Regional Center (RC) Measures Workgroup - Shared screen with speaker view
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La presentación de hoy se publicará en el sitio web del DDS en: https://www.dds.ca.gov/initiative/stakeholder-events/
Today’s materials are posted on the DDS website at: https://www.dds.ca.gov/initiative/stakeholder-events/
Comments? Questions? Us the Q&A in Zoom or email RCMeasures@dds.ca.gov
It is to everyone's advantage that people and organizations they are a part of - providers and regional centers - achieve incentives. With regional center performance incentives, what help or corrective steps do we need to have in place in the event a regional center is falling short in meeting a performance incentive(s).
Hi, Karen Mulvany here, family advocate & mom of a 24 year old living independently in an ADU.
Love the idea of monitoring choice by the number of vendors, but it should by a) service code and b) by county or zip code served. Also, we'd need to monitor whether the vendors are accepting new clients or not, as is done with doctors.
Could you pls advise on what the Person Centered Planning for Self Advocates would entail ? Is it with an end to help them write their own PCP ? or what to expect ? isnt the person themselves person centered ?
From Beth Burt to All Panelists 01:21 PMI agree with Marty. Will we be discussing the accountability piece if RCs are not meeting goals?
This is the comment Mary Lou is addressing right now.
Eva Casas Sarmiento
I'd like the incentives we craft to be made public, to have transparency. Accountability. For example, in the restaurant world, some counties post a grade for restaurants, clearly visible for all patrons to see on meeting public health standards.
In a later slide it talks about “What will make incentives meaningful?” One of the bullet points is “Frequency or Modified Reviews.” Frequency should mean more often and/or less often and Modified Reviews should be easier and/or harder.
Using Eva's good example on restaurants: I see the regular accountability in the system as the "health department grades" of restaurants while the incentives would be more like the Michelin Stars process. Is that accurate?
You can chose another restaurant, you cant chose another regional center.
Great point Mark!
However, the distinction between health department grades and Michelin Stars is still relevant to our conversation. We simply want all RCs to be starred.
It might be useful to have background information on Regional Center accountability for meeting basic standards (outside of the incentive program).
Like CARF accreditation.
I'll second that, Harry. Seems frustrations many families face at times might push the focus toward what is lacking or needs to be improved instead of improvements beyond what are base level expectations.
I agree with Harry’s view that we need to understand the process for meeting basic standards.
A lot of this will also depend on budget policy making and decisions made at the State level - that the department, the Administration - and Legislature is providing enough funding and resources so incentives can be met - and some measures (or consequences) on the state
@Harry - re: your question on background info - the 2022 RC Performance Contract Guidelines: Measurement Methodology for Public Policy & Compliance Measures are available online here: https://www.dds.ca.gov/wp-content/uploads/2021/11/RCPMmtg_Handouts_11172021.pdf
i have a comment too along the lines of tims comment
With respect to Tim's comments about SDP performance measurement, some of the measurements that we are discussing may not be appropriate for SDP, and we may have to figure out alternative measurements for those situations. For example, the number of vendors available will not make sense in for SDP participants, because they use generic providers and only the FMS is vendored.
Autho’s/Utilization is not an outcome.
Strongly agree with Mark.
exactly Mark! How many individuals were reporting being successfully employed longterm would be the outcome wouldnt it ?
What would an employment outcome look like for you, Mark? Authorization and utilization are core to the Service Access and Equity grants currently in place.
Is it competitive and integrated. Is there opportunity for advancement. Have wages or hours increased. etc...
Agree with Mark as well. Having a job the person likes that pays min wage job in an integrative environment is the outcome, And what about the families living in the white areas :(
Are we also - in addition to looking at other states - also looking at other systems within CA, such as the major changes that include incentive payments, and more person centered outcomes that could be a part of CalAIM (CA Advancing and Innovating Medi-Cal) - many people under DDS are eligible for Medi-Cal
Those are valuable and reasonable measures. Seems that may fall partly to the vendors, however, and not specifically the RCs. The overlap, which we've looked at in this workgroup before, are hard to distinguish.
Regional center measures must result in a positive impact on people receiving services. We will have failed as a workgroup if incentives too not lead to improved access to an individuals chosen way of life.
Yes, absolutely Mark!
Exactly Mark !!
Mark brought up earlier that there is no choice about which Regional Center you belong to. So even if the Regional Center "fails" the standards or chooses not to participate in these incentives, you still are part of that Regional Center.
The danger to a "Michelin-like" rating system is that it is specific to the specific measure in question. Ideally if there are a set of measures all of which apply to all regional centers, there would be a "roll-up" score for achieving multiple goals reflected in the rating.
Eventually, what matters is “How positively has a RC /casemanager” impacted the life of an individual they serve ?How do we determine that ?- “Response time”- “Culturally competent support provided to address any and all barriers to access”- “regular reviews of the Case workers by Consumers /Families”- “Happiness or Satisfaction quotient” of Consumer (determined by their level of integration into their local community with the support provided)
I agree with Jacquie Dillard Foss' point or comment in the Q&A - except in the way she spelled restaurant. Seriously, she makes good point about the problems of comparing these incentives to restaurants or Michelin stars
Michelin stars would be great if individuals could chose the highest rated Regional Center to access services.
Marty, copying my response from the Q&A, it's not a perfect metaphor. However, it provides clarity between what this group is responsible for and what it is not. All of us understand there is no RC choice. That's why we need measures that help all RCs to be ones we would choose given the option.
One thing is to underscore somewhere an incentive(s) that credibly responds to needs of the whole person (or whole child or whole persons in a family) who the regional center serves - and what other needs or help is needed even if outside the regional center system including housing security, food security, special education or education, employment, transportation, - health care - IHSS, etc or services referred to as generic (as Judy mentioned).
And Gabriel's point is important. RCs want to do well (same as service providers). Limited resources produce limited results no matter what sticks you use to try and provide additional motivation.
I also agree with Larry in the Q&A: Need to be careful not to push quantity of vendors vs. quality.
I agree with Gabriel--a very important point
Will (or should) these incentives recognize individuals within a regional center? There are many people who doing good work above and beyond what others might do - and somehow that should be recognized/incentives (same goes with individuals in a provider agency).
I'd like to see incentives around SC's directly assisting the consumer with obtaining generic resources. For example, a denial of a regional center service is often linked to the "availability" of a generic resource, payor of last resort. Therefore, it would be beneficial if the SC would assist the consumer in locating the generic resource, applying for the service, etc.
Very well said Harry
Bingo Harry !
Less compliance, more human service! Yes Harry.
I agree there should be more about the client and what our goals are and fallow through
The topic of risk is important, because it's very expensive to achieve low risk for everyone when the standard is set by the most vulnerable individuals. Risk should be person centered, assessed for each individual with mitigation person centered.
indeed Michi ! this is about improving the quality of life of all individuals served by the RC regardless of where they live
Well said Michi. I agree.
Agree with Michi overall point - ultimately though, as I mentioned at the beginning - this is about the person or family who needs help, supports and services - and if they got it, how they got it and got it when it was needed. That's why any incentive or performance measure has to ultimately link back to person centered outcomes.
Will Sanford point on federal funding dollars is an important one - something that many years Ken Buono (DDS) gave a friendly warning about as the state (with our support) moved to capture more and more federal Medicaid dollars - and what that meant in terms of focusing on compliance of federal rules
Thank you so much for your comment Kathy! I agree.
Good points Kathy!
LAO Report: Enhancing Federal Financial Participationfor Consumers Served by the Department ofDevelopmental Services https://lao.ca.gov/reports/2021/4471/Enhancing-Federal-Financial-Participation-Consumers-DDS-110921.pdf
Whatever we come up with initially, will not be perfect - but a work in progress. We just need to make these incentives as meaningful, person centered as possible. And every year or more often, we tweak or fix the incentives.
Appreciate Beth's earlier questions and comments
All of the Chat & Q&A comments are being saved, thank you everyone for helping us document your thoughts/concerns.If you have input you'd like to share after this meeting closes, please email comments to RCMeasures@dds.ca.gov.
I have been a case manager for LA County for 16 years; yes, it's exhausting, overwhelming, and frustrating at times. My son has been a regional center consumer for 17 years, and I can only remember one SC that I believe was highly motivated.I have the saying below in my cubicle, because I have to constantly remind myself that...One person can make a difference, and everyone should try-John Fitzgerald Kennedy.
Per the good comment about the complexity of person-centered plans. A good PCP should include the balance between "important for" and "important to" so that both should be in the plan and annual goals should be inclusive of both important for and important to. It will be a big lift to reach the point where every individual has a true PCP where they can develop and measure individual annual goals; there can be intermediate performance measures to help us get there (e.g. training in PCP, percentages of individuals with PCPs, etc.). Thanks for facilitating!
Right on Harry (to use a 1970's phrase that Brian Winfield uses a lot)
BTW, shout out to interpreters on this meeting including ASL and Spanish