STATE OF THE SHIP: WHERE ARE WE GOING? July 26, 2016
Agenda 2 SHIP Evaluation Overview Mission, Vision, and Strategic Objectives Performance Management Improvement System Volunteer Risk and Program Management Questions
INTRODUCTION OF THE EVALUATION What did we do and why did we do it?
Why do a program evaluation? 4 Given the move from CMS to ACL in 2014, the program evaluation gave ACL an opportunity to: Learn more about the history of the SHIPs Gain an understanding of how the SHIPs operate nationally Determine what pieces of the current structure were working and what wasn t as effective Identify areas for growth and improvement Map a plan to better deliver on the mission in the future
What did we do? 5 ACL contracted with Coray Gurnitz Consulting (CGC) and partner, Keybridge LLC, to conduct a program evaluation of the SHIP. The evaluation looked at all aspects of the program including both the grantee and ACL structures and functions. The evaluation was broken into two parts: An As-Is analysis of the program, and A To-Be recommendations based on the information learned during the As-Is portion
Who was involved? ACL SHIP Directors: ME, NY, DC, NC, FL, LA, OK, MT, CA SHIP Volunteers: Directors interviewed chose up to 3 volunteers to be interviewed with varying levels of experience. SHIP Steering Committee ACL: ACL leadership, OHIC leadership, OHIC project officers CMS: 1-800-Medicare, Medicare Plan Finder, Training, SHIP Liaisons (Central Office staff and Regions), Other partners: NCOA
What did we find? As-Is - Themes
As-Is Themes: 8 # Theme 1 2 3 4 5 6 The SHIP network has a solid foundation from which to move forward. Currently, the long-term mission, vision, operating principles and objectives for the SHIP have not been clearly articulated. ACL depends on CMS and other federal agencies for information and infrastructure critical to the SHIP network. SHIP grantee operating models fall on a spectrum of centralized to decentralized approaches for reaching beneficiaries. SHIPs require ACL operational assistance in four key areas. There are opportunities to enhance performance infrastructure.
1 Theme 1: The SHIP network has a solid foundation from which to move forward. 9 SHIPs are able to operate within the current program infrastructure and keep pace with the growing number of beneficiaries. ACL has started to create a positive culture focused on responsiveness, customer service, accountability and collaboration.
10 2 Theme 2: Currently, the long-term mission, vision, operating principles and objectives for the SHIP have not been clearly articulated. The As-Is analysis revealed that while the SHIP network has a dedicated and mission-driven workforce, but the long-term strategy for the program is unclear. In the absence of a formal strategy, grantees make strategic decisions based on the information available. Example SHIP Mission prior to transfer to ACL: Strengthen the capability of grantees to support a community-based, grassroots network of local SHIP offices that provide personalized counseling, education, and outreach to assist Medicare beneficiaries with their Medicare and related questions.
11 3 Theme 3: ACL depends on CMS and other federal agencies for information and infrastructure critical to the SHIP network. ACL relies on CMS and other federal agencies to supply critical information and infrastructure to the SHIP network. Grantees rely on ACL as the administrator and champion of the program at the national level to facilitate this engagement with stakeholders. Examples: ACL is the key communicator and integrator with CMS. ACL is viewed as the champion for SHIPs at the national level (with Congress, CMS and other federal partners).
4 Theme 4: SHIP operating models fall on a spectrum of centralized to decentralized approaches for reaching beneficiaries. 12 Grantees have implemented varying models for executing the SHIP grant. Some of the differentiators include: SHIP Location (Aging or Insurance Department), Funding Sources, Demand for SHIP Services, and Challenges Recruiting and Retaining Volunteers. Location of SHIP Grantees Co-location with SMP Aging 67% Insur. 33% Not Co- Located 52% Co- Located 48%
5 Theme 5: SHIPs require ACL operational assistance in four key areas. 13 There is a need for guidance, support and advocacy from ACL in four areas: 1. Provide Technical Assistance 2. Clarify Integration Points (Roles & Responsibilities) 3. Stabilize Grantee Funding 4. Provide Training and Certification Support
6 Theme 6: There are opportunities to enhance performance infrastructure. 14 The current performance measures do not measure dimensions of performance beyond quantity of contacts, such as quality of contacts, timeliness or cost/savings. The performance results are used as the basis for a relative ranking of all grantees, rather than a tool for setting annual or long-term performance goals. There is an opportunity for ACL to make adjustments to both the set of measures and the use of these measures to improve grantee performance.
MISSION, VISION, AND STRATEGIC OBJECTIVES Building on Theme 2 Findings
New Strategic Plan
SHIP Mission and Vision: The mission is the SHIP s statement of purpose and the vision shows where we want the program to be in the next 3 years. 17 Mission Our mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling, and training, to make informed health insurance decisions that optimize access to care and benefits. Vision We are the known and trusted community resource for Medicare information.
Strategic Themes & Goals: The strategic themes highlight our areas of focus and goals explain the desired outcomes in each area. 18 Strategic Theme Service Excellence Capacity Building Goals 1. Consistently and confidentially provide accurate, objective, and comprehensive information and assistance. 2. Promote awareness, knowledge, and visibility of the program. 3. Recruit, train and retain a diverse, sufficient, and effective workforce at all levels. Operational Excellence 4. Develop and strengthen the program structure and organization, including policies, processes, and procedures, to enable effective and efficient operations. Innovation 5. Promote adaptable and sustainable processes and activities to position the SHIP for changes in the programmatic landscape.
Objectives: The objectives are the continuous improvement activities that break the goals into tangible pieces. 19 Objectives Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Objective 1.1/3.2/4.2: Increase knowledge of program expectations at all levels. Objective 1.2/3.3: Increase the content knowledge of SHIP counselors. Objective 1.3: Increase the content knowledge of SHIP clients. Objective 2.1: Increase exposure of the public to the program. Objective 2.2: Increase the awareness of SHIP to those in greatest need of our services. Objective 3.1: Enhance team member management. Objective 4.1: Improve alignment of policies, processes, and procedures to program goals. Objective 4.3: Increase accountability to program expectations. Objective 5.1: Increase innovation within the SHIP program to better serve Medicare eligible individuals. Objective 5.2: Expand strategic awareness within the SHIP network.
Initiatives: Initiatives provide how we will achieve the goals and objectives. 20 Objectives Initiatives Examples 1.1/3.2/4.2 Increase knowledge of program expectations at all levels 1.1.1 Improve the workforce management infrastructure, including policies and procedures 1.1.2 Set program expectations at all levels, and periodically meet to assess and reassess expectations 1.1.3 Develop and execute a communication plan for all levels 1.1.4 Develop standard operating procedures for OHIC staff VRPM performance measures; grant terms and conditions; applications; project officer guidelines Conduct ACL monthly SHIP Director calls Standardize OHIC Project Officer job descriptions
Setting this in to practice 21 Remember, this is a national program: While it s reasonable to assume basic nation-wide similarities, we are not and will not be trying to make SHIPs identical across the country This is a living document: Nothing we ve presented is set in stone; this is our starting point If we find something important has been omitted we can add it later or we can delete things that don t seem to fit in practice The new SHIP Strategic Plan will be integrated into the 2017 SHIP application.
So, what are we asking SHIPs to do? 22 1. Align, as much as possible, their program to the new SHIP Strategic Plan 2. Look at the Strategic Goals, Objects, and Initiatives to determine: a. How are SHIPs currently meeting them and how (and if) can they improve? b. Are there any areas that SHIPs are not currently addressing but should be? 3. Identify anything SHIPs are currently doing that does not align to this Strategic Plan: a. Are these things they maybe shouldn t be doing? b. Or are they things missing from our Plan?
PERFORMANCE MANAGEMENT IMPROVEMENT SYSTEM Performance Measures & More
Status Quo What do the measures look like now?
Current Performance Measures and Weights 25 Current Performance Measures and Weights for Overall Performance Scores PM Definition Weight 1 Total client contacts per 1,000 Medicare beneficiaries in the State 20% 2 Persons reached or enrolled at specific public events per 1,000 Medicare beneficiaries in the State 3 Substantial, personal, direct client contacts per 1,000 Medicare beneficiaries in the State 4 Contacts with Medicare beneficiaries under age 65 in the CMS-defined Disabled program per 1,000 Medicare beneficiaries in the CMS Disabled program 5 Low-income Medicare beneficiary contacts and/or contacts that discussed lowincome subsidy (LIS) per 1,000 low-income Medicare beneficiaries 6 Contacts with one or more qualifying enrollment topics discussed per 1,000 Medicare beneficiaries 7 Contacts with one or more qualifying Part D enrollment topics discussed per 1,000 Medicare beneficiaries 8 Total number of counselor hours per 1,000 Medicare beneficiaries 10% 10% 15% 10% 15% 10% 10%
County Groupings into Slices 26 6 Slices: Large Central Metro (LCM): 1 million plus Large Fringe Metro (LFM): Counties tied by commuting, social, and health care access to the LCM (even some relatively small population counties) Medium Metro (MM): 250, 000-999,000 Small Metro (SM): 50,000 249,000 Micropolitan (MIC): 10,000 49,000 Outside Metro-Micro (OUT): no metro or micro areas The slices in each state vary depending on the population characteristics of the state. Not every state has all six slices.
Scoring 27 States receive two scores: Attainment Score: based on how well the State preforms relative to the MAT and EB. Improvement Score: based on how well the State performs relative to their performance the previous year and the EB. State keeps the highest of these two scores for each Performance Measure for each Slice. Each of the final slice scores for a given PM is weighted based on the proportion of Medicare beneficiaries that live in that slice in that state and added together to get a final overall PM score.
Status Quo 28 Pros Allows for true comparisons across states Allows for simple ranking among states Issues Too much duplication and overlap between measures Little focus on public events Very complicated and hard to explain Metrics are not aligned with strategic vision Weightings add confusion and emphasis that is not intended Crossing performance metrics with internal management measures
New Performance Measures Aligning Metrics with Strategic Objectives
New Metrics 30 PM1: Client Contacts Percentage of total client contacts (in-person office, in-person home, telephone [all durations], and contacts by e-mail, postal, or fax) per Medicare beneficiaries in the State. (unchanged) PM2: Outreach Contacts Percentage of persons reached through presentations, booths/exhibits at health/senior fairs, and enrollment events per Medicare beneficiaries in the State. (unchanged) PM3: Medicare Beneficiaries Under 65 Percentage of contacts with Medicare beneficiaries under the age of 65 per Medicare beneficiaries under 65 in the State. (unchanged) PM4: Hard-to-Reach Contacts (NEW) Percentage of low-income, rural, and non-native English contacts per total hardto-reach Medicare beneficiaries in the State. PM5: Enrollment Contacts Percentage of unduplicated enrollment contacts (i.e., contacts with one or more qualifying enrollment topics) discussed per Medicare beneficiaries in the State (mostly unchanged). Pilot PM6: Beneficiary Part D Savings (NEW) Composite measure of (1) percent of clients for whom a Part D enrollment or likely enrollment results in lower prescription drug costs and (2) average savings accrued per client for whom prescription drug costs are reduced.
Performance Measure System Improvement What does the broader system look like?
Performance Measure System Improvement 32 Eliminate performance-based funding Restructure SHIP performance measures on a qualitative Likert scale for comparison across states Providing State Reports Establishing National Targets
Eliminating Performance-Based Funding 33 Findings: The current system discourages cooperation and encourages competition SHIPs are reluctant to share best practices. SHIPs have reported that other programs are inappropriately taking credit. Performance-based funding incentivizes teaching-to-the test. Performance-based funding creates funding uncertainty. Although the current performance-based funding is a relatively small portion of total funding, it creates the perception that poor performance could lead to significant cuts.
Moving to a Likert Scale Comparison Tool 34 Findings: A system of 54 rankings is excessively granular. The calculations underlying the current ranking system are overly complex (i.e. slices). New Measures: Restructured SHIP performance metrics a qualitative Likert scale: Eliminates slices. SHIPs will receive rating for each metric. Ratings will not affect annual funding levels. SHIP performance will be released publically.
Example of Likert Scale 35 State PM1 PM2 PM3 PM4 PM5 A Excellent Fair Excellent Good Average B Low Average Low Average Low C Average Average Low Average Average D Excellent Fair Average Average Excellent E Average Fair Average Excellent Fair F Average Low Good Excellent Average G Fair Low Low Average Low H Fair Fair Good Average Fair Score Key Score Location Top 10% (5 States) Next 20% (11 States) Middle 40% (22 States) Next 20% (11 States) Bottom 10% (5 States) Rating Excellent Good Average Fair Low
VOLUNTEER RISK AND PROGRAM MANAGEMENT Moving VRPM to SHIP
What is VRPM? 37 Set of state of the art policies and procedures providing a framework for volunteer involvement. Designed to assist and protect both the SHIP/SMP programs, the program volunteers, and the public we serve. Provides a consistent framework for the programs that can be applied nationally establishing a standard of care for the network.
VRPM Connection to SHIP 38 SHIPs and SMP are remarkably similar in structure and operation with the exception that SHIPs are typically much larger. SHIPs have been asking for assistance with volunteer management for years. Many SHIPs are already using VRPM in conjunction with their SMP programs.
VRPM Roll-out to SHIPs 39 Revision of original VRPM policies with SHIP lens; creating a streamlined version usable by both SHIPs and SMPs SHIP and SMP grantees will help with the review and roll-out The SHIP TA Center will provide detailed technical assistance similar to that utilized by SMPs (much of the original technical assistance materials developed for SMPs can be reused) Formal roll-out of the revised policies will be released at the 2016 SHIP/SMP Conference Implementation will be required to begin with FY 2017 grant awards
Questions? Contact Information Rebecca Kinney Josh Hodges SHIP Program Director OHIC Director Rebecca.Kinney@acl.hhs.gov Josh.Hodges@acl.hhs.gov 202-795-7375 202-795-7364