NDIS & LEARNING FROM THE UK EXPERIENCE OF PERSONALISATION: A PROVIDER PERSPECTIVE Peter Gianfrancesco [email protected] .

NDIS & LEARNING FROM THE UK EXPERIENCE OF PERSONALISATION: A PROVIDER PERSPECTIVE

Peter [email protected]

www.galeruconsultancy.com

OVERVIEW

About me The UK & ‘Personalisation’ How we prepared What we did Insights arising from our experience Lessons for NDIS providersMy emphasis is on the long term

view of market engagementA provider emphasis and focus

THE INTERNATIONAL PICTURE

Providing care through a model of regulated brokerage and personal purchasing is not new:

Examples can be found in ENGLAND, USA, BELGIUM, SCOTLAND and may or may not be limited to disability care. The private insurance and/or managed care model also fits into this context

The best current comparator is the UK Personalisation Model as it has a uniquely disability focus and is national in its scope

IN ALL OF THE MODELS, IT IS THE PROVIDER RESPONSE AND NOT THE REGULATION THAT WILL DETERMINE THE SUCCESS OF THE MODEL

THE GREATEST RISK TO ALL MODELS IS IF PROVIDERS WITHDRAW FROM OR FAIL IN SUPPLY OR IF THE PROVIDER MARKET CHANGES TOO QUICKLY

THE EVOLUTION OF A MODELRegulator Provider Consumer

Phase 1: Implementation

HelpfulStimulates Provider MarketSupports existing providersOptimal inclusivenessOptimal generosity re TariffSeparation of Funding

AnxiousShort Term FocusCollaborativeRe-engineers existing servicesProducts emerge from existing capabilityWorkforce modification

ConfusedAnxiousWants more of the sameChooses familiar supplier

Phase 2: Embedding

HelpfulLess Market InvolvementSupport for struggling providersIntegration of FundingLess inclusive

Sees a way to make it workLoss of other funding sourcesStarts to subsidise careMore competitionEmerging product innovationNew PartnershipsEmerging new providersEmerging new workforce

ReassuredStarts to exercise influenceProvider swappingStill choosing traditional care

Phase 3: Market Maturation

Less HelpfulMarket DrivenTariff adjustment as budgetary control

Model has shaped provider cultureIncreasingly innovative productsCompetitive MarketNon MH providersProviders compete on added valueNew workforce

DiscerningMore recovery orientatedExpects more

UK EXPERIENCE AS A PROVIDER

PERSONALISATION – THE ENGLISH EXPERIENCE A national policy approach with strong political support Implementation devolved to 250+ UnitaryAuthorities Introduced on a national scale 5 years ago Tariffs and products (regulation) determined locally

(with some exceptions) or by provider Consumers ‘hold’ the budget (reality is different) or get

a ‘notional’ budget Brilliant when it is allowed to be used creatively (the

Lathe example) It has not worked that well in mental health Being used to drive price down and eligibility up Implemented at a time of great financial austerity and

loss of contracted care

UK EXPERIENCE AS A PROVIDER

WHAT WE KNOW IS THAT THE SMALLER PROVIDERS DEMONSTRATED FASTER MARKET ENTRY AND GREATER INNOVATION AND RESPONSIVENESS BUT THE LARGER PROVIDERS OUTLASTED THEM IN THE MARKET BECAUSE OF THEIR INFRASTRUCTURE, CAPACITY AND LOWER UNIT PRICE - IN THIS SCENARIO EVERYONE LOSES BECAUSE LOCALISM AND INNOVATION DISAPPEAR

DESPITE THE CHAOS PERCIEVED BY PROVIDERS, MANY CUSTOMERS REPORTED:- BETTER SATISFACTION - BETTER ENGAGEMENT - IMPROVED QUALITY OF LIFE

WHAT WOULD HAVE HELPED

CLEAR NATIONAL TARRIFFS SUPPORT FOR PROVIDERS SUPPORT FOR CUSTOMERS INDEPENDENT CARE PLANNING MORE GRADUAL REDUCTION IN CONTRACTS BETTER PLANNING AND LESS CHAOS MORE STRATEGIC AND LESS REACTIVE SUPPLY TIME TO UNDERSTAND WHAT WE WERE DOING

WE SURVIVED AND THRIVED SO WHAT DID WE DO?

WHY US?

THE 5 C’SCultural confidence and readiness

Customer service and focusCapability was understoodCapacity was identifiedCosts were known (eventually!)

CULTURAL CONFIDENCE & READINESSWho are we here for?Is the whole organisation on board?

What are the cultural barriers?

What values must we preserve?

What can we move on from?

CUSTOMER SERVICE & FOCUSWho are our customers?How do we provide GREAT customer experience?

What do our customers tell us about our effort?

What more can we do to add value?

CAPABILITYWhat is it we ACTUALLY do?What is it that makes a difference?

What else are we good at?Who else might benefit?How can we develop to match REAL customer needs?

CAPACITYHow much can we provide?How productive do we need to be?

How can we be more efficient?What new partnerships emerge?

What are the markets we are seeking to appeal to?

What else do we need and how will we pay for it?

COSTSHow much does it cost us to supply?

Can we supply within the market tolerances?

Do we ‘loss lead’?Do we subsidise care?What assumptions do we make about our supply model?

What are the cost pressures we must respond to?

KEY QUESTIONS WE CONTINUALLY ASKED…. Why are we considering entering this market? What are our ambitions as a provider? Do we have a duty to supply? What happens if we choose not to? How does it fit with our organisational

purpose? Can we afford to do it? Do our values limit our market? What hidden capability is there? What would we do with the profit? How would we manage revenue loss?

WHAT WE CAME UP WITH…..

IN NORFOLK, ENGLAND…

Population of 1 million people In any given year:*

120,000 people experience a mental health problem requiring help

65,000 see a GP ONLY and/or use public or NGO mental health services

55,000 people need help, get nothing or have no eligibility but many have a capacity and desire to purchase

What are the market opportunities here?

DEVELOPING A PRODUCT RANGE Dis-aggregating current supply into

products Assessing current product range against the

market opportunity Testing the offer and refining it Identify new product opportunities Assess the supply issues and challenges Defining the story associated with the

product offer Develop marketing, perhaps JUST for the

product Launch and supply

LIFEHELP Part of Norwich Mind (A$5M) New brand and product range developed Offered universally 600+ customers first two years 25% clients hold a personal budgets 40% have care purchased for them (notional

budget) 25% self fund 10% free Profit is used to provide free care to 10% of the

clients who would otherwise receive nothing Growth is projected at 20% pa

UNIVERSALITY

The 2011 Australian Census indicated that the incidence of a mental health problem could be as high as 1 in 3

Why would we not want to include the whole population as potential customers for our purchasable care products?

The larger the market, the larger the potential revenue, the more mixed a customer base is, the less stigma is attributed to any customer

It IS possible to broaden your market and retain (and enhance) your offer to your core beneficiaries

ADVANTAGES OF UNIVERSAL SUPPLY

Larger Market Less Stigma Less Regulation Greater Public Benefit & Impact & Reach Customer Expectations Higher Better Organisational Profile Fewer people excluded from available care Larger profit, greater potential to subsidise

WE SUCCEEDED IN SUPPLYING BUT, MORE IMPORTANTLY, WE BECAME A MUCH BETTER ORGANISATION ALONG THE WAY

LIFEHELP – MAIN LESSONS

Staff are much more productive Staff are more flexible and multi-skilled Staff have become innovators and promoters The workforce is more diverse and more

casualised Volume matters as does a broad customer base Mixed economy of purchasers is critical MAXIMISING market size is key Financial planning and management is very

complex Client retention is good Clients say the service works and they welcome

the choice Staff are satisfied The number of NGOs providing has halved.

10 INSIGHTS THAT ARE RELEVANT HERE

Our offer is 90% RELATIONAL and 10% technical There is very little product differentiation on the provider

side in mental health (it’s the people and their lives that represent difference)

Market the relational promise (the employee profile and story)

Celebrate and communicate success through stories – real people, real photos, real narrative

Keep your values and history at the heart of your message

Continually ask what makes us different Emphasise localism and cultural relevance Add delight and value at every opportunity Provide GREAT customer service Continually innovate (because your competitors will copy

you)

OUR EVIDENCE ON CUSTOMER PRIORITIES System defaulted to traditional suppliers at start

up (seems to be same in some NDIS launch sites) Peer support over-rated by providers (not a factor

in initial purchase but a factor in re-purchase) Customers value:

Responsiveness Great customer service Familiarity / low risk / continuity Help that works (from the customers perspective) Flexibility Value Pleasant surprises People that they like and who like them

SUPPLY CHALLENGES – WHAT WE HAVE

LEARNED IN THE UK Our workforce had to increase productivity by 20% ‘Standing’ liability needs to be minimised Customers demand different qualities to those that organisations

often hold dear….eg: Less qualified but experienced in life Flexible and responsive Relationally competent

A new paradigm of staff deployment Move away from traditional structural model (teams) Multi-skilled staff covering full range of client needs are more efficient

Big increase in infrastructure demands Requires a different understanding of outcome Workforce has become more casual and/or self employed and

generally operating at a lower level of qualification but with new sought after attributes

Organisational complexity increases Creativity needed to continually add value Greater reliance on technology to support distant delivery Very hard to supply remotely unless additional investment (by

provider, regulator or co-purchasing)

MEASURING SUCCESS

Rewarding staff who are BOTH effective and productive – how would we do that?

The Loved One Test Market Capture Customer Loyalty (a good thing?) Health and other client outcomes (QOL, Goals etc) Testing value for money Financial monitoring – efficiency monitoring Practice governance Public ratings (Patient Opinion, Whitecoat) Matching the promise to reality - stories

SUMMARY OF KEY POINTS It’s bloody hard! NDIS offers great opportunity The implementation approach seems sound Providers need to think differently

In terms of who they supply to In terms of brand and marketing In terms of supply and productivity

Early to market is important Competition is inevitable (particularly in urban

settings) Funding will be more complex and chaotic Customers will benefit if suppliers adapt Preparating for supply will improve your organisation

FURTHER INFORMATION www.norwichmind.org.uk

www.personalhealthbudgets.england.nhs.uk

www.mind.org.uk

www.scie.org.uk/topic/keyissues/personalisation

www.thinklocalactpersonal.org.uk

www.whitecoat.com.au

www.patientopinion.org.uk