SUMMARY

Issue for Discussion

Purchasing vocational rehabilitation (VR) services under the Unified Contract Services (UCS) agreement.  This report focuses on the procedures that have been put into place during the first year of the Unified Contract Services to assess vendor effectiveness and assist VESID staff in providing cost-effective, quality rehabilitation services.

Reason for Consideration

To inform the Regents regarding the UCS process, the method by which VESID purchases disability-related services for persons with disabilities.         

Proposed Handling

This item will come before the VESID Committee for discussion at its February 2010 meeting.

Procedural History

In May 2006, VESID presented a plan to redesign its future.  One of the recommendations regarding the implementation of this plan was the redesign of the Unified Contract Services, which is the primary method by which VESID purchases disability-related services for persons with disabilities.

In October 2008, VESID presented to the Board of Regents a plan to redesign the UCS process.  This was a component of VESID’s redesign of the vocational rehabilitation process and functions to meet changing consumer needs and respond to changes in the larger federally funded vocational services system, resulting in better use of limited resources. 

Introduction

VESID undertook a comprehensive effort to improve its Unified Contract Services in order to: better serve consumers with disabilities; offer sufficient consumer choice options; provide adequate compensation to vendors for services purchased; assess provider effectiveness; assist VESID staff and consumers to make informed decisions regarding providers, and allow for the timely approval of new providers based on consumer needs.  The new contract process included a broader range of services which previously had been purchased off contract with limited monitoring and controls.

The year one budget allocation for UCS services is $36 million for all vendors.  During the first year, VESID is projected to expend about $24 million with over 50,000 consumers accessing one or more of these services to assist them in becoming employed.

This report describes three major VESID initiatives that have been undertaken to improve provider effectiveness in the provision of UCS services and to insure consumers are receiving quality cost-effective services. These initiatives will allow VESID to maximize resources by more effective management of the funds used for contracted services through improved data collection and contract management.

I. Contract Development

              The development of the UCS was done in collaboration with the SED’s Contract Administration Unit, the Office of the State Comptroller and VESID’s Operations and Contracts Units.  Five-year contracts were developed instead of the previous one-year contracts, which minimized yearly contract amendments and saved countless hours of staff time for processing. In the Fall 2008, over 350 contracts were awarded to service providers across the State. Each vendor’s contract was prepared by estimating the contract value based on historical utilization and costs for the first year. Years 2-5 will be budgeted based on actual utilization and performance.  Contracts are awarded statewide which allows access to key services by district offices from vendors across the State. In addition, there are new vendors in each region which has expanded consumer choice for services. New services were also added that did not previously exist in a region under UCS.

II. Implementation of Services

              The new UCS contracts began on January 1, 2009. Several work groups were established to assure that services were provided in a cost-effective manner. For example, a work group reviewed the services that are required to evaluate a consumer’s eligibility for VESID services, employment needs and career planning. Early monitoring trends showed costs for some of these services were higher than anticipated.  In addition, costs for purchasing placement services, another key component of VESID services, were also initially very high. Upon review, it was determined that it would be more cost-effective to authorize these services in stages, based on need and use, rather than all at once at referral. This action would save significant funds and enable VESID to allocate money when the services were actually delivered. These changes allowed VESID to make funds available for other purchases so resources are maximized.  A UCS Guide to Contract Principles will be issued to all staff that incorporates these changes and will provide further guidance to staff.

Previously, contract management was very limited because many services were purchased off contract. The new UCS placed all services on contract, which allows staff to review data on a regular basis, as well as meeting state procurement practices. Also, prior to the new contract, monitoring of service utilization was done mainly by VESID’s Central Office, which at times resulted in a disconnect between consumer need, service capacity and intended outcomes. The new contract process provides a partnership between VESID’s Central and District Offices to better meet consumers’ needs and maximize resources. The UCS services allow VESID staff to purchase services specific to each consumer’s needs and employment objectives.

III. Contract Management Process

VESID District Office and Central Office staff continually review consumers’ needs and office trends to assure that individuals with disabilities are provided services, when needed, in the most cost-effective manner. In partnership with service providers, VESID strives to improve service delivery, while maximizing existing resources. The five-year contracts allow staff to manage yearly utilization and then request contract amendments only where needed.

 A variety of methods are being used to monitor consumer needs and services as well as contract expenditures.  VESID reviews what services are being used, costs for those services and vendor performance based on specific indicators. District Office contract management includes monitoring utilization trends and forecasting service need for the District office (examples of possible reasons for contract fluctuations):

• By consumer need - A particular office may have an influx of consumers               depending on job availability or an economic downturn.
• By individual vendor performance - Based on key performance indicators.
• By service category - Some services may be over-used and not required             to meet consumer needs.
• By region - A particular service may not be readily available from one region       but can be accessed, if appropriate from another geographic region.

Vendor Assessment:

              District Offices have, at a minimum, semi-annual reviews with all UCS vendors to assure continuous improvement of services. Areas of concern, plans for improvement including timelines, as well as levels of compliance, are discussed. A report of the review is provided to the vendor including identified next steps and areas needing improvement.

              Performance indicators were established for each UCS service category.  The indicators are a tool to be used by VESID to assist in evaluating performance of UCS providers, support on-going contract management and determine contract adjustments, if necessary, to meet changing needs in a region. Outcomes and timeliness are the two major performance categories. Data is gathered from vendor billing reports and information on authorizations in the VESID Case Management System (CaMS) data base.  The indicators are part of the monitoring process that is used at both the state and regional levels.

              A report on the first year’s performance has been completed. The next step is to test the data for reliability and validity.  For some vendors, due to low utilization, some data are inconclusive, although much of the data shows significant promise in its value. Once the data are refined, the information will be used to:  track the percent of success of job placement providers; determine how long it takes the provider to locate employment for VESID consumers; and compare consumer salaries, level of benefits and whether the jobs are full or part time.  In areas of assessment and entry services, timelines have been established which will allow for tracking an individual vendor’s performance based on those time frames. Data will be available to VESID staff on a monthly basis.

Next Steps:

In 2010, VESID will:

• refine the performance indicators and share them in the semi-annual meetings with vendors;
• provide 2010 total budgets for UCS that will more realistically mirror actual utilization;
• secure amendments to contracts only when trending data indicate the need to exceed the total five-year contract amount; and
•  continue VESID’s efforts to improve services by working closely with its service delivery partners.

Recommendation

              The Board of Regents will continue to support VESID’s “Unified Contract Services” process.

Timetable for Implementation

              With Regents support, the described activities will continue to move forward.