individualised services – what’s the buzz?
As mental health providers and practitioners come to terms with more individualised policy settings they can look to the learnings of their colleagues in aged care and disability for a bit of a head start. Whilst the mental health reforms don’t quite go to the point of consumer controlled funding there are many similar features, and the large possibility that it may head there in the future.
For those of you who haven’t got easy access to in house info here is a quick look at some of the typical challenges you might expect to see.
you’ve just undergone an engine replacement, not an oil change
The introduction of individualised services will affect your business model. In many cases this is a move from a “B2B” model, where organisations transact with each other around the client, to a “B2C” model where you transact directly with consumers. Don’t under estimate what a significant rewiring this is of all parts of your organisation. It means thinking about mindset, performance metrics, reward systems, financial accounting methods, marketing, delivery channels, processes – the list goes on.
the mantra of flexibility and choice doesn’t extend to providers
Under traditional block funding models, providers have had greater flexibility to manage dollars to meet different client needs. This meant the provider had the capacity to adjust to individual circumstances as they saw fit (a double edged sword). When done well it allowed providers to ration and manage resources across their client base often with very good results. Under individualised models where dollars are attached to an individual much more directly, there is far less capacity to move dollars between clients. Cross subsidy or population based thinking may be a thing of the past for commissioned providers. Primary Health Networks could step into this role but for them to succeed will require a new understanding between different actors, including a renegotiation of how information flows across the system.
consumer expectations may not change immediately but they will change
Policies that encourage a purchaser:provider relationship bring with them a different set of behaviours from those you see under universal access settings. Expectations change as consumers or their carers participate in the financial transaction and learn the true monetary value of a service. It encourages consumers to compare cost and experience across providers and reach judgements of relative value. In aged care, consumers are shopping around so they are often well informed purchasers. Brokerage providers are emerging, and it is foreseeable that some of the contemporary models common in commercial professions (like freelancer and uber) will make their way into complex service sectors like aged care, disability and mental health.
you are about to swallow a whole new dictionary
Whether stated openly or not, individualised funding models are at least in part premised on the idea that competition between providers will produce better outcomes for clients. The terms ‘consumer choice’ and ‘service contestability’ sit front and centre in the policy announcements. This means words that often are seen as an anathema to caring professions (like competition, profit, cost and affordability) now sit side by side with patient outcomes, clinical governance and wellbeing. Many staff will feel a passionate disconnect between their beliefs and the language being used. Make it an absolute priority to create some harmony (or at least tolerable co-existence) between the values you want your staff to have and the accoutrements of more competitive policy settings. The lesson from the field is it is doable, but it is hard.
don’t go to a professional fight without a good trainer in your corner
We know individualised funding intends to create a more competitive marketplace amongst providers. We know more competitive policy settings open up the door for non traditional players to enter the market. This brings with it a whole new set of challenges for existing providers. They need additional business intelligence to monitor and understand changes in market dynamics, and different skill sets to respond to what they learn. Get on the front foot and hire in the new capability if you haven’t already – you may not have time to grow your own. And every design decision you make about how you are going to provide services should be informed by, and then reinforce, your information and business intelligence.
beware the self fulfilling prophecy
There is opportunity in times of volatility and change, even when it doesn’t feel like it. If you approach the change with negativity your organisation will pick up on the vibe. It is essential to try and move past rhetoric and unhelpful opposition as quickly as possible so you can identify and deal with the real issues. One option is to deliberately start the conversation early. Identify how people are feeling and let them voice their concerns. Acknowledge and then develop a way for those who don’t agree with the policy premise to be able to continue to disagree but still be part of the solution. Once you have started the dialogue make deliberate disruptive changes to create the space for people to move to the new way of operating as quickly as possible.
Whether you feel pessimistic or optimistic about the new mental health policy, it doesn’t change the fact that this is a great chance for cross sector experience to help avoid the pitfalls of the past. Reach out to your networks and continue the conversation. It might save you a heap of pain!