Preparing for the Ticket to Work
Dan O'Brien, OK VR
Oklahoma KEYS to Employment
·
One of 12 SSA funded State
Partnership Agreements, 6 additional funded by RSA
·
Oklahoma Department of Rehab
Services
·
Purpose
·
Inform consumers, advocates and MH
Staff on the value of work in recovery and use of WI’s
·
Facilitate Medicaid buy-in
Oklahoma
·
Pilot Several Ticket
Implementation Issues:
·
Response Rate, effect of assertive
engagement
·
How Choice can be facilitated -
Report Card
Oklahoma Ticket Pilot
·
SSA selects names of newly
approved or re-approved (CDR) SSI and SSDI beneficiaries who have a primary
diagnosis of Schizophrenia or Affective disorders.
·
KEYS Project Coordinator randomly
selects control group - experimental design
·
WI Contractor invites selected
beneficiaries to a Work Incentive Education Meeting - with Consumer Trainers
·
OK KEYS Voucher (Ticket to Work)
·
Choice of 4 Vendors
·
Vendor Past Performance Report
Card
·
Consumer Assigns Voucher to Vendor
·
Enrolled by VR who pays 6
Milestones
·
SSA funds used for Quarterly
Ongoing Support Payment
OK Pilot Milestone Payments
·
Six Milestone Supported
Employment payment structure + Ongoing Support
·
Determination of Needs - 10% of
Bid $650
·
Vocational Preparation - 10% of
Bid $650
·
Placement 3rd day of work- 10%
“
$650
·
4 Weeks Job Retention -
20% “ $1,300
·
Stabilization 10 weeks work - 20%
$1,300
·
Rehabilitated 6 months work - 30%
$1,950
Total
=
$6,500 BID
·
Quarterly Job Retention Payment -
SSA Funds - $400/Qtr.
Work Incentive Meeting
·
Trainers and Exemplars/Role Models
explain value of work as part of recovery
·
Trainers review SSI/SSDI work
incentives
·
Trainers review “average”
scenarios using VCU’s WorkWORLD software
·
OK Ticket to Work vouchers and
Provider Report Cards distributed
·
The Four Providers explain their
programs
·
Consumers assign their voucher to
Provider
Assertive Engagement
·
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 give home visit
·
Repeated attempts at contact for
three months
·
If no response, refuse or don’t
assign voucher, beneficiary goes on inactive list
·
About 1/3 of invitees attend a
meeting
OK KEYS Voucher
·
Individuals who get Ticket but
don’t assign it get reminders and follow-up questionnaire
·
If no response Ticket goes
inactive after 30 days - can be reactivated or reassigned at consumers request
·
Once beneficiary is working job
satisfaction questionnaire for Report Card at one month and six month of work
·
Preliminary Project Results after
7 months
·
323 Beneficiaries Invited to a WI
meeting
·
28 Work Incentive Training
Sessions held
·
Beneficiaries attended meetings
·
14 WI Home Visits using Work World
·
96 (30% of total) took a
Vocational Voucher
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
·
CBO’s Milestone Fantasy
·
6 weeks Job Retention - $500
·
9 months of work at SGA/ 0
Benefits - $1000
·
Job Retention Payment for 60
months @ $258 SSDI/$175 SSI per month at $0 Benefit Level
Ticket to Work Voucher (Dan’s
Milestone Fantasy)
·
Voucher worth $17,000 SSDI/$12,000
SSI for milestone + outcome
·
Placement:
- $500
·
6 weeks Job Retention - $1000
·
18 weeks Job Retention-$1500
·
39 weeks Job Retention - $2000 (9
mo. SGA, $ 0 benefits)
·
Quarterly Job Retention Payment
for 20 quarters @ $600 SSDI/$350 SSI per quarter
Ticket to Work Voucher (Dan’s
Nightmare - SSI )
·
Real Cost of 9 month of Voc. Serv.
= $5,000-10,750
·
Voucher worth $12,000
·
9 Months Milestone Payment -
$4,000 (qualify for 0 benefits)
·
Quarterly Job Retention Payment
for 20 quarters @ $400 per quarter
·
Deficit @ 9 months
$1,000-$6,750/worker
·
Break even point about 2-4 years
cumulative work at $0 benefit level
Risk Management - Vendor
·
Deferred Payment Risk
·
Break even point is 2-4 years of
employment
·
Option 1 - Profile/Cream the
$1,500 Clients
·
Option 2 - Forward Fund - risk
assessment
·
Option 3 - Only accept Ticket for
individuals you intend to hire - ex. NISH
·
Option 4 - Bill Medicaid for part
of the cost of getting to 9 months - case management
·
Option 5 - Join a publicly
financed Employment Network - WIA, VR, MH/DD
States with Milestone based rates
·
VR Milestone Employment Networks
·
Oklahoma, Massachusetts, Alabama,
Delaware, Louisiana, Pennsylvania,
·
States working on it - Virginia,
Kansas, Texas, New Mexico, Missouri, Florida,
Indiana, California (region)
·
MH Vocational Milestone Networks
·
Terrant Co. Texas, NY State OMH,
Texas MH/MR
·
To Make the Ticket viable in your
state DMH needs to establish a Empl. Network
Overview of Milestone Concept
·
Based on incentive payments for
outcomes
·
Win/Win/Win
·
Consumers
receive quick, quality service
·
Vendors
receive adequate compensation, less
regulation and greater flexibility
·
Funding
Agency purchases outcomes not process, achieving better results at lower cost
with greater accountability.
Definition of a Milestone
·
An important event or turning
point in a lifetime or career.
·
Three Levels of Milestones
·
The BIG
Milestone - such as 12 cumulative months of employment or starting a career that
leads to improved self esteem and identity shift.
·
The small milestones or steps
that help reach the BIG Milestone.
·
Ongoing
milestones related to maintenance of
the Job and Career advancement.
Risk Sharing - Milestones
·
Milestones - Win/Win situation
·
Increases competition - Lowers
barriers to small Vendors by reducing capital requirements
·
Meets funders need for
accountability
·
Vendors for liquidity - cash flow
Planning the Change
·
Executive authorizes change and
timetable
·
Executive delegates planning to
cross-functional team and sets parameters
·
Planning Team
process-6+meetings/3+mths
·
Develop operational definitions
for outcome(s)
·
sub-divide into incremental
steps/Milestones
·
develop payment % for each
step/Milestone
·
define quality indicators for
Milestone paymnts
Grant Revell (VCU) How To’s
·
Define the specific outcome
desired
·
Define the Payment Units or points
·
Establish a cost or percentage for
units
·
Establish the total cost of final
outcome - bid or cost averaging
·
Add any supplemental services
The Solution - Planning
·
Cross-functional teams - Agency
+Vendors +Stakeholders plan the incentive structure
·
All planning partners agreed to
create a system which will meet customer, vendor and agency needs
·
Committed to collaboration and
negotiation
·
Resulted in less resistance to
change
Stakeholder Planning
·
A stakeholder is a person who has
an interest in a business, project or task of major importance.
·
By collaborating we can distill
the wisdom of the different perspectives and create a WIN/WIN situation for all
stakeholders.
·
Collaboration - To work together
·
Consensus - to think together and
consent to the final product.
Planning Principles
·
Equality of all partners
·
Every participant has wisdom to
bring
·
Decision making by consensus
·
Integrity and Transparency
·
Rules and Decision boundaries
should be clear
·
Decisions should be recorded at
meetings
·
No changes without consultation
·
Simplicity - simplest solution is
the best
Website Address:
·
www.milestonemanagement.com
e-mail:
(Dan
O’Brien)
or
(Becky Cook)