NDIS & LEARNING FROM THE UK EXPERIENCE OF PERSONALISATION: A PROVIDER PERSPECTIVE

1. NDIS & LEARNING FROM THE UK EXPERIENCE OF PERSONALISATION: A PROVIDER PERSPECTIVE Peter Gianfrancesco galeru@btinternet.com www.galeruconsultancy.com

2. Overview • About me • The UK & ‘Personalisation’ • How we prepared • What we did • Insights arising from our experience • Lessons for NDIS providers • My emphasis is on the long term view of market engagement • A provider emphasis and focus

3. The International Picture • Providing care through a model of regulated brokerage and personal purchasing is not new: • Examples can be found in ENGLAND, USA, BELGIUM, SCOTLAND and may or may not be limited to disability care. The private insurance and/or managed care model also fits into this context • The best current comparator is the UK Personalisation Model as it has a uniquely disability focus and is national in its scope

4. In ALL OF THE models, it is the provider response and not the regulation that will determine the success of the model

5. The greatest risk to ALL models is if providers withdraw from or fail in supply OR if the provider market changes too quickly

6. The Evolution of a Model

7. UK experience as a provider

8. PERSONALISATION – THE ENGLISH EXPERIENCE • A national policy approach with strong political support • Implementation devolved to 250+ UnitaryAuthorities • Introduced on a national scale 5 years ago • Tariffs and products (regulation) determined locally (with some exceptions) or by provider • Consumers ‘hold’ the budget (reality is different) or get a ‘notional’ budget • Brilliant when it is allowed to be used creatively (the Lathe example) • It has not worked that well in mental health • Being used to drive price down and eligibility up • Implemented at a time of great financial austerity and loss of contracted care

9. UK experience as a provider

10. What we know is that the smaller providers demonstrated faster market entry and greater innovation and responsiveness but the larger providers outlasted them in the market because of their infrastructure, capacity and lower unit price - In this scenario everyone loses because localism and innovation disappear

11. DESPITE THE CHAOS PERCIEVED BY PROVIDERS, MANY CUSTOMERS REPORTED:- BETTER SATISFACTION - BETTER ENGAGEMENT - IMPROVED QUALITY OF LIFE

12. WHAT WOULD HAVE HELPED • CLEAR NATIONAL TARRIFFS • SUPPORT FOR PROVIDERS • SUPPORT FOR CUSTOMERS • INDEPENDENT CARE PLANNING • MORE GRADUAL REDUCTION IN CONTRACTS • BETTER PLANNING AND LESS CHAOS • MORE STRATEGIC AND LESS REACTIVE SUPPLY • TIME TO UNDERSTAND WHAT WE WERE DOING

13. WE SURVIVED AND THRIVED SO WHAT DID WE DO?WHY US?

14. THE 5 C’S • Cultural confidence and readiness • Customer service and focus • Capability was understood • Capacity was identified • Costs were known (eventually!)

15. CULTURAL CONFIDENCE & READINESS • Who are we here for? • Is the whole organisation on board? • What are the cultural barriers? • What values must we preserve? • What can we move on from?

16. CUSTOMER SERVICE & FOCUS • Who are our customers? • How do we provide GREAT customer experience? • What do our customers tell us about our effort? • What more can we do to add value?

17. CAPABILITY • What is it we ACTUALLY do? • What is it that makes a difference? • What else are we good at? • Who else might benefit? • How can we develop to match REAL customer needs?

18. CAPACITY • How much can we provide? • How productive do we need to be? • How can we be more efficient? • What new partnerships emerge? • What are the markets we are seeking to appeal to? • What else do we need and how will we pay for it?

19. COSTS • How much does it cost us to supply? • Can we supply within the market tolerances? • Do we ‘loss lead’? • Do we subsidise care? • What assumptions do we make about our supply model? • What are the cost pressures we must respond to?

20. KEY QUESTIONS WE CONTINUALLY ASKED…. • Why are we considering entering this market? • What are our ambitions as a provider? • Do we have a duty to supply? • What happens if we choose not to? • How does it fit with our organisational purpose? • Can we afford to do it? • Do our values limit our market? • What hidden capability is there? • What would we do with the profit? • How would we manage revenue loss?

21. WHAT WE CAME UP WITH…..

23. IN NORFOLK, ENGLAND… • Population of 1 million people • In any given year:* • 120,000 people experience a mental health problem requiring help • 65,000 see a GP ONLY and/or use public or NGO mental health services • 55,000 people need help, get nothing or have no eligibility but many have a capacity and desire to purchase • What are the market opportunities here?

24. Developing a Product Range • Dis-aggregating current supply into products • Assessing current product range against the market opportunity • Testing the offer and refining it • Identify new product opportunities • Assess the supply issues and challenges • Defining the story associated with the product offer • Develop marketing, perhaps JUST for the product • Launch and supply

25. LIFEHELP • Part of Norwich Mind (A$5M) • New brand and product range developed • Offered universally • 600+ customers first two years • 25% clients hold a personal budgets • 40% have care purchased for them (notional budget) • 25% self fund • 10% free • Profit is used to provide free care to 10% of the clients who would otherwise receive nothing • Growth is projected at 20% pa

26. Universality • The 2011 Australian Census indicated that the incidence of a mental health problem could be as high as 1 in 3 • Why would we not want to include the whole population as potential customers for our purchasable care products? • The larger the market, the larger the potential revenue, the more mixed a customer base is, the less stigma is attributed to any customer • It IS possible to broaden your market and retain (and enhance) your offer to your core beneficiaries

27. Advantages of Universal Supply • Larger Market • Less Stigma • Less Regulation • Greater Public Benefit & Impact & Reach • Customer Expectations Higher • Better Organisational Profile • Fewer people excluded from available care • Larger profit, greater potential to subsidise

28. WE SUCCEEDED IN SUPPLYING BUT, MORE IMPORTANTLY, WE BECAME A MUCH BETTER ORGANISATION ALONG THE WAY

29. LIFEHELP – MAIN LESSONS • Staff are much more productive • Staff are more flexible and multi-skilled • Staff have become innovators and promoters • The workforce is more diverse and more casualised • Volume matters as does a broad customer base • Mixed economy of purchasers is critical • MAXIMISING market size is key • Financial planning and management is very complex • Client retention is good • Clients say the service works and they welcome the choice • Staff are satisfied • The number of NGOs providing has halved.

30. 10 insights that are relevant here • Our offer is 90% RELATIONAL and 10% technical • There is very little product differentiation on the provider side in mental health (it’s the people and their lives that represent difference) • Market the relational promise (the employee profile and story) • Celebrate and communicate success through stories – real people, real photos, real narrative • Keep your values and history at the heart of your message • Continually ask what makes us different • Emphasise localism and cultural relevance • Add delight and value at every opportunity • Provide GREAT customer service • Continually innovate (because your competitors will copy you)

31. Our Evidence on Customer Priorities • System defaulted to traditional suppliers at start up (seems to be same in some NDIS launch sites) • Peer support over-rated by providers (not a factor in initial purchase but a factor in re-purchase) • Customers value: • Responsiveness • Great customer service • Familiarity / low risk / continuity • Help that works (from the customers perspective) • Flexibility • Value • Pleasant surprises • People that they like and who like them

32. SUPPLY CHALLENGES – WHAT WE HAVE LEARNED IN THE UK • Our workforce had to increase productivity by 20% • ‘Standing’ liability needs to be minimised • Customers demand different qualities to those that organisations often hold dear….eg: • Less qualified but experienced in life • Flexible and responsive • Relationally competent • A new paradigm of staff deployment • Move away from traditional structural model (teams) • Multi-skilled staff covering full range of client needs are more efficient • Big increase in infrastructure demands • Requires a different understanding of outcome • Workforce has become more casual and/or self employed and generally operating at a lower level of qualification but with new sought after attributes • Organisational complexity increases • Creativity needed to continually add value • Greater reliance on technology to support distant delivery • Very hard to supply remotely unless additional investment (by provider, regulator or co-purchasing)

33. Measuring Success • Rewarding staff who are BOTH effective and productive – how would we do that? • The Loved One Test • Market Capture • Customer Loyalty (a good thing?) • Health and other client outcomes (QOL, Goals etc) • Testing value for money • Financial monitoring – efficiency monitoring • Practice governance • Public ratings (Patient Opinion, Whitecoat) • Matching the promise to reality - stories

34. Summary of Key Points • It’s bloody hard! • NDIS offers great opportunity • The implementation approach seems sound • Providers need to think differently • In terms of who they supply to • In terms of brand and marketing • In terms of supply and productivity • Early to market is important • Competition is inevitable (particularly in urban settings) • Funding will be more complex and chaotic • Customers will benefit if suppliers adapt • Preparating for supply will improve your organisation

35. Further Information • www.norwichmind.org.uk • www.personalhealthbudgets.england.nhs.uk • www.mind.org.uk • www.scie.org.uk/topic/keyissues/personalisation • www.thinklocalactpersonal.org.uk • www.whitecoat.com.au • www.patientopinion.org.uk