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STATE OF THE SHIP: WHERE ARE WE GOING?

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(1)

STATE OF THE SHIP:

WHERE ARE WE GOING?

(2)

Agenda

SHIP Evaluation Overview

Mission, Vision, and Strategic Objectives

Performance Management Improvement System

Volunteer Risk and Program Management

Questions

(3)

INTRODUCTION OF THE

EVALUATION

(4)

Why do a program evaluation?

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

(5)

What did we do?

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

(6)

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),

(7)

As-Is - Themes

(8)

As-Is Themes:

8

# Theme

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 2 3 4 5 6

(9)

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)

Theme 2: Currently, the long-term mission, vision, operating principles and objectives for the SHIP have not been clearly articulated.

10

 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)

Theme 3: ACL depends on CMS and other federal agencies for information and infrastructure critical to the SHIP network.

11

 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).

(12)

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.

4

Aging 67%

Insur. 33%

Location of SHIP Grantees

Co-Located 48% Not Co-Located 52% Co-location with SMP

(13)

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

(14)

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.

(15)

MISSION, VISION, AND

STRATEGIC OBJECTIVES

(16)
(17)

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

(18)

Strategic Themes & Goals: The strategic themes highlight our areas of focus and goals explain the desired outcomes in each area.

18

Strategic Theme Goals

Service Excellence

1. Consistently and confidentially provide accurate, objective, and comprehensive information and assistance.

2. Promote awareness, knowledge, and visibility of the program.

Capacity Building 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

(19)

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

(20)

Initiatives: Initiatives provide how we will achieve the goals and objectives.

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

VRPM

1.1.2 Set program

expectations at all levels, and periodically meet to assess and reassess

expectations

performance measures; grant terms and conditions; applications; project officer guidelines

1.1.3 Develop and execute a communication plan for all levels

Conduct ACL monthly SHIP Director calls

1.1.4 Develop standard operating procedures for OHIC staff

Standardize OHIC Project Officer job descriptions

(21)

Setting this in to practice…

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.

(22)

So, what are we asking SHIPs to do?

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?

(23)

PERFORMANCE

MANAGEMENT

IMPROVEMENT SYSTEM

(24)

What do the measures look like now?

(25)

Current Performance Measures and Weights

25

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 10%

3 Substantial, personal, direct client contacts per 1,000 Medicare beneficiaries in

the State 15%

4 Contacts with Medicare beneficiaries under age 65 in the CMS-defined Disabled

program per 1,000 Medicare beneficiaries in the CMS Disabled program 10% 5 Low-income Medicare beneficiary contacts and/or contacts that discussed

low-income subsidy (LIS) per 1,000 low-low-income Medicare beneficiaries 15% 6 Contacts with one or more qualifying enrollment topics discussed per 1,000

Medicare beneficiaries 10%

7 Contacts with one or more qualifying Part D enrollment topics discussed per

1,000 Medicare beneficiaries 10%

8 Total number of counselor hours per 1,000 Medicare beneficiaries 10%

(26)

County Groupings into “Slices”

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.

(27)

Scoring

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.

(28)

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

(29)

Aligning Metrics with Strategic Objectives

(30)

New Metrics

30

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)

PM1: Client Contacts

Percentage of persons reached through presentations, booths/exhibits at health/senior fairs, and enrollment events per Medicare beneficiaries in the State. (unchanged)

PM2: Outreach Contacts

Percentage of contacts with Medicare beneficiaries under the age of 65 per Medicare beneficiaries under 65 in the State. (unchanged)

PM3: Medicare

Beneficiaries Under 65

Percentage of low-income, rural, and non-native English contacts per total “hard-to-reach” Medicare beneficiaries in the State.

PM4: Hard-to-Reach Contacts (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.

Pilot PM6: Beneficiary Part D Savings (NEW)

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).

(31)

What does the broader system look like?

Performance Measure System

Improvement

(32)

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

(33)

Eliminating Performance-Based Funding

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.

(34)

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.

(35)

Example of Likert Scale

35

Score Location Rating

Top 10% (5 States) Excellent Next 20% (11 States) Good Middle 40% (22 States) Average

Next 20% (11 States) Fair Bottom 10% (5 States) Low

Sco

re

K

ey

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

(36)

VOLUNTEER RISK AND

PROGRAM MANAGEMENT

(37)

What is VRPM?

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.

(38)

VRPM Connection to SHIP

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.

(39)

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

(40)

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

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