Choice and the New Rehabilitation Market Basket

1
Choice and the New Rehabilitation Market Basket

• Susan Stoddard
• InfoUse

2
VR and the market model

• Will informed choice lead to changes in services
  in the community?
• Will consumer demand re-shape the supply of
  rehabilitation services?
• What does this mean for the rehabilitation system?

3

• Demand and Supply
• Consumer demand for goods and services
• Needs
• Preferences
• Desires
• Budget
• Providers and vendors meeting the need for goods
  and services
• Price
• Quality
• Features
• Benefits

4
Demand conditions in the market model,
consumers need

• Information on alternatives availability, price,
  quality
• Be able to evaluate results
• As a group, control of enough resources to make
  the system respond
• As a group, enough leverage to influence resource
  decisions

5
Demand, Continued

• Cost of change facing consumers is not
  prohibitive
• Consumer is free to change or to enter the
  marketplace

6
Supply Conditions

• Alternative choices available among providers
  /vendors
• Providers and vendors have freedom to offer
  significantly varying products
• Costs of entry into system with innovative
  products not prohibitive

7
Options for designing a CHOICE model that
stimulates market response

• What can the consumer purchase?
• Where can the money be spent?
• Is price regulated, or determined by the market?
• Who is eligible for choice?
• What is the amount that can be spent?
• Who is paid?
• When are payments made?

8
Design Options cont.

• How is supply quality assured?
• Can suppliers screen consumers?
• What consumer information is available?
• Is the buyer identified as a client?

9
Choice demonstrations seven models

• Three VR agencies, four independent organizations
• Variations in staffing, consumers participating,
  approach to choice
• See InfoUse, Evaluation of Choice Demonstration
  Projects Report and Manual

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Promising practices

• Innovative outreach and expedited eligibility
• Empowerment training
• Helpers and coaches
• New methods for planning
• Self-employment
• Payment systems, checks
• Provider recruitment, open provider system

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Methods for qualifying providers

• Vendor orientation
• Vendor lists
• Open Market
• State Bid System
• Use accredited or licensed providers

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Strategies for developing provider pools

• Rely on existing relationships
• Recruit new types of providers
• Rely on the open market

13
Pricing and payment methods

• Cash
• Reimbursement
• Purchase orders
• Negotiated prices

14
Patterns of Purchasing in the Choice
Demonstrations

• Case file extraction
• to create a purchased service data set
• 30-34 consumers in each of 7 Choice models
• What was purchased?
• From what type of provider?
• At what cost?
• Identify how Choice dollars were allocated by
  Choice participants, through their purchases

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Annual purchases

• Overall average purchased services 1,700 per
  year per participant (for national VR, average
  annual purchased services cost per consumer was
  997)
• Project average annual purchased services ranged
  from 654 to 3,306 per year per participant

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How purchased services dollars were used
overall

• Business/voc training
• College or University
• Voc assessment
• Job placement services
• Job-finding services
• Computers
• Assistive Technology
• Self-employment inventory
• Maintenance
• Other

• 14
• 8
• 11
• 9
• 9
• 9
• 7
• 6
• 5
• 27

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Overall purchase allocation
Pie chart showing percents from prior slide
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Arkansas Rehabilitation Services

• Business/voc training
• College/University
• Maintenance
• Assistive Technology
• Assessment

• 30
• 13
• 17
• 7
• 7

19
Vermont DVR

• Assistive technology
• Self-employment inventory
• Business/voc training
• College/University
• Maintenance

• 21
• 11
• 9
• 8
• 9

20
Washington State DVR

• Other services
• Job-finding services
• Computers
• Self-employment inventory/start-up
• Grooming/clothes

• 22
• 15
• 5
• 7
• 7

21
BCIL

• Business/voc training
• Computers
• College/University
• Self-employment Inventory/set-up

• 28
• 25
• 19
• 13

22
Southwest Business, Industry and Rehabilitation
Association (SWBIRA)

• Assessment
• Job Placement
• Job-finding services
• Assistive technology

• 39
• 19
• 19
• 5

23
The Development Team, Inc. (TDTI)

• Computers
• Motor Vehicle purchase
• Assistive technology

• 39
• 20
• 8

24
United Cerebral Palsy Associations (UCPA)

• Job Placement
• Job-finding services
• Assessment

• 50
• 25
• 13

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Service rules shape consumer choice

• The way that each model defined its rules led
  to different patterns of purchasing
• These demonstrations were limited in size, and
  their market impact was not great.
• Larger impact on local supply can be expected if
  VR changes how and what it buys

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Rehabs purchasing power

• 1996 section 110
• Total Purchased Service Costs 1,449,325,059
• (purchased service costs include expenditures for
  public and private rehab facilities, other
  services, public vendors, and other private
  vendors.)

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• Choice of choice model will greatly influence
  services and purchases
• Patterns of purchase may change the face of local
  supply.
• Prepare consumers to use market to gain outcomes
• Which providers will succeed in a market model?

28
Market Outcomes

• Personal outcomes. What are the individual
  outcomes of new choices?
• System outcomes. How do these choices shape the
  rehabilitation system in our states? In our
  communities?