Preparing for the Ticket to Work: Market Leadership - It’s Our’s to Lose

Dan O’Brien

Oklahoma Dept of Rehabilitation Services

VR Thinking Like a Business

• We have prime positioning in an $80 B Market

• Analyze the Market and Competition

• GROWING our business using the Ticket:

– Market our services to customers - Assertive Engagement

– Develop and use choice based self-screening

– Develop expandable networks of sub-contractors

– Collaboratively plan with Vendors and Customers

– Create incentives for VR staff to serve SSA beneficiaries

Ticket to Work Basics

• TWWIIA Signed into Law Dec. 1999

• New Work Incentives + the Ticket to Work

• National Program Manager will manage Tickets and Employment Networks, the service providers

• Some EN’s pre-selected-VR, One Stops ,AP’s

• Milestone Payments during 1\ul\>st 9 Mos. + Monthly (outcome) payments for 60 months if check=0

• Only VR can choose the existing reimbursement system or the Ticket payment by individual

• Jan 2001 – Ticket Implemented in 12-14 States

Ticket to Work Voucher

• Voucher worth 40% of estimated savings over 5 years off benefits

– $17,000+ for SSDI

– $12,000+ for SSI

– Milestones+outcome payments

• SSI Ticket Underfunded

– Voucher worth $12,000 about 1/3 paid during first 9 months balance over 60 mo.

– Average VR SSA case cost at 9 months SGA = $11,000 leaving a deficit $6-7,000

• VR likely to be the only willing Provider

Analyzing the Market/Competition
Empl. Network Risk Management

• Employment Networks must manage Deferred Payment Risk to break even under Ticket

• Option 1 - Identify and Target - Low Cost Clients

• Option 2 - Forward Fund - use risk assessment

• Option 3 - Only accept Ticket for individuals you intend to hire - ex. NISH

• Option 4 - Bill third party for cost of services, ex. HCB Waiver – and/or regular Medicaid - personal assistance at work or case management

• Option 5 - Join a publicly financed Employment Network –VR, One Stops, MH, DD

Option 5 – Form a Publicly Funded Employment Network

• VR agencies are positioned as Leaders in the employment market – it’s ours to lose!

• Oklahoma VR is piloting a VR sponsored EN

• Title: Oklahoma KEYS to Employment

• One of 12 SSA funded State Partnership Agreements, 6 additional funded by RSA

• Started issuing Vocational Vouchers Sept. 1999

• Issuing vouchers/ticket to randomly selected SSDI/SSI beneficiaries -- affective or schizophrenic diagnosis

• 5 Year research project ending in Sept. 2003

Okla. Social Security SPI Project

• To Inform consumers, advocates and MH Staff on the value of work in recovery and use of Work Incentives

• Facilitate Medicaid buy-in Oklahoma

• Pilot Ticket Implementation Issues:

– Response Rate including the effect of assertive engagement

– Equitable provider payment rates

– Facilitating Choice - Report Card

– Work out methodology for a VR sponsored Employment Network

OK Ticket to Work Structure

• VR Contracts with competing Vendors

• Issue OK Ticket at Work Incentive Meeting

• NRC Vendor Performance Report Card

• Consumer has choice of Models & Vendors

• Consumer Assigns Voucher to Vendor

• Enrolled by VR – 6 Milestones total=$6,500 ave.

• SSA funds used for Ongoing Support Payments Total=$4800 plus up to $2400 bonus for job with medical benefits

Marketing to the SSA Beneficiary: Selling Work

• Four contacts before each meeting

• Two by mail and two by phone

• If they can’t or don’t attend, invite to next meeting or arrange a home visit

• Held at an All you can eat Buffet

• Consumer Trainers and Exemplars/Role Models explain value of work as part of recovery

• Consumer Trainers review SSI/SSDI work incentives

• IF we provide World Class service and choice why would anyone go anywhere else?

Choice based Customer Screening

• The Work Incentive Meeting is an effective, inexpensive, choice/behavior based, self screening tool

• Of the 323 individuals (MH Consumers) invited to a WI meeting 30% attended and 11% engaged with a vendor

• Vendors who marketed their programs as providing quick, consumer focused job placement and support got majority of Tickets

From Sharecropper to Partner

• Vendors will bring Tickets to VR if they are full partners paid at Market based rates

• We need the Vendor

– We don’t have the capability to Job Coach with our caseloads, most SSA beneficiaries will need a Job Coach or Personal Assistant

– Cheaper and faster to contract out

• They need VR

– They don’t have risk tolerance (funding) we do

– Under Ticket we can manage the risk better

– We can choose by individual whether to bill under existing reimbursement system or Ticket system

Collaboratively Planning Change

• Executive authorizes change and timetable

– Usually 3 to 6 months with 12 month pilot

• Executive sets parameters

– Ex. Can’t raise costs, must incentivize outcomes, must be consumer driven

– assigns staff – must assign a “change agent”

– delegates planning to stakeholder cross-functional team

– 30-50 diverse members

– 1/3 customers, 1/3 vendors and 1/3 VR Staff

Stakeholder Group Responsibilities

• Develop operational definitions for outcome(s)

• sub-divide into incremental steps/Milestones

• develop payment % for each step/Milestone

• define quality indicators for Milestone payment

• Review bidding/rate setting methodology

– Vendor negotiated rate or bid, or

– Ave. (regional) rate based on vendor costs

• Meet periodically (ex. twice per year) to evaluate pilot and implementation – for 1 to 3 years

Website Address:

www.milestonemanagement.com

Email:

deobrien@aol.com (Dan O’Brien)

deobrien@drs.state.ok.us

or

Rfcook@drs.state.ok.us

(Becky Cook)