Below we give our 10 Point Checklist for CDC (consumer directed care) success for home care providers and case managers:
1. Medicare claims accountability, transparent and sitting with correct organisational role
All home care operators have a Medicare subsidy claim process in place, however, a significant number do not have Medicare funds coming in at the start of the month and are not completing full reconciliations on receipt of remittance. This is more prevalent in smaller organisations where the responsibility sits with an overworked case manager, whole client facing responsibilities have been correctly taking precedence.
Without the prepayment of Medicare, organisations are using their own money to finance their homecare business, at a cost to significant organisational cash flow that is difficult to spot within monthly finance statements.
Claiming is too important to assign as a job for an already overworked staff member. The role of claims should be formalised and assigned to a staff member, ideally with a finance background. The timing of cash collections and claim reconciliations need to be reported as part of their key performance indicators.
Suppliers contracted to invoice electronically and quickly
Suppliers taking over a month to invoice a client cannot happen as the consequences of slow invoicing is significant. Slow invoices burden an approved provider with needing to administratively manage accruals or not have individual statements up-to-date. Additional costs sit with the supplier who misses out on cash flow and requires a lengthy process for any disputed invoices that could have been dealt with quicker closer to the date of the service.
Further, with new legislation coming in regarding the return of monies to the government and consumer, approved providers will need to quickly sort out all accounts prior to the return deadline. If any are missed, approved providers will be liable.
Finally, paper invoices are a thing of the past. Anything not in electronic format increases the administrative burden of transparency and also increases the possibility of mistakes with rekeying invoices.
Crediting Brokered suppliers GST
The supply of home care services by a service provider is GST-free under the Aged Care Act. Private tax rulings have been issued by the ATO in respect of no GST payable under a CDC homecare package.
Most Approved Providers are still not crediting the brokered service GST on invoices.
Case managers do individual budgets, not finance
Under CDC, Case Managers have a core role of maximising their client’s wellbeing within the given resources. Budgeting for an individual cannot therefore be outsourced to the finance department, as it must be central to case management accountability to not under or over-service clients with an approved provider footing the bill.
Case management must be separated from other services
Care recipients will choose case managers who represent their interests. Where case managers also represent services from their organisation, or feel pressure to push their organisations services, care recipient perceptions can assume that their goals are not aligned to organisational objectives.
For a Case Manager to truly optimise services and the budget for a care recipient, they need to consider all supplier options and manage them dispassionately regardless of the owner of these services.
Utilise volunteers first in planning
With the goal to maximise an individual’s welfare, it’s important to get the free stuff first, then use the budget for the rest. Care planning needs to actively challenge the case managers to build in activities and support that do not necessarily cost money. Organisations might have their own volunteer networks or the ability to tap into others. Case managers can make willing family and friends accountable for certain activities, in the interest of maximising a budget. A good plan will let relatives know what is expected of them and when. There are even the opportunities for family and friends to take on case management duties for a lower fee.
Complete a real care plan
A plan is not just a summary of services and cost. These plans were very prevalent with CAPS packages and are still used by operators today.
A plan is no different to a formal business plan that requires a qualitative and quantitative document that outlines: where an individual is at; where they want to be; and how they are going to get there.
A plan is a document that stands on its own with such strength, it doesn’t even need to be linked to a homecare package to be of value to the individual. In fact, it might recommend other options, such as private care arrangements, house sharing, village environments, or the Commonwealth Home Support Program in the initial instance.
Like the travel agent industry had to justify directly charging for their services when commissions were significantly cut and direct internet bookings appeared, approved providers will be judged on their care plan and be assessed for what it costs.
Encourage coopetition and networking
Quality at any cost will not keep an organisation in business. An organisations’ gardeners might be very good (thorough and process driven), however does a client want to pay $50 per hour or $35 per hours to Jim’s Mowing? Is a client willing to pay a premium for an overqualified carer, or will the carer’s organisation pay the difference?
No organisation can be good at everything. Being good means not only having the best staff, its having the best price, or mixing the two to offer best value for money. Approved providers and service organisations will need to network and work together, including organisations paying competition to service their clients.
Approved providers will also need to be locally networked to local senior citizens clubs (there are many, everywhere), councils and general community events.
Keep it local
Approved providers of tomorrow will need to source carers locally to minimise travel. Except for isolated regional areas, travel costs cannot be passed on to clients.
It’s nice to send your own care staff to a client, however, not when they have to drive 20Km. Travel is dead money and there is the cost to the staff member and the cost for the transport itself.
Where tight scheduling with route optimisation is not possible, the use of other home care organisations eg. coopetition and innovation with semi-formal carers will become necessary.
Put the client first
Consumer Directed Care is consumer directed. Organisations who fight the desires of consumers with restrictive work practices will lose customers.
Minimum shifts, demarcations of types of work and traditional rostering doesn’t necessarily meet care recipient needs and is administratively costly. Further, work place award structures, and on-cost demands are not necessarily valued by carers as these can reduce the demand for hours and work types they might prefer (via penalties and loading).
Only the largest care providers with a willing full-time, locally based workforce with very tight scheduling and a significant number of clients could possible meet CDC client needs. Even then, they would still be at a cost disadvantage to nimble new operators emerging giving carer’s access independently to clients similar to what Uber has done with the highly regulated taxi industry.
Bottom line, clients will not pay for inefficient work practices that they don’t want. Most organisations will need to embrace innovative methods to legally use contractors, casuals and even neighbours and family who have passed provider standards.