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The Emerging Role of Community-based Agencies in the Managed Care Environment

The Emerging Role of Community-based Agencies in the Managed Care Environment

The term managed care or managed healthcare is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing for profit health care and providing health insurance while improving the quality of that care (“managed care techniques”).  

It has become the essentially exclusive system of delivering and receiving American health care since its implementation in the early 1980s.  Over the past thirty years managed care has continued evolve.  According to the trade association America’s Health Insurance Plans, 90 percent of insured Americans are now enrolled in plans with some form of managed care.  While state government have mostly “carved out” vulnerable populations from managed care arrangements, 26 states have contracts with managed care organizations to manage long-term care services for the elderly and individuals with disabilities. Today, as part of a national trend, this is changing.  States are slowly starting to move vulnerable populations such as children and adults with disabilities and individuals with mental health issues, into managed care systems.

This far-reaching change has significant implications.  Managed Care companies are been reaching out to the traditional providers of care to these populations, creating partnerships that will, I believe change the provider landscape. As the Fedcap Group is immersed in preparation for these changes, we are also advocating for the way that they unfold.   The populations that will be moved into managed care arrangement often face social barriers and have chronic, complex conditions. Effective care coordination is imperative to meet the needs of these individuals and requires strong relationships between medical providers, insurance companies, social service agencies, and individuals and families. Further, we are interested in exploring the social determinants of health, which research suggests are the “secret sauce” of truly improving population health, patient experience, and the cost of care. These social determinants include such things as:

    • Availability of resources to meet daily needs (food, transportation, housing);
    • Access to affordable education;
    • Access to job training and employment opportunities;
    • Availability of community-based resources;
    • Social supports; and
    • Socioeconomic conditions (concentrated poverty and the stress that accompanies it).

Comprehensive solutions are needed as vulnerable populations shift  to managed care. With a person-centered focus, state-of-the-art technology, expertise in helping people access benefits, and data to quantify our intervention and prove our impact, we look forward to being part of that solution.

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Organizational Risk Management

Organizational Risk Management

 

Last week, I examined essential inquiry around assessing Strategic Risk Management in a complex nonprofit. It’s equally important for senior leadership to assess and establish a protocol for managing day-to-day Organizational Risk Management. Successful organizational risk management requires its own set of analysis as described below.

1. Do we have an integrated, firm-wide, risk management process?

Effective risk management is achieved through comprehensive risk reporting, governance policies and limits, escalation procedures, action triggers, and dynamic and integrated firm-wide processes.  As a pre-requisite to all of these issues, nonprofits must possess an analytical system capable of properly identifying, measuring, and aggregating all risks across the enterprise.

Equally importantly, an appropriate, “risk mindset” must be adopted throughout the organization. The goal should be that every employee feels they are a risk manager and are responsible to manage the risks that occur on their jobs every day. Once this mindset is in place, risk exposures and the risk analysis of key business initiatives must be routinely and intentionally discussed. Senior Management must also ensure that relevant risk measures are among the key metrics monitored by program managers on a daily basis. Finally, senior management must ensure that risk issues are handled proactively, and communications across program units are open and effective. Red flags to be watched and immediately addressed include 1) excuses that specific risks do not lend themselves to quantitative measurement, 2) that certain risks are the “nature of the business” and therefore should not be monitored or managed, and 3) phrases like “don’t worry,” “this is a low probability event,” or “local managers have it all under control,” need to be stricken from the organization’s vocabulary.  Instituting a rigorous firm-wide risk process also ensures that directors do not start questioning senior managers about risks that the corporation has undertaken only after it is too late.

 

2. Are professionals at all levels empowered and expected to manage risk?

 For the risk management of a large, complex nonprofit to be effective, it must be built not only into every part of the decision-making process, but also every into control mechanism throughout the organization. Common risk management language must be established throughout the organization, along with clearly delegated responsibilities for managing risk at all levels. Finally, leadership and risk management structures must be correctly aligned with the not-for-profit’s business model, and the right balance established between competing priorities and constituencies.

 

3. Do we have an appropriate risk management culture?

There are specific signs that we are on the right track, and that risk management has become part and parcel of a nonprofit’s DNA.  First, leadership must assume the ultimate responsibility for risk oversight responsibility, clear measures of success, using well-understood metrics for risk appetite, and risk limits.

Risk training and awareness programs must also be in place throughout an organization, with senior line managers and risk professionals responsible for formal postmortems of major mistakes. Senior management ensure that management incentives encourage responsible and value-added risk taking, and emphasize the importance of embedded risk management processes in the organization’s decision-making and communications.

With such a risk culture in place, silos will be broken down, open communication will be encouraged, and risk successes will be publicized and imitated. And when this happens, employees will make better decisions, keep their not-for-profit out of harm’s way, and reduce potential legal liabilities and reputational risks.

What is your protocol for both strategic and organizational risk? As always, I welcome your comments.

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Risk Management

In the past few decades, the business landscape for the larger, more complex, nonprofits that provide social services has changed dramatically.

In addition, the integration of social values within for-profit companies has further blurred the line between for-profit and nonprofit organizations, resulting in greater competition in the social services sector.

Equally as important, there has been a major philosophical shift away from contracts that pay for services rendered, and toward contracts that pay based on achieved goals, outcomes, or measurable impact. If, for example, your agency was once paid to provide job training skills, it is now more likely to be paid based on how many clients in your program actually secure employment. Thus, the need to achieve measurable objectives—whether those objectives are commercial or social—is now as much a requirement for nonprofit as it has long been for for-profit organizations. This, in turn, has exponentially increased not only the day-to-day risks of not-for-profits, but in some cases threatened their very survival.

As a result, senior management of nonprofits is faced with a somewhat new and daunting challenge—i.e., the need to create an infrastructure capable of synthesizing vast amounts of information, connecting the dots across myriad of programs, and simultaneously integrating business strategy, goals, and risk management. The failure to do so—at least historically—was usually due to a pervasive fear-based approach that was primarily backward-looking and focused on flat financial metrics and ratios. As a result, hidden risks were often left uncovered, problems that kept organizations from achieving their goals were not anticipated, and risk mitigation strategies, if any, were ineffective. Risk management, in fact, whether adapted to for-profit or not-for-profit enterprises, requires a forward-looking approach—one that is integrated with business strategies and goals to achieve measurable results in a continually changing environment.

Therefore, the new risk paradigm for nonprofits forces management to consider two separate aspects of risk management—the first strategic, and the second organizational. Succeeding in the former requires thinking about risks throughout the organization.  Succeeding in the latter entails the creation of a risk-centric culture, both empowering management and employees to effectively deal with risk and demanding that they execute enterprise-wide initiatives related to those risks.

Turning first to Strategic Risks, management must begin with a short inquiry:

 1. Do we fully understand our risk exposures?

Senior managers need to ensure that all risks facing the enterprise have been properly identified and measured, beginning at the business unit level where program managers intimately familiar with their individual landscapes can adopt an appropriate risk management framework and establish an ongoing risk-based dialogue with the senior management. Together they can then discuss current and emerging risks in detail, establish risk limits, and put specific action triggers into place.

From there, it is critical to establish an enterprise-wide view of risk. Once defined, the strategic implications must be contrasted with resource adequacy and availability, leading to a clear understanding of how risk can and ought to be managed.

Given the complexity of the modern world, senior management must also regularly devote time to discussing the so-called unknown unknowns—events and risks beyond the scope of traditional discovery processes and systems. For example, an acknowledged but unknowable unknown in a not-for-profit might involve apolitical or philosophical change in the way state and local governments view their funding, emerging business models, or changes in the competitive environment (including for-profit service providers).

2. Are our risk exposures appropriate to our objectives, our appetite for risk, our resource levels, and our desire for long-term sustainability?

In addition to proper risk identification and measurement, senior management must establish an explicit link between risk, resources, and strategy. To avoid surprises and ensure that a not-for-profit does not respond to pressures through blind risk and leverage, the organization’s risk appetite must be fully aligned with funding and service targets. Senior management must fully understand and approve the amount of risk required to achieve the organization’s stated objectives and goals.

3. Is our organization adequately dynamic from the viewpoint of risk management?

The lack of organizational dynamism—a company’s ability to detect coming crises and environmental changes, understand their potential impact, and develop the agility to react in a timely fashion—was a common feature of for-profit companies that failed during the recent financial crisis, and not-for-profit companies whose traditional approach no longer worked in the post-crisis environment.

Senior management can and should play an important role in ensuring that a company is well-prepared to withstand volatility, crises, disruptive technologies, and the changes in the market, and in its competitors. An integrated risk management framework, early warning systems, and comprehensive contingency plans must be continually reviewed by senior management and the board of directors and included in all strategic discussions.

4. How do risk and uncertainty factor into our strategic decisions?

Strategic decisions—again, in the public as well as the private sectors—have often been focused on business and customer strategies, new product development, and pursuit of market share, with risk management remaining an afterthought—that is, a sort of police function used to check on safety and soundness only after strategic and investment decisions had already been made. To remedy this after-the-fact approach, the role of risk in a not-for-profit’s business model must be continually reevaluated by senior management, thus making risk management an input into strategic decisions and governance.

Continually asking fundamental questions in rigorous yet practical ways vastly improves the effectiveness of senior management, helping them steer their not-for-profits through the ever more difficult conditions of the modern global environment.

Next week we will explore Organizational Risk.

As always I look forward to your comments

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Celebrating the Power of Possible

Celebrating the Power of Possible

Possible [pos–uh-buhl]

  1. being within the limits of ability, capacity, or realization
  2. having an indicated potential

Every day here at Fedcap, we experience the Power of Possible. We hear story after story of individuals—and their families—who have crossed the threshold from thinking that their recovery, their re-integration into society, their ability to live and thrive alongside their disability, or even their ability to get a job were once just a dream—and who now know that they have a future that offers promise, economic well-being, and hope for a new path to dignity and worthiness. They have persevered and triumphed. And they have won.

In a little over a month, we will be hosting our annual Gala in what will be a magnificent celebration of the Power of Possible. We will be celebrating the lives of those individuals who have experienced  transformation and those whose lives have been changed because someone believed in them.

One such success story belongs to Fernando Santiago. Fernando says, “It was easy to fall into the wrong crowd,” growing up where he did in the Bronx. Living in a tough neighborhood riddled with crime, he, too, ended up breaking the law, selling drugs and ultimately landed in prison. The statistics tell us that recidivism among men is 40% within three years of release. But Fernando beat the statistics. He got training and skills through Fedcap Career Design School and learned custodial skills. And, it is because he had the right tools at the right time with the right kinds of support that Fernando went from potential statistic to thriving individual who today, has employees depending on him and his strong leadership. His is a story of the Power of Possible.

Here is Fernando’s story.

Stay tuned to more stories in the coming weeks as we gear up to celebrate The Power of Possible.

Each one of us—through our support, our interest, and our contributions can also become part of the movement that is the Power of Possible.

How might you contribute to transforming a life and helping to create a Power of Possible story?

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Creating an Entrepreneurial Culture

Creating an Entrepreneurial Culture

“An entrepreneur always searches for change, responds to it, and exploits it as an opportunity.”                                                                                                                                                                  — Peter Drucker

When one thinks of entrepreneurship, one thinks usually of a “fast” company—one that is steeped in product resources and that holds profit as the top and bottom line. But entrepreneurship is not relegated to fast-paced for-profit organizations. For a nonprofit organization to thrive, entrepreneurship must be woven into the day-to-day fabric of our work.

It isn’t enough to invite our staff to “be” entrepreneurial. Instead, we must work together to build an entrepreneurial culture so that it is embedded in the conversations about the what, the why, and the how of our mission and vision.

What does it look like to promulgate an entrepreneurial spirit and culture in a nonprofit?

To be entrepreneurial, we must talk as entrepreneurs do. This means actively and intentionally looking at a variety of factors:

First, are we questioning the status quo? Are we asking questions that assure us that we are working to solve the right problems? Is the way we’ve always done things the right way to address the problem we are working to fix? And importantly, how do we know? Have we analyzed and examined the politics, policies, and practices that affect the populations we serve? Have we talked with our consumers, outside stakeholders, and colleagues in the field?

Second, are we cultivating a spirit that invites innovation? Are we ensuring that our staff—at every level—feels safe in introducing a new idea? Are we encouraging our staff to share their learnings? Is there a regular forum for sharing what we’re learning? How do we incorporate our learning into our work so that we’re not just talking about new ideas, but we are implementing them?

Third, are we inspiring an internal culture that embraces—and seeks—risk?  Are we openly talking about risk on a regular basis? Are we experimenting with rapid-paced pilots or projects that we can assess and potentially spread throughout the organization as a way to balance the tension between trying something new and managing outcomes?

Fourth, are we using data and metrics—both quantitative and qualitative—to measure our success? Is process improvement a regular part of our lives? Do we know what measure of data we would need to determine that we need to do a rapid course correction?

These are four of the essential elements of entrepreneurship. Asking ourselves these questions on a regular basis will help cultivate a spirit of entrepreneurship as well as establish a culture that embraces change on a daily basis so that we continue to learn and to grow.

What are some  other questions you might consider as you cultivate an entrepreneurial spirit?

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Leadership

Leadership

Last week, we held a Leadership Forum for staff from across our growing family of agencies. In it, we started planning for 2025, explored trends in the nonprofit marketplace, in human resources, in technology, in government funding and we identified strategic directions.  We then identified the DNA of leaders required to effectively advance us toward our goals.

Included in that DNA are vision and the ability to operationalize that vision, integrity, influence, analytical skills, compassion, resilience, and the skills required to drive change.  AND in addition, we discussed two traits absolutely critical to leadership: the willingness to stand for something and the ability to take bold, yet calculated, risks.

I’ve heard many leaders pay lip service to the idea that they want their “followers” to disagree with them. However, what I’ve discovered in my career is that while many say that this is what they want, in actuality, they want to have the people they lead follow them by operationalizing their vision.   There’s absolutely nothing wrong with that, but frankly, I prefer people who really will disagree with me.  I want to be shown a better way, invited to a wider vision.  I want to engage in discussions where staff share perspectives different from my own. I want to work with people who have different backgrounds, experiences, and expertise. I want the people I work with to be here because they stand for something and because they will be fierce in standing for what they believe.

It is in this diversity of perspectives that we are truly better together.

Besides leaders who stand for what they believe, we also need leaders who are able to see the ways the environment is rapidly changing and are able to call forward the next “thing.”  We need people who can understand the environment enough to take smart, planned risks— understanding that without some degree of risk there is no future.  We need leaders who are students of their profession, who never stop learning and as such, the risks they take are based on knowledge, wisdom and instinct.

What do you stand for? What risks do you take in your organization? What is the DNA of your leadership?

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Busting the Myths around Employment of Those with Disabilities

Busting the Myths around Employment of Those with Disabilities

I am so looking forward to our Solution Series discussion next week on the Employment of People with Disabilities. (See info below.) This exciting panel discussion is an opportunity for the business community to hear the compelling arguments about why it is not only a socially responsible practice to hire those with disabilities, but also why and how it is a proven boost to the bottom line.

There are some perceived myths about hiring those with disabilities. Those perceptions only add to the stigma that we spend every day here at Fedcap trying to dispel. Next week, we will be hearing more from business leaders about their own experience with increasing the bottom line based on their hiring of people with disabilities. Here are some of those perceptions and some realities that disprove those misconceptions:

Myth: “We need fast workers! The person with a disability will slow us down.”

The Reality: Those with disabilities are generally better able to solve problems—and quickly. They have had to navigate barriers that many of us don’t see. They have had to find short cuts, workarounds, and process improvements—many times just to perform daily tasks with ease.

Myth: “It will cost me too much to install expensive accommodations—way beyond ‘reasonable.’”

Reality: According to the President’s Job Accommodation Network Committee (courtesy of AMSVan), beyond employer-required ADA accommodation, most individuals with disabilities do not require special accommodation. Of those who do, 50% cost $500 or less, 12% cost between $501 and $1000, and 22% exceed $1000. These are small investments given the overall contribution to the bottom line.

Myth: “My workers’ comp payments will go way up.”

Reality: Actually, there is no difference in workers’ comp claims between those with disabilities and those without.

Myth: “Those with disabilities will call out sick more often.”

Reality: Statistically, there is no difference in absenteeism between those with or without disabilities.

Myth: “I can’t count on the job performance of those with disabilities.”

Reality: A Dupont survey of 2,745 employees with disabilities found that 92% of employees with disabilities rated average or better in job performance compared to 90% of employees without disabilities. Surveys by Walgreens, 3M, AT&T, Pepsico had similar findings.

Another reality about hiring those with disabilities is that employers, once leery about hiring, discover that as they get to know their employees and get to see the type of commitment and work that they do, they become champions of hiring those with disabilities. Part of the problem is lack of exposure to this segment of the workforce. My own experience bears out the statistics and realities I’ve outlined. Hiring those with disabilities isn’t just a socially responsible thing to do—but it contributes mightily to the culture and to the bottom line of any organization.

There’s still time to register for our Solution Series on the morning of October 3rd at the Mutual of America building on Park Avenue. Our roster of speakers represents business, government, and foundations all united in common commitment to educating employers about the benefits of hiring those with disabilities. This forum promises to be fascinating. I urge you to join us!

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The Next Chapter in Business Innovation: Hiring Those with Disabilities

The Next Chapter in Business Innovation: Hiring Those with Disabilities

Hiring and engaging people with disabilities isn’t about being nice, or being charitable. It’s smart business that can positively impact your bottom line and your talent needs from the mailroom to the boardroom.

Kris Foss, Managing Director, Disability Solutions @Ability Beyond

On October 3rd, we will be hosting our 14th Solution Series—an initiative of our Community Impact Institute, which is the research and innovation arm of our work here at Fedcap. The Solution Series convenes business, thought leaders, academia, and policy makers to engage in a conversation about  issues affecting business in the 21stcentury .   From the conversations we have in this forum come ideas, systems, programs, and solutions. The Solution Series events are among the high points of our year.

This fall’s series is entitled Employment of People with Disabilities: Moving Beyond Social Responsibility to a Business Solution. I am particularly excited about this forum as it reflects the heart of our work here at Fedcap.   There are close to 40 million people in the U.S., about 12.6 percent of the population, living with a disability. These individuals – your sisters, brothers, neighbors, parents, friends and colleagues – can perform the same work as people without a disability. Yet as of May, 2016, the US Bureau of Labor cites that only 28.3 percent of working-age (16-64) persons with a disability were employed, compared to an employment rate of 72.3 percent for those without a disability in the same demographic. By not integrating people with disabilities more fully into the workforce, we are neglecting a source of energy, productivity and talent that could address the needs of business in the 21st century. The social and economic vitality of our nation is also impacted. The poverty rate for people with disabilities ages 21 to 64 is 28.8 percent – higher than any other demographic group – compared to 12.5 percent for individuals without a disability. Their average annual income is $38,300, $5000 less than their peers without disabilities.

But there is reason for optimism.  On our panel are national experts and business representatives who will highlight efforts being made across the country to significantly expand the number of people with disabilities who are employed.   The business case  for doing is strong.  Hiring people with disabilities reflects a clear commitment to creating a more diverse workforce which in turn delivers a better return for shareholders.  To not hire people with disabilities means missing out on an untapped pool of creative, educated, and experienced individuals who bring a critical perspective to the workplace. For example, generally speaking, people who are living with disabilities tend to bring with them an innovative mindset. Because they have had to navigate a world that is often not easily accessible, they have had an opportunity to build resilience. They have often worked hard to find solutions to a variety of challenges those without disabilities may have never considered. Kevin Cox, the Chief HR Officer at American Express, suggests that hiring people with disabilities is the “next frontier” in business. He believes—and has proof—that hiring those with disabilities has improved the overall culture of the organization and has clearly impacted the company’s bottom line.  This has been my experience as well.

There’s still time to join us for this informative, engaging, and important discussion.  Please click here to register for this timely event on October 3rd in Manhattan. I look forward to a great discussion and I hope to see you there.

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Organizational Alignment: Flexible Talent is Key

Organizational Alignment: Flexible Talent is Key

My colleagues often hear me say that our growth is about looking forward—not looking in the rearview mirror.   What I mean is that we have to be continually looking down the road at what environmental, political, cultural, and evidence-based practical changes are taking place in our nonprofit landscape.  If we are not looking ahead, we are missing out on opportunities to meet the needs of our constituents.  We are also missing out on excavating the skill sets, the capabilities, the processes, and strategies that ought to be in place in order to keep up—and lead—the relevant solutions to community and societal problems. And, as we evolve and grow, we need to ensure that all of these systems and processes are growing along with us. Otherwise, we are doomed to play catch up, which will result in stunted growth.

Creating and capitalizing on opportunities requires that our organization works to be a nimble, agile institution.

As leaders of an organization, it is our charge to inspire a mindset and a culture that is steeped in flexibility, one where leaders are able to take in new information rapidly, assess its relevance and importance, and then make smart data driven decisions.

This type of flexibility requires a specific type of talent and the ability to build the “muscle” in the form of skills that will meet the future.  Hiring talent who are experts in their respective fields, and who have the ability to stretch themselves, to hone the skills to see around the corner, take calculated and well-thought out risks is critical to organizational long-term success.

This type of talent is not easy to find and not readily discernible in the traditional interview process.  Knowing what to look for, too, requires stretching of leadership muscles. Over and above content expertise is the need to work with staff who think critically, who are brave, and who are willing to challenge the status quo. We look for individuals who are unafraid to ask the hard questions, who will inspire innovation and risk-taking, and who are capable of managing that risk from a multifaceted lens—including financial, reputational, and existential forecasts. This approach to our talent is the foundation of Fedcap’s organizational DNA.

I attribute the success of Fedcap over these past 80 plus years and our recent growth surge to an overarching culture of courage, calculated risk management, and to a flexible mindset and capacity of our staff.

What is it like in your organization? Your department? Your lens? Do you cultivate a flexible mindset and culture? If so, how does that translate into your day-to-day operations?

As always, I welcome your thoughts.

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The Cornerstone of Success: Inspiring Confidence in Others

The Cornerstone of Success: Inspiring Confidence in Others

Everybody wants to be somebody. The thing you have to do is help them build  confidence in their ability to succeed.  – George Foreman

As a nonprofit agency, we are in the business of helping others recognize their strengths and find the most effective tools for every individual to overcome barriers to economic well-being.

Our family of agencies all have in common the commitment to help those we serve through hands-on, one-on-one connection and through advocacy and influence of policy and leadership. Our goal is to provide leadership—as a model nonprofit agency, as leaders of our organization, as service providers, and as mentors to help guide others to their greatest potential.

Common among our work—as providers, advocates, influencers, and mentors is the call to inspire confidence. So many people come to us with the belief that they are not capable of accomplishing their goals or dreams. We offer them the skills, tools, opportunities, resources, and connections to help propel them forward. But we can’t give them what they must find in themselves. We can’t give them confidence. But we can do the next best thing. We can inspire confidence.

There isn’t one among us who hasn’t feel unsure at some point in our lives. Throughout my life, I’ve discovered common elements that have given me confidence or that have helped me help others feel more sure of themselves and willing to take the next step.

The first element is quite simply: care.  And while most of us in the nonprofit world enter this field because we care deeply about the mission and the work and each individual we serve, sometimes it doesn’t always show. We can get bogged down with our day-to-day work and the sheer numbers of people we are seeing and the paperwork and the follow up that we can forget to show our care. But this is a critical piece of inspiring confidence. We show those with whom we interact that they are worthy of our care, that they are equals, and that we are partners in solving whatever issues are present for them.

Closely linked and clearly essential is connection. This means finding something in common, relating, and acknowledging that connection. Pursuing connection makes the work more meaningful for us and it inspires confidence in others. When one feels connected to another, when she or he feels that someone else will remember us and is rooting for us, we want to do our best and we are propelled to action. And, of course, action is a building block of confidence.

Caring and connection are both foundational elements to inspiring confidence. But of course, the tangibles, like skill-building and competence are also key. Clearly, when one has learned—and tested—a skill—whether it be a work-related or a social skill—there is more confidence. Competence is closely related to confidence.

In addition, calling out individuals’ strengths is another building block to confidence. When we ask people whom we serve about their greatest strengths, often it is the first time they are considering the question. And, often people don’t consider the things that come easily to them as strengths. It is our job to help bring those strengths to light.

While caring and connection and competence and calling out strengths seem like very basic blocks, they need to be intentional actions that we take every day—with our teams, with those we serve, and even with our families. These intangible pieces, while immeasurable, are the “secret sauce” to helping propel others in reaching their potential.

As always, I welcome your thoughts

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