Performance-Based Contracting Information
FAQ Last Updated: 10/25/2024
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Reviewing providers will involve both self-reporting by providers and external oversight. PBC established a Residential Provider Data Submission Tool for providers to self-report on their performance. ODP, with the assistance of a Performance Analysis Services (PAS) vendor, will use provider information and other data sources to evaluate each provider’s performance against established standards.
ODP expects that through the workforce, or staff, requirements in the performance standards, there will be enough trained professionals to meet the demand. There are four ways ODP expects the PBC staff requirements will help providers to have enough trained staff to serve individuals.
– Credentialling: Providers must make sure a portion of their staff have a nationally recognized competency-based credential. Having a credential or certificate will increase staff knowledge and skills and improve quality of service. Because providers are required to use a training program that is the same everywhere, there will be more consistency in the skills and knowledge of staff at all providers. In addition, research shows that when workers have a training certification, they are happier with their jobs and are more likely to stay in their jobs.
– Stability: Providers must send ODP information about how long their staff are employed, and if they have open positions. This is called staff vacancy and turnover. By looking at data on staff vacancy and turnover, providers and ODP will be able to use data to identify more effective ways for staff retention.
– Technology: For every individual, Individual Support Plan (ISP) teams should explore whether there are technology solutions that support better health, safety, and greater independence. They should look to see if a service can be provided through remote support or other technology rather than having a staff person come to their homes.
– Direct Support Professional (DSP) wages: Rate add-ons and pay-for-performance (P4P) will support higher DSP wages, better training, and staff retention. Better training will enable DSPs to serve individuals with more complex needs and lead to better outcomes for individuals.
There is a Clinically Enhanced tier for providers that offer clinically enhanced medical or behavioral supports. Providers in the Clinically Enhanced tier are expected to serve individuals with the top Needs Level group and Health Care Level group. Providers must meet additional requirements, or enhanced measures, to be placed into the Clinically Enhanced tier. Some of these additional requirements include:
– Providers must offer extra training for their staff on Autism Spectrum Disorder (ASD), crisis prevention strategies, trauma informed care, etc.
– Providers must employ a minimum number of clinical staff to support individuals
– Providers must use data to help individuals meet outcomes
Yes, the goal of PBC is to make sure individuals and families have access to residential services in the communities where they want to live.
One of the performance standards that residential providers must meet is providing communication options, or contact methods, to maintain and build relationships between the provider and individual/family. Individuals and families can provide feedback to the provider on their satisfaction. The provider will be supporting ODP in helping to collect feedback from individuals and families on the provider’s performance to be included as part of the yearly provider review process.
The goal of PBC is to ensure the best quality services for individuals and families. One way PBC will drive improvement in care, is through the performance standards and what providers must do to meet them. A few examples of performance standards that will lead to better care include the following:
– Demonstrate use of technology to improve health and wellness, address workforce issues, and create additional opportunities to increase independence for individuals
– Demonstrate ability to support individuals to access necessary physical health and behavioral health treatments
– Demonstrate balancing the workforce to reduce and manage turnover and vacancy rates of Front-Line Supervisors (FLS) and Direct Support Professionals (DSP)
– Demonstrate ability to predict and de-escalate crisis, when possible, and, when not, to respond quickly and effectively
– High quality services and continuous quality improvement
– Access to high quality providers
– Making sure individuals and families have less restrictive and less costly residential living options such as Life Sharing and Supported Living
– Allow individuals and families with complex needs have their needs met with qualified clinical teams
– Use of remote support technology to create opportunities for individuals and families to increase independence
– Wellness programs for nutrition, high blood pressure, mental health, diabetes, heart disease, and more
– Increased communication and support from providers
All providers will be assigned a tier and transitioned to PBC by July 2025. Individuals and families can stay with their current providers as long as they wish. They do not need to make a change of provider unless they want to. Individuals and families will have access to provider tier classification information to help with making informed choices about continuing with current providers or selecting a new provider.
ODP has seen that the support needs of individuals has been increasing in complexity over time and is expected to continue to increase. PBC’s Clinical Capacity performance standard has been established to meet complex support needs. All providers will need to meet clinical capacity performance measures no matter which tier they are in.
Providers in the Clinically Enhanced tier will have to meet even more performance measures to ensure they are able to support individuals with the most complex needs. Some examples of clinical capacity performance standards are below.
– Clinical teams: Residential providers should have clinical teams in place that ensure individuals have homes that provide therapeutic and restorative environments. Additionally, providers should sustain or develop relationships with health partners to improve clinical outcomes.
– Trauma and crisis intervention training: Residential providers should have organizational approaches and comprehensive staff training on evidence-based trauma informed care and crisis response will be able to meet individual needs and minimize the use of restrictive procedures. If staff must use restrictive procedures, staff must be trained in procedures that use physical intervention or restraint as a last resort.