Performance Based Contracting - PowerPoint Presentation

1. Performance Based Contracting2016 Improving Data, Improving Outcomes ConferenceNew Orleans, LAAugust 2016

2. 2DefinitionPerformance Based Contracting is a results-oriented contracting method that focuses on the outputs, quality, or outcomes that may tie at least a portion of a contractor's payment, contract extensions, or contract renewals to the achievement of specific, measurable performance standards and requirements.Source: National Institute of Governmental Purchasing

3. 3DefinitionIt is a type of contracting with:A clear set of objectives and indicators;Systematic efforts to collect data on the progress of the selected indicators; and Consequences, either rewards or sanctions for the contractor, that are based on performancehttp://siteresources.worldbank.org/INTHSD/Resources/topics/415176-1216235459918/ContractingEbookSection2.pdf

4. 4Funding ProgressionHistoric Contracts: provide services with minimal consideration for effectivenessPerformance Contracts: measure specific criteria (i.e., outputs, compliance) against identified standardsPay for Success: payment tied to specific criteria, focus on outcomes vs. outputs – focus on data and evaluation

5. Vermont’s Experience with Performance ContractingDanielle Howes: Part C Coordinatordanielle.howes@vermont.gov

6. 6Vermont Service StructureVermont’s Part C services are delivered as part of a continuum of early childhood services identified as Children’s Integrated Services (CIS) for children and their families prenatally-age 6 including:NursingFamily Support Social WorkPart C Early InterventionEarly Childhood and Family Mental HealthSpecialized Child Care Services

7. 7Vermont Service StructureCIS serves approximately 5,000 children and pregnant women annually (approx. 880 receive Part C services)The State writes 12 contracts annually with regional Visiting Nurse Associations, Parent Child Centers, or Designated Mental and Developmental Health AgenciesContractors bill Vermont’s Medicaid system a per-member, per-month rate

8. 8Performance Based ContractingSince 2010, the State contracts with a single agency in each of our 12 regions to serve as the fiscal agent for all CIS services within the regionThe fiscal agent subcontracts with other regional agencies to provide all 5 CIS ServicesUsing Results Based Accountability the State: identified 6 contract performance measures with the regional service providers in 2009-2010New measures were introduced for FY’17 at the request of regional partners

9. 9Performance Measures Serve To:Measure regional compliance with performance standardsMeasure quantity and quality of servicesSupport regions and the State in making data-informed decisionsProvide meaningful data about service value and the needs of children and families to inform State leadership and legislators

10. 10Example of Performance Measure Data:

11. 11Example of Performance Measure Data:

12. 12Changing Performance Measure Data:

13. 13Additional Performance MonitoringIn addition to Performance Measure Data reported by regional Fiscal Agents, Vermont:Monitors two regions annual for contract complianceMakes regional determinations for Part C Early Intervention Services in accordance with federal regulations and shares determinations with the fiscal agentsIn all monitoring, the same Quality Improvement Plan expectations are used to support integration

14. 14Looking to the FutureVermont sees contractors as partners and value working with them to improve the systemVermont developed a position focused on data analysis and quality assuranceVermont is currently recruiting a position to improve consistency and follow-up with contract monitoringVermont is considering consequences for continued performance issues

15. Missouri’s Experience with Performance ContractingPam Thomas: Part C Coordinatorpam.thomas@dese.mo.gov

16. 16Missouri’s Part C ProgramCurrent Infrastructure Central Finance Office: single entity (est. 2001)Service Providers: sub-contracted/vendors (est. 2002)Service Coordination: 10 regional contracts (est. 2003)Service Delivery: Transdisciplinary teams/PSP (est. 2009)Child Count:Day count of IFSP children – 5,388 (12/1/14)FY count of IFSP children – 9,628Total FY count – 12,720 (includes all children tested plus IFSP)

17. 17Missouri ContractsTwo Types of ContractsProvider Agreement Signed once at the time of enrollmentSystem Point of Entry (SPOE) ContractBid for service coordination services every five years

18. 18Missouri’s Provider Agreement Purpose Identifies initial and ongoing expectations Establishes activities for provider to maintain an account in good standingRequires procedures for ongoing oversight of the activities MonitoringAccounts (Contractor): Licensure, Background Checks, Liability Insurance, Training Requirements, Availability/SDAPayments (State): Timely Claims, Hours Billed in Single Day, No-Show Visits, Travel Incentive, Reported Billing Issues

19. 19Missouri SPOE Contract Purpose Initial: Focus on compliance (2002 – 2008)Intermediate: Focus on service delivery (2008 – 2014) Current: Shift focus to practices (est. 2014)Monitoring 6 Standards (Liquidated damages): Child count, Timely IFSP data entry, Team assignments, Correction of non-compliance, Complete needs assessment1 Standard (Incentive): Family Cost Participation fee collection/suspension

20. 20Example Results

21. 21Lessons Learned Purpose What you identify will get attention … will get measured … will get done. Be selective in which activities you choose to measure, you cannot select everything! Start with the fundamental or critical pieces. Training/TA is critical for the activities you select, and can range from a few written documents to regular onsite TA.Monitoring Measuring performance in compliance is not the same as measuring practice, they require different approaches to identifying and monitoring contract standards.

22. Illinois: Performance Contracting Evolution Ann Freiburg: Part C CoordinatorAnn.Freiburg@illinois.gov

23. 23Illinois’s Part C ProgramCurrent Infrastructure Central Finance Office: Administrative contract under DHS/EIService Providers: Provider Agreements, independent or agency basedService Coordination: Staff within 25 Regional Points of EntryService Delivery: Multidisciplinary Child Count:Day count of IFSP children – 15,292 (10/31/15)FY count of IFSP children – 21,183 (SFY15/FFY14)Total FY count – 34,478 (includes all children tested plus IFSP)

24. 24Illinois Relationships for EI ServicesTwo Types of RelationshipsPayee Agreement Signed by Payee (being an agency or an individual) with language of compliance to EI service provision for anyone working under the Payee as a therapy provider.Signed one time and only renewed if changes.System Point of Entry (SPOE) ContractRFP for 5 years – GATA impacting length in futureIncludes Performance Contracting languageBase payment is driven by caseload to have Service Coordination.

25. 25Illinois History of Performance ContractingIllinois created a statewide Early Intervention program in 1991 under state statute.In 2002 we created Performance Contracting for our regional points of entry called Child & Family Connections offices. Original Performance Contract measurements based on three components of system.Participation rate: Find needy children and provide services% of children under 1 in Intake: Find children earlier% of children transitioned to Special Ed: Appropriate services at age 3

26. 26Illinois Funding with Performance ContractingQuarterly calculation of an annualized amount to pay CFCs. Base caseload size at 43 active IFSPs per Service Coordinator. Ten “incentives” for performing well.Four “penalties” for not meeting benchmarks.Have other key components broken down based on caseload as well.Contracted and paid based on quarterly “earned” amounts compared to allowable expenditures. Direct Service Providers:Work under Payee Agreements, not contracts.Follow all applicable laws, policies and procedures.Paid based on insurance rate (allowable services billed to private insurance) or state rate (based on Medicaid State Plan rate).

27. 27Illinois: Performance Contracting CalculationsTen incentives: 1% of base grant for having one of the highest 12 CFCs of 25 CFCs percentages:IFSPs initiated before child’s first birthdayTransition meetingsParticipation rates for children under 1Natural EnvironmentsIFSP completed within 45 daysClosure at age 3 to SE or appropriate referralLowest closures for Family Reasons from IntakeLowest closures for Family Reasons from IFSPLowest cases with older infants/toddlers (2.5+)Lowest days between referral to IFSP

28. 28Illinois: Performance Contracting Calculations (Continued)Four Penalties: 1. Insufficient staffing – value of missing staff.2. 1% of base for cases over 45 days with no IFSP if over 5% of # from past; 2% if exceed 7.5%.3. 1% if less than 85% of children have services predominantly in natural environments.4. 1% if average age of new children exceeds 630 days old and 2% if over 640 days.

29. 29Illinois: Above Performance ContractingAnnualized calculation of payments also includes:Local Interagency Council Coordination: Minimum grant of $19,000 plus extra $3,000 per LICParent Liaison Activities: Minimum grant of $19,000 and maximum grant of $76,000 based on caseloadDevelopmental Pediatric Consultation: Funding to contract for specialized consultation based on $88.90 per active caseSocial Emotional Consultation: Minimum grant of $37,500 and maximum grant of $100,00 based on caseloadPlus $3,000 to fund “extra” services of SE function

30. 30Illinois: Performance Contracting History

31. 31Illinois Performance Contracting Calculation

32. 32Illinois: Time to Evolve/Lessons LearnedSSIP focus on Results Driven Accountability State focus on Return on InvestmentIllinois EI focus on SiMR

33. 33Questions

34. 34For more information:Visit the DaSy website at:http://dasycenter.org/Like us on Facebook: https://www.facebook.com/dasycenterFollow us on Twitter:@DaSyCenter

35. 35The contents of this presentation were developed under a grant from the U.S. Department of Education, # H373Z120002. However, those contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government. Project Officers, Meredith Miceli and Richelle Davis.