available to new users  Refurbishment: Repairing/restoring donated devices to working order www.passitoncenter.org

26.  Remanufacturing – making changes to donated items that alter original manufacturer’s specifications or function  NOT RECOMMENDED!  Recycling – breaking down unusable devices into spare parts or disposing of in an environmentally appropriate manner www.passitoncenter.org

27.  What kinds of reuse programs exist?  Some accept and refurbish durable medical equipment.  Some accept and refurbish computers and other digital devices.  Some are dedicated to sharing AT in school settings.  Some receive donated medical supplies for redistribution. www.passitoncenter.org

28. Company LOGO AT Programs funded under the AT Act AT Programs funded under the AT Act  56 Statewide AT Programs (one per state and territory).  The majority of states/territories receive awards of less than $400,000.  AT reuse is one of 7 activities that these programs carry out in a statewide, comprehensive manner.

29. Company LOGO Highlights of Year 5 in Review Expanding Reuse through Specific Events  State Summits  ATIA Pre-Conference and Reuse Strand  Agrability National Conference  National Hurricane Conference  FEMA Region IV & III Conference

30. Company LOGO State Summits held in several states: California, Arizona, and North Dakota Highlights of Year 5 in Review Expanding Reuse through Specific Events

31. Company LOGO North Dakota AT Reuse Summit Highlights of Year 5 in Review  Diverse statewide planning group for web network and distribution program across the state  Started small & Grew!  Solid representation of agencies & organizations  “Hero” site visit  Developed a Plan Expanding Reuse through Specific Events

32. Company LOGO California Reuse Summit Highlights of Year 5 in Review Expanding Reuse through Specific Events  Diverse & comprehensive statewide planning group for exploring developing a New DME reuse program.  Good mix of agencies & organizations - ILCs  Explored various Reuse Models  Developed the outline for a RFP & a Policy Group

33. Company LOGO Arizona Reuse Summit Highlights of Year 5 in Review Expanding Reuse through Specific Events Identifying the potential partners and laying a foundation to develop an AT Reuse network Small, but solid group “Loan Closets” In-depth Discussion of Policies & Procedures Network Growing!

34. Company LOGO ATIA Pre-Conference and Reuse Strand  ATIA Chicago 2011 & Orlando 2012  Pre-Conference on How to Start to Start or Improve an AT Reuse Program  7 session strand on AT Reuse  Booth in exhibit hall Highlights of Year 5 in Review Expanding Reuse through Specific Events

35. Company LOGO AgrAbility National Conference  Conducted a Workshop & Exhibited  Introduced the definitions of Reuse, Discussed IQ-ATR, Policies & Procedures and the national network  Made strong connections  Excited about future collaboration Highlights of Year 5 in Review Expanding Reuse through Specific Events

36. Learn about reuse. Pass It On Center offers resources to promote new programs and to help existing ones improve.  Indicators of Quality (online tool)  Knowledge Base  Free webinars  Reuse Locations Database  Find AT  NEED AT

37. Company LOGO The Pass It On Center is Here to Help You! www.passitoncenter.org

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44. Company LOGO Guiding Principles

45. Company LOGO www.passitoncenter.org The Pass It On Center is Here to Help You! Check out Our Webinars!

46. Company LOGO www.passitoncenter.org

47. Company LOGO  Assistive technology reuse provides an opportunity for those in need to access assistive technology items no longer needed by others.  NEED AT is an online database where persons may list assistive technology items for sale, donation, or things they need.  NEED AT is the place for individuals to either advertise used equipment for sale, donation, or express a need for a specific item(s). www.passitoncenter.org www.need-at.org COMING SOON!

48. Company LOGO www.passitoncenter.org

49. Company LOGO www.passitoncenter.org

50. The Vision is to Erase State Lines

51. Company LOGO  Social Media  PIOC blogs on general topics and Emergency Management  Facebook  YouTube (Video Project Update)  Newsletter of PIOC activities Highlights of Year 5 in Review Expanding Modes of Communication

52. Company LOGO PIOC Blogs  AT Reuse http://thepassitoncenter.blogspot.com/  Emergency Management http://pioc-emergency.blogspot.com/ Highlights of Year 5 in Review Expanding Modes of Communication

53. Company LOGO www.passitoncenter.org Blog with Us!

54. Company LOGO

55. Company LOGO PIOC YouTube Channel http://www.youtube.com/PassItOnCenter  Channel Views - 996  Total Upload Views - 2,789  These videos showcase sanitization models, warehouse tours, success stories, and much more.  We’re still adding more Videos! Highlights of Year 5 in Review Expanding Modes of Communication

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57. Company LOGO PIOC Facebook  230 Likes  Of those, 89 are active users each month on average  Countries  226 - United States  3 – Canada  1 - Italy Highlights of Year 5 in Review Expanding Modes of Communication

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60. Company LOGO  ArgAbility Training  ATIA Chicago 2011  New EM Consultant  PIOC Consultant Honored  EM and Reuse Summit  Reuse Summits  Complex Rehab Project

61. Company LOGO  Reuse Locations Database  New NTF Members  Annual NTF Meeting  ATIA Orlando 2012  EM and Reuse Summit  Great Shakedown  AT Reuse in Schools

62. Company LOGO  Web Enhancements and Usage Report  Webinars  Development of an AT Reuse Business Plan Template Training and Technical Assistance

63. Company LOGO Usage Report – Definitions Usage Report – Definitions  A 'Session' is defined as a series of clicks on your site by an individual visitor during a specific period of time.  A 'Pageview' is defined as a request from a visitor's browser for a displayable web page, generally an HTML file.  A 'Hit' is simply a successful request to your web server from a visitor's browser for any type of file, whether an image, HTML page, an MP3 file, or any other type.

64. Company LOGO Usage Report Usage Report www.passitoncenter.orgwww.passitoncenter.org - 04/01/09 to 03/31/10 www.passitoncenter.org Total Sessions 146,197.00 Total Pageviews 426,160.00 Total Hits 893,210.00 Average Sessions Per Day 400.54 Average Pageviews Per Day 1,167.56 Average Hits Per Day 2,447.15 Average Length of Session 00:09:54

65. Company LOGO Usage Report Usage Report www.passitoncenter.orgwww.passitoncenter.org - 04/01/11 to 03/31/12 www.passitoncenter.org Total Sessions 233,544.00 Total Pageviews 530,818.00 Total Hits 1,139,910.00 Average Sessions Per Day 365.87 Average Pageviews Per Day 1,454.30 Average Hits Per Day 3,123.04 Average Length of Session 00:12:05

66. Company LOGO Webinars  Webinars have been a useful tool for sharing information about the issues and solutions in the area of reuse.  The Pass It On Center has facilitated 32 webinars over five years and this year conducted 6 Webinars.  We have had from 15 to 150 participants  Offering CEU and CRC credits has helped increase attendance.

67. Company LOGO  How to Develop a Continuity of Operations Plan  Going Green in Schools: an Effective AT Reuse Experience  Making the Business Case for AT Reuse  People First Language: Words with Dignity for People with disAbilities  Emergency Preparedness: Strategies and Resources  Lessons Learned from the 12 Demonstration Projects  How to Build a Statewide Reuse Network: Georgia  Expanding Reuse Through Public/Private Partnerships  Creating Your Own Sources of Revenue

68. Company LOGO  We Need Your Input on Proposed Webinars For Year 7!

69. Company LOGO In five years…  As of May 9, 2012, the number of states and programs listed had increased to 214. Of these:  116 conduct reassignment activities  87 conduct refurbishment activities  44 conduct equipment exchange activities  60 conduct reassignment & refurbishment  18 conduct reassignment & exchange activities  15 conduct refurbishment and exchange activities  12 conduct reassignment, refurbishment & exchange  1 state and 3 territories have no AT reuse listing on the database of AT reuse programs.

70. Company LOGO Behind every Reused Assistive Technology device there is – A Story to be Told, A Dream being Realized, A Goal being Met.

71. Company LOGO 71 State AT Act Programs Fiscal Year 2011 Reutilization Data April 2011

72. Company LOGO Types of Reuse Programs  Device Exchange  Want-Ad Digest/e-Bay for AT  Device Reassignment/Refurbish  Devices accepted (usually by donation) into an inventory; are repaired, sanitized, and/or refurbished as needed; and then offered for sale, loan, rental, or give away to consumers as recycled products.  Includes devices repaired for an individual (without the ownership of the device changing hands)  Open-Ended Loan  Borrower of a device can keep the device as long as needed

73. Company LOGO Reutilization FY2011 Data—All 56 Reporting  Device Exchange Data  36 State AT Program Reported in FY 2010  38 State AT Programs Reported in FY 2011  Refurbish/Reassignment Data  44 State AT Programs Reported in FY 2010  45 in 2011  Open-Ended Loan Data  33 State AT Programs Reported  32 in FY 2011  Multiple Programs Reported by Most States  20 AT Programs reported all 3 -- Exchange, Refurbish & Open-Ended Loan -- 19 AT reported 2 of 3  4 reported Exchange only, 11 reported Refurbish/Reassign only, and 2 reported Open-Ended Loan only

74. Company LOGO 2006 – 2011 Data Comparison TOTAL RECIPIENTS

75. Company LOGO 2011 Device Reutilization Summary States w/dataActivity Device Recipients% Total # of Devices Savings To ConsumersDevice %Savings % 38Exchange13424.25%1564 $ 2,474,1734.05%14.28% 45Recycle/refurb2530180.12%30,928 $ 12,745,44480.09%73.54% 32Open loans493415.63%6124 $ 2,110,91615.86%12.18% Total31,577 38,616 $ 17,330,533100.00%

76. Company LOGO Combined Total Type of AT Ave Saving Per DeviceDevice %Device #Current PriceSale PriceSavingsSavings % Vision $ 849.55 1.24% 495 $ 430,032 $ 9,504 $ 420,528 2.43% Hearing $ 184.57 0.96% 383 $ 72,379 $ 1,689 $ 70,690 0.41% Speech $ 909.97 1.71% 685 $ 644,230 $ 20,902 $ 623,328 3.60% Learning/cognitio n $ 107.33 2.60% 1039 $ 112,174 $ 662 $ 111,512 0.64% Mobility, seating $ 559.21 50.28% 20108 $ 11,694,547 $ 450,026 $ 11,244,521 64.88% Daily living $ 205.53 30.32% 12127 $ 2,676,969 $ 184,526 $ 2,492,443 14.38% Environmental $ 236.67 2.97% 1187 $ 322,166 $ 41,235 $ 280,931 1.62% Vehicle mods and $ 6,727.95 0.42% 169 $ 1,787,759 $ 650,736 $ 1,137,023 6.56% Computers $ 250.61 8.35% 3339 $ 917,827 $ 81,032 $ 836,795 4.83% Rec/leisure $ 244.60 1.15% 461 $ 121,821 $ 9,059 $ 112,762 0.65% Total $ 433.34 39,993 $ 18,779,904 $ 1,449,371 $ 17,330,533

77. Company LOGO Combined Total Type of AT Ave Saving Per DeviceDevice % Number of Devices Current Price Sale PriceSavingsSavings % Vision $ 849.55 1.24% 495 $ 430,032 $ 9,504 $ 420,528 2.43% Hearing $ 184.57 0.96% 383 $ 72,379 $ 1,689 $ 70,690 0.41% Speech $ 909.97 1.71% 685 $ 644,230 $ 20,902 $ 623,328 3.60% Learning/cognition $ 107.33 2.60% 1039 $ 112,174 $ 662 $ 111,512 0.64% Mobility, seating $ 559.21 50.28% 20108 $ 11,694,547 $ 450,026 $ 11,244,521 64.88% Daily living $ 205.53 30.32% 12127 $ 2,676,969 $ 184,526 $ 2,492,443 14.38% Environmental $ 236.67 2.97% 1187 $ 322,166 $ 41,235 $ 280,931 1.62% Vehicle mods and $ 6,727.95 0.42% 169 $ 1,787,759 $ 650,736 $ 1,137,023 6.56% Computers $ 250.61 8.35% 3339 $ 917,827 $ 81,032 $ 836,795 4.83% Rec/leisure $ 244.60 1.15% 461 $ 121,821 $ 9,059 $ 112,762 0.65% Total $ 433.34 39,993 $ 18,779,904 $ 1,449,371 $ 17,330,533

78. Company LOGO Financial Support (1 of 2)  In 2008 Statewide AT Act Programs from 10 states and 2 territories secured $629,227 from collaborative partners  In 2009 Statewide AT Act Programs from 12 states and 1 territory secured $772,679 from collaborative partners  In 2010 Statewide AT Act Programs from 15 states and 1 territory secured $970,706 in support from collaborative partners

79. Company LOGO Financial Support (2 of 2)  In 2011 Statewide AT Act Programs from 12 states and 1 territory secured $3,461,963 in support from collaborative partners—Includes new $2,400,000 from IL

80. Company LOGO Financial Support  Funding received was from a variety of sources—State appropriations, Health & Human Services, CMS (Real Choice and Medicaid), public/state agency, and private entities

81. Company LOGO Leveraged Funds Year# of ProgramsAmount% Gain or Loss 2008 12$629,227 2009 13$772,679+22.80 2010 16$970,706+25.63 Year# of Programs Amount% Gain or Loss 2008 12$629,227 2009 13$772,679+22.80 2010 16$970,706+25.63 2011 13$3,461,963+356

82. Company LOGO Looking At Current Collaborators  Connecticut –MFP---$10,000 (2008, 2009 & 2010) NONE REPORTED IN 2011  Florida-General Revenue--$50,000 (2009 & 2010), $124,270 in State Appropriation in 2011  Georgia—General Assembly--$46,196 (08),41,577 (09), $40,000 (10), $40,000 (11)  Idaho—Department of Special Ed-- $135,000 (09), $14,000 (10), $34,970 (11)  Illinois- Human Services Div-Rehab Services— $22,989 (09) $35,322 and ARRA $45,330 = $80,652 (10), $2,400,00 (11)

83. Company LOGO Looking At Current Collaborators  Indiana---Older Blind Grant--$29,555 (08), State Fund--$6,000 (09),Dept. of Education, $14,000 (10), NONE REPORTED in 2011  Kansas—Health Policy Authority--$244,579 (08) $247,487 (09), $271,487 (10) & Dept. of Ed. $85,468 (10), $271,487 (11)  Louisiana—State Appropriations--$41,763 (08), $28,406 (09), $21,455 (10), $45,352 (11)  Louisiana—Restricted Donations--$1,150 (08), $11,165 (09), $2,430 (10)  Montana—Health & Human Services--$93,484 (08,09,10), $93,484 (11)

84. Company LOGO Looking At Current Collaborators  Ohio—State Funds-- $47,500 (08), Local Law 264-- $38,000 (080, State agency-$20,000 (09), $26,000 (10), $25,000 (11)  Puerto Rico—State Approp.--$35,000 (09), $30,000 (10), $40,000 (11)  Vermont—Medicaid Infrastructure Grant-- $44,000 (08), $61,571 (09), $48,230 (10)  Massachusetts– Family Foundation--$22,500 (10), $22,500 (11)  Kentucky—United Way/Private (BTC)--$15,000 (10), NONE REPORTED IN 2011  North Dakota—General Funds--$10,000(08, 09, &10), $33,333 (11)—state appropriation

85. Company LOGO Summary  Even factoring out the $2.4 M award that Illinois received, support for reutilization increased in 2011  Given the state of the economy, increase in leveraged funding is surprising and positive  Consider collecting leveraged funding data from other reutilization programs Questions?

86. Company LOGO 86 April 2011 Environment for Device Use Education 9.71% Employment 3.84% Community Living 86.45%

87. Company LOGO 87 April 2011 Customer Satisfaction Highly Satisfied 85.56% Satisfied 14.03% Satisfied Somewhat.33% Not at all Satisfied.08%

88. Company LOGO RETURN ON INVESTMENT AND THE BUSINESS CASE FOR AT REUSE

89. Company LOGO  Projects tracked:  Number of usable devices donated  Value of donated devices  Number of devices reassigned  Number of individuals served  Value of reassigned AT  Most helpful tool: a good inventory system with flexible reporting capabilities (Kansas, Paraquad, Project MEND and others) Basic: Tracking Volumes

90. Company LOGO  Kansas led the way in recommending that programs apply a standard business practice and calculate Return on Investment.  This calculation requires only the total program expenses and the value of equipment made available for reuse.  Calculation: Divide NET value (value of reused equipment minus total program expenses) by expenses to derive return percentage or return for each dollar invested. Using Business Analysis

91. Company LOGO Sara Sack’s application of business model of return-on-investment analysis to Kansas program in 2010: ROI: (Value of donated equipment minus program expenses) divided by program expenses Example: $960,004 - $271,487 = $668,517 divided by $271,487 = 2.46 or a return of $2.46 for each dollar invested Example of Simple ROI

92. Company LOGO FREE Assesses Avoidable Outcomes Problem 20% of Virginians were uninsured persons, no access to healthcare or needed AT Some insured persons unable to get needed equipment or get in a timely manner Consequences Unable to recover fully Falls Repeated hospital stays, Dr. visits ER visits Stays in SNFs and ALFs Lost wages of patient and caregivers Measurable Costs Typical office visit Average daily cost of hospital stay Average cost of an ER visit Cost of typical stay in SNF for recovery Financial impact of a job loss

93. Company LOGO What did the availability of an AT device avoid?  Healthcare costs related to avoided falls:  ER visits  Stays in skilled nursing or assisted living facilities  Lost income due to missed work for customer or caregiver What other costs did reuse of the device avoid?  Landfill costs for disposal Identifying Avoided Costs

94. Company LOGO Objectives in collecting data:  Show equipment donors the therapeutic and financial impact  Show financial supporters the impact of funding  Test and monitor the service model Surveyed AT recipients to determine if they:  Had become more independent  Had fewer falls  Reduced number of medical visits, services  Been able to remain at home FREE’s Methodology

95. Company LOGO Identify cost of undesirable outcomes:  Average cost of ER visit = $1,896  Typical doctor’s visit = $155  Average daily cost of hospital stay = $1,149 (Typical stay is five days = $5,745.)  Average annual of cost of stay in SNF = $74,095 (Average stay for recovery is 50 days = $10,150.)  Average annual cost of stay in ALF = $35,616. (Average stay for recovery is 50 days = $4,879.) Financial impact of a job loss to a family of three at the poverty level = $17,170. FREE’s Methodology

96. Company LOGO For every 100 persons served:  26 hospital stays were avoided. 26 (average 5 days x $1,149) = $149,370  29 Emergency Room visits were avoided. 29 x $1,896 = $54,984  11 moves to skilled nursing facilities were avoided. 11 (average 50 days) x $10,150 = $111,650  11 moves to assisted living facilities were avoided. 11 (average stay 50 days) x $4,879 = $53,669 FREE’s survey results (partial)

97. Company LOGO  Total cost savings for each 100 recipients served: $465,586 FREE’s bottom line: 97

98. Company LOGO Quantitative outcomes measures use numerical data under standardized conditions  Volume tracking (donations, devices assigned, value of donated devices)  Use of business tools, from cost-benefit to ROI analysis: Sara Sack, Kansas  Calculation of avoided costs (e.g., lost work time avoided, healthcare expenses avoided, environmental impact minimized) based on customer follow-up: FREE Foundation/VATS  Combining those and more: CAVIAR Path to a better measure of ROI

99. Company LOGO Calculation of Approximate Value of Investment in AT Reutilization Expanding ROI to include more than the value of reused equipment Value of Reusable AT Devices Value of Avoided Healthcare Costs Environmental Impact Savings Economic Value of Work 1.Sum values 2.Subtract program expenses 3.Divide result by program expenses Improved ROI KS: ROI VA KS, GA VA CAVIAR

100. Company LOGO  Value of Reusable AT  Track value of donated AT devices in a standardized manner (e.g., MSRP)  Value of Prevention  Use specific healthcare costs for customer population  Collect survey data to show avoided expenditures Compiling Values for CAVIAR Pass It On Center | Dec 2011

101. Company LOGO Environmental Impact Savings  Track the weight (use some standard tables for simplicity and ease of calculation) of AT diverted from landfill (that is, used)  Determine cost (per ton) of landfill disposal in your area Economic Value of Work  Determine number of lost work days avoided  Use minimum wage for your state or use federal poverty guideline to be conservative Compiling values for CAVIAR NOTE: Revenue from end-of-life recycling should be reflected in program income, not here.

102. Company LOGO  FREE Foundation and Virginia Reuse Network use calculation of avoided healthcare costs to lobby for funding for the reuse program.  You can collect the data from your customers and use the calculations appropriate to your area to develop a financial impact analysis to use for advocacy.  See Knowledge Base for questionnaire.  See Webinar archive for March 2011 Webinar on Making the Business Case for AT Reuse Analyzing Avoided Costs 102

103. Company LOGO  Determine average weight of items kept from landfills  Identify landfill costs in your area  Calculate savings for tonnage kept from landfills  Add the landfill savings to the value Calculating Environmental Impact

104. Company LOGO This affords the greatest degree of specificity and accuracy – and will probably have the greatest impact. Use Virginia’s results and make a conservative assumption to estimate the impact in your service area. Collect data for your service area; survey your customers Until you have your own data, use Virginia as a benchmark Using FREE’s methodology

105. Company LOGO Using only the value of the equipment: FY 2011 data resulted in a Return on Investment (ROI) of $3.49 for each dollar invested. For FY 2011, assuming that only one percent of Kansans who received DME delayed or avoided a move to assisted living (versus 8% in Virginia), the ROI went to $4.13 for every dollar invested, an increase of 18%. Original ROI Adding avoided healthcare costs Recalculating for Kansas 105

106. Company LOGO  Pass It On Center will prepare a paper on this extended model for ROI.  We would like to have some programs volunteer to participate in this expanded calculation. If you’re interested, please contact Joy Kniskern or Trish Redmon at Pass It On Center.  Many thanks to Sara Sack and Sonja Schaible for your leadership in making the business case for AT reuse. Using CAVIAR to calculate ROI 106

107. Company LOGO Sara Sack  AT Reuse Partnerships with Medicaid Medicaid programs are showing increasing interest in the reuse of durable medical equipment (DME). Do you want a partnership with Medicaid? Checking inventory at the Kansas Equipment Exchange Expanding Reuse Through Specific Events:

108. Company LOGO What is Medicaid?  State-administered (with federal funding) health insurance program  Third largest source of health insurance after employer-based insurance and Medicare  Eligibility:  Low-income families with children  People with disabilities  Also provides:  Long-term care for the elderly and people with disabilities  Supplemental coverage for low-income Medicare beneficiaries

109. Company LOGO Factors driving increased interest from Medicaid programs  Unemployment levels and weak economy add to the number of uninsured and makes increasing numbers eligible for Medicaid.  Implementation of the Affordable Care Act will change eligibility and add huge numbers of uninsured adults under 65 to Medicaid.  DME will be a major cost. A manufacturer study found that 28% of wheeled mobility equipment and seating was paid by Medicaid.

110. Company LOGO AT reuse benefits reduce costs  We know that access to DME:  Improves health and safety  Minimizes doctor visits and returns to hospitals  Reduces or delays assisted living and nursing home placements  Enables some people to return to work  May enable caregivers to continue working

111. Company LOGO Medicaid and Reuse Programs  At least 20 states have considered DME reuse as part of the Medicaid program.  Sara Sack has consulted with 18 states about Medicaid and reuse in the past five years.  Status today (as we know it):  Programs with some Medicaid component: KS, DE, OK, ID, VA, IN  Just starting: SD, GA, IA  Investigating: CO, MN, OH, AK, NB, CT, ND, NJ, VT, WA, CA

112. Company LOGO  Some examples of different approaches:  Medicaid pays for inventory tracking of all donated DME and the refurbishing of Medicaid-purchased devices that come into the reuse program. (KS)  Medicaid-purchased equipment is stickered for return to a reuse program when no longer needed. (VT, VA)  Some Centers for Independent Living provide Medicaid-billable services (e.g., equipment repairs). (ID, Paraquad)  Proposed Georgia model will provide low-value DME (e.g., manual wheelchairs) to five hospitals in state with most Medicaid patients to free more Medicaid funds for complex rehabilitation (GA) Different Models for Involvement

113. Company LOGO  Retention of consumer choice  Reused equipment should not be the first and only option for consumers; may result in inappropriate matching.  Safe and appropriate reuse  Matching to the needed device, not “a device”  Focus on interim solution when delays occur, secondary device, transition device  Maintaining a positive or at least neutral impact on the DME industry and providers  Maintain healthy partnerships  Avoid reducing the supply of equipment available for reuse Concerns for reuse programs

114. Company LOGO  Developing a program:  Administrative issues  Legal/compliance issues  Accreditation requirement?  Workplace safety  Sanitization and consumer safety  Equipment tracking for recalls and alerts  Transfer of ownership implications  Warranty requirement? Challenges for Partnerships

115. Company LOGO  Financial  How the program is funded  Identifying which items or categories represent the most significant return on investment (ROI) for Medicaid  Fraud prevention  Reimbursement models Challenges for Partnerships

116. Company LOGO  Program Operations  Agreements, roles, responsibilities  Prescriptions required for some devices?  HIPAA compliance  Priority holds, wait-listing  User Services  Matching to appropriate devices  Compliance with state laws that require set-up of some devices by professionals with specific credentials  Follow-up  Outcomes measurement Challenges for Partnerships

117. Company LOGO Pass It On Center tech assistance  August Webinar  Overview of experiences of Medicaid programs with reuse  Examination of different successful models of reuse in Medicaid  Reports from reuse leaders who have a Medicaid partnership or are in the process of developing one  How-to Guide A document for reuse program leaders and Medicaid administrators examining successful models, providing guidance in exploring the issues and the process of expanding reuse in partnership with Medicaid Release date: Sept. 2012

118. Company LOGO Questions Questions?

119. Company LOGO If we Nurture our Dreams, they will take Root in our Souls & Bear Fruit in our Lives Over 9,300 PCs “ReBooted” and counting…

120. Company LOGO Examples of Reuse Programs  AT Specific Program:  AAC  Perkins Brialle  CCTVs  GPS  Smartphones/PDAs  Hearing Aids  DME  Computers

121. Company LOGO Examples of Reuse Programs  New Mexico and Delaware:  networking of state agencies involved in AT purchase and distribution.

122. Company LOGO Examples of Reuse Programs  Virginia:  networking of programs involving community-based organizations, IL centers, advocacy groups, etc.

123. Company LOGO Examples of Reuse Programs  Missouri, Texas & Utah:  DME Focus – hands-on  community-based organizations, IL centers, advocacy groups, etc.

124. Company LOGO Examples of Reuse Programs  Georgia: intra and interstate infrastructure expansion to increase reutilization of computers and DME.

125. Company LOGO WHAT IS THE STAR NETWORK? The Southeastern Technology Access and Reuse (STAR) Network is the distribution model that provides new and reuse assistive technology (AT), computers, durable medical equipment, and home care equipment to centers that are members of the Network in Georgia and the Southeastern United States. This encompasses logistics (such as scheduling, trucking, communications), methods and procedures, training, data collection and reporting, and outreach marketing activities. The STAR Network consists of Enterprise Depots, Regional Access Centers, Access Outreach Centers, Outreach Centers, Affiliates, Community Partners and National Collaborating Partners.

126. Company LOGO WHAT IS THE STAR NETWORK? The STAR Network increases access to and acquisition of AT in underserved regions of the Southeast for individuals with disabilities, newly injured, seniors, and disadvantaged communities. This Network promotes increased independence and more participation in educational environments, the workplace and in the community. The STAR Network establishes partnerships of existing reuse efforts and helps those creating new reuse programs in Georgia, Florida, South Carolina, North Carolina, Alabama, Tennessee and Mississippi.

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129. Company LOGO Walton Options HUBSCRUB CLEANING BUILDING 12 x 24 Hubscrub Utility Sink Cleaning Stations

130. Company LOGO Walton Options Two HubScrubs One will be stationed permanently for the re- use program The other will be transported for events and for contracting to facilities. Sales is a component of our Sustainability plan

131. Company LOGO Walton Options Our Latest Edition We purchased a trailer that we can take to different sites for collection and or HubScrub Cleaning events.

132. Company LOGO Connecting the Dots In Alaska! Participant Matching & Training Plan? Marketing Plan? Participants? Donors? Staff/Volunteers Skilled Techs? Equipment Management Plan? Policies? Liability? Sustainability Plan? Strategic Partnership Plan?

133. Company LOGO Successful Strategies, Innovative Partnerships, Futures Planning Guiding Principles  This is:  the Right Time,  the Right Place and  You are the Right People for Collaboration on Reuse  What are your ideas or needs around AT Reuse?

134. Company LOGO  Visualization: Building Bridges to Collaboration around AT Reuse  What are our points of Collaboration?  What are our gaps and barriers?  What are possible solutions to gaps and barriers?  What are logical “next steps” to continue this conversation? Photo: Oklahoma, AgrAbility

135. Company LOGO If a person does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away. - Henry David Thoreau

136. Company LOGO Photo: West Virginia AgrAbility I am Glad to be here, and Glad You are Here, TOO!

137. Company LOGO 137 http://www.passitoncenter.org Contact us: Joy@passitoncenter.org carolyn@passitoncenter.org liz@passitoncenter.org trish@passitoncenter.org sara@passitonecenter.org amy@passitoncenter.org lindsey@passitoncenter.org DISCLAIMER This work is supported under five-year cooperative agreement #H235V060016 awarded by the U.S. Department of Education, Office of Special Education and Rehabilitative Services, and is administered by the Pass It On Center of the Georgia Department of Labor – Tools for Life. However, the contents of this publication do not necessarily represent the policy or opinions of the U.S. Department of Education, or the Georgia Department of Labor, and the reader should not assume endorsement of this document by the Federal government or the Georgia Department of Labor.