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WELCOMEUNITED WAY VOLUNTEERS!The Mission of UCP Heartland is to provide thehighest quality of programs, services and supports whileadvancing the independence, productivityand full citizenship of individuals with disabilities.Brenda J. Wrench, President & CEO
AGENCY HIGHLIGHTS 3 year CARF Accreditation – no findings,top 5% nationwide Program Evaluation redesigned inpartnership with Washington University Systems updated in preparation formanaged care: Electronic Health Records Automated payroll and brought inhouse New VOIP phone systemsBrenda J. Wrench, President & CEO
AGENCY HIGHLIGHTS Real Estate portfolio: completed majorrenovation & purchased new respitefacility Direct care staffing shortage: Regrettedattrition is less than 1/3 the nationalaverage Pilot program: Parent Advocacy & Support Leadership Team: investments inDevelopment and Marketing Investment management rebid
COMMUNITY NEED:Brenda J. Wrench, President & CEO
COMMUNITY NEEDBrenda J. Wrench, President & CEO
COMMUNITYNEEDBrenda J. Wrench, President & CEO
COMMUNITYNEEDBrenda J. Wrench, President & CEO
WHAT IS MANAGED CARE? Currently: Funding flows from Feds to State (DMH- 67% of UCPHeartland revenues) to 1300 providers in MO If Managed Care: Funding flows from Feds to State (DMH) toFor Profit Insurance companies to providers Likely outcome: consolidation of service providers- favorslarger agencies with strong management systems, statewidepresence, broad service lines (include behaviors), rates fixedat typically lower levels When? Can be simply signed into practice by executive orderBrenda J. Wrench, President & CEO
MEDICAID LONG TERM SERVICESAND SUPPORTS (MLTSS)National Association of States United for Aging and Disabilities. (2017). June 2017 MLTSS Map. Retrievedfrom: rvices-and-supports/mltss-mapBrenda J. Wrench, President & CEO
NEW POPULATIONS OF NEED;NEW DEFINITIONS OF SERVICES In anticipation of cuts in Medicaid fundingfrom the federal government - states arelooking to move folks through and off therolls “MARF’s community providers offer a varietyof quality community-based resources topromote individual empowerment- therebyREDUCING RELIANCE on state services andfacilities” Change in how vocational rehab is fundingemployment services In MO as of April: Non Medicaid eligible losecase management servicesBrenda J. Wrench, President & CEO CMS regulations that transform adult dayservices (38% of UCP current services)effective 2019
PROGRAMS:OVERVIEW New Service Definitions for Adult Day ProgramsUCP eliminated First Steps MO; Early Intervention ILFunding streams fluctuating: DMH 3% rate cut all programsContinuing wage pressure in direct care positionsRate of reimbursement doesn’t keep up with costsUnited Way funding helps sustain quality servicesBrenda J. Wrench, President & CEO
PROGRAMS: ADULT DAY38% OF AGENCY EXPENSESGoal: Provide continued learning opportunities to developindependent living skills and increase participation in thecommunity. 131 consumers served in 3 locations acrossMO; most with severe disabilities Outcomes: manage disabilities, developfriendships, enhanced community integrationJudy Grainger, Senior VP Programs
PROGRAMS: ADULT DAYGrowth in community integration New vans New program partnerships Interactive on-site activities: Eye Gaze Technology Promethean Boards Washington UniversityOccupational Therapist trainingstaff Fluctuations in enrollment Judy Grainger, Senior VP Programs
PROGRAM EVALUATION:EVENING SOCIALIZATION Consumers awarded fixed number of reimbursable units annually UCP eliminated spring and winter program closures to maximize usage PLB needs assessment identified additional socialization and communityintegration as top priorities UCP Heartland piloting evening habilitation program featuring enhancedcommunity options, i.e. Baseball games and game nights Program projected to break even or generatenet profit based on reimbursable units Community may also access on fee-forservice basisJudy Grainger, Senior VP Programs
PROGRAMS: EMPLOYMENT7% OF AGENCY EXPENSESGoal: provide supports to obtain andmaintain employment allowing for increasedeconomic self sufficiency Assess and establish goals Job readiness Job search On the job training Ongoing support 189 consumers through ongoingservicesJudy Grainger, Senior VP Programs
PROGRAMS: EMPLOYMENTHIGH SCHOOL GRADUATETRANSITIONS Vocational Rehabilitation:46 case managers with an average caseload of 115 WIOA: Redirecting funds from low need to high need High school graduates must now have real experience in market rateemployment prior to sheltered work options VR must demonstrate in customized pilot programs employment supportsin partnership with DMH - UCP one of three sites chosen Difficult to obtain waiver for habilitation programming Adult “Day Care”: question of appropriate placements and waitlistsJudy Grainger, Senior VP Programs
PROGRAMS: TALENT CONNECT Seed grant completed- Talent Connect programming now incorporatedinto overall employment optionsUCP Heartland successfully secured VR and local government fundingfor ongoing participationExpanded hotel sites from 2 to 7; negotiating participation at Lake ofthe Ozark locationsBusiness partners award the program highest level of satisfactionAnchor partner Hyatt St. Louis selected to host upcoming internationaldisability employment conference of over 1000 in attendanceVR “order of selection” impacting eligibilityJudy Grainger, Senior VP Programs
PROGRAMS: s-program-at-hyattdowntown/video 18706831-b07a-5991-9fef-05c1ca3be306.htmlJudy Grainger, Senior VP Programs
PROGRAMS:EARLY INTERVENTION4% OF AGENCY EXPENSESGoal: Through early identification,families and children learn skills tominimize developmental delays 189 families provided services inhome and school environments inMissouri and Illinois Opened new fee for servicesummer camp in ColumbiaJudy Grainger, Senior VP Programs
PROGRAMS: RESIDENTIAL33% OF AGENCY EXPENSESGoal: Individuals with severe and or multiple disabilities live withsupports independently in their own home with roommates of their choice.Two programs: Independent Supported Living (ISL) and IndependentSupported Living Assistance (ISLA)ISL: 12 accessible homes throughout St. Louis- 19consumers provided direct care staffing 24 hours per dayISLA: 13 homes throughout St. Louis – 15 consumersprovided skills training 2 to 10 hours per weekJudy Grainger, Senior VP Programs
PROGRAMS: RESIDENTIAL Program funded by Department ofMental Health and the ProductiveLiving BoardRates fixed at time services areinitiated64 Skilled direct care staff :turnover reduced from 75% to13.4% over two yearsStabilized staffing improvesprogram qualityDue to unfunded mandates,program requires United Wayfunding to break evenUCP Heartland part of providercoalition seeking rate rebasingJudy Grainger, Senior VP Programs
PROGRAMS: RESIDENTIAL Trend is to move people out of institutional careinto community based, appropriate servicesGoal is to grow this program by 20% annually –two homes in 2017Program growth will strengthen the overallagency’s financial resultsNew market of private pay consumers- averageannual staffing costs of 90,000/yearJudy Grainger, Senior VP Programs
PROGRAMS: RESPITE18% OF AGENCY EXPENSESGoal: Provide families withtemporary overnight services thatallows them an evening or weekendof relief as needed 405 consumers, 3 funding sources:Productive Living Board,Developmental Disability Resources,and the Department of MentalHealthJudy Grainger, Senior VP Programs
PROGRAMS: RESPITE Respite direct care staffturnover decreased from162% to 48% over two years Restructured, streamlinedmanagement of program,increased base wage for CNAto 14 /hour plus benefitsJudy Grainger, Senior VP Programs
In facility respite does not break even Multiple points of concern:staff turnoverfacility limitationsPROGRAMrate structureEVALUATION: IN Operations committee studied all aspects ofFACILITY RESPITEprogram over 1 year period Pro forma budgets analyzed with rate andoccupancy improvementsTod Raeber, Board Member Board voted to purchase 450 Oak Tree June 2018
PILOT PROGRAM: PARENTADVOCACY AND SUPPORT DMH reduced services for all non Medicaid eligible consumersJuly 2018 UCP Heartland researched all available support options tocompliment available services Currently providing one on one counseling and guidance on an asneeded basis Tracking types and location of requests, duration of relationshipand outcomes Partnered with PLB and United Way 211 on IDD HelpTod Raeber, Board Member
PROGRAMS: IMPACT Electronic health records implemented agency widethroughout 2017- crystal reporting options cover300 aspects of service delivery Program evaluation reviewed quarterly by the board Agency acts to implement ongoing improvements inservices: progress on programmatic goals analyzedmonthlyTod Raeber, Board Member
PROGRAMS: STAKEHOLDERS Board of Directors’ first priority is providingthe highest quality of care for ourconsumersEmployee survey highlighted need forincreased recognitionWork in partnership with other agenciesand funding sourcesBuild relationships with employersponsored volunteer groupsEngage staff as enthusiastic ambassadorsTod Raeber, Board Member
GOVERNANCE:BOARD OF DIRECTORS20 members – staggered termsExecutive Committee meets bi-monthlyFull Board meets 5 times per yearBylaws were revised to add Chair Elect andincrease number of members to 20 Board has complete understanding of needs,threats, program structures and challenges Tod Raeber, Board Member
GOVERNANCE:BOARD MEMBERSHIPBoard orientation andongoing training Mission & HistoryField of disability servicesProgram delivery modelsUpcoming regulatory changesFinancesRoles and dutiesSigned code of ethicsAnnual self assessmentTod Raeber, Board Member
GOVERNANCE: STRUCTURE 6 Committees – all chaired by amember of the boardDeveloped new programmaticdashboard that is reviewedmonthlyBoard reviews and approvesannual operating budget:monitors actual to budgetExecutive committee annuallyreviews executive structure andcompensationServiceHuman CapitalConsumer Demographics - from United Way 2015 report (as of June 2014)Consumers RegionsConsumersGenderConsumers806 St. Louis City75Male5135,977 St. Louis County563Female2936,783 Columbia, MO68Total806Jefferson City, MO38878 Maryville, IL624547Total8065425Service Usage by ConsumerProgramConsumers 2016 REPORTResidentialFamily Support2923574%Early Intervention188218Adult DayEmployment141160and TherapyFamily SupportAdult Day -Therapy (52 80618%EarlyColumbia90Service TypeDirectIndirectTotal2016 ReportDirectIndirectTotal020Employee Engagement (Jan 2014)4060Adult Day and .9%Early Intervention24%35%16.7%Administration13%Early Invention2725%11%25%1758%16%26% 2%51%Administration36%47%11%2%35%13%5%162.5%Family Support110%50%Attrition RateFamily Support100%150%200%# of St. Louis 94450,171117,059193,2616,132,916-& Illinois5%Other (Incl.loss oninvestment)1%Fund Raising& Events7%United Way6%Division ofSt. LouisVocRehab/SWEP County (PLB)13%5%33%0%20%Strongly AgreeAgree28%40%11%60%Disgree27%80%100%Strongly DisagreeRisk132%Program Expenses (Budget)Adult Day and TherapyEmploymentEarly InventionFamily SupportResidentialAdministration ( mostly allocated )Amount 3,180,221908,599966,3061,099,9571,994,218151,392 TD38 s i gni fi ca nt preventa bl e events (27 med errors , 10 fa l l s , 1 a bus e negl ect)15 1 fall,12med 2dea46-23 falls 20 med,3Financial Risk (Funding Utilization)Adult Day andTherapy38%EarlyInvention Employment11%12%2016145%Operational RiskIncidents 2015Incidents Per ConsumerJULY-APRIL 2016 12 s enti nel events requi re emergency s ervi ces - 4 preventa bl e fa l l s , others medi ca l2%FamilySupport13%2015141%ProgramAdult Day and TherapyResidentialEmploymentEarly InterventionFamily SupportAdmi nistrationResidential24%State ofMissouri(DMH)51%Operating Reserves- Per United WayYear20132014129%44%4927.3%EmploymentBudget for 2016Funding Sources (Budget)State of Missouri (DMH)St. Louis County (PLB)Division of Voc Rehab/SWEPUnited WayFund Raising & EventsContributionsFood and Family FeesSt. Louis City & IllinoisOther (Incl. loss on investment)Total% of 12 Mos20%1004Total (less Therapy duplicates)Food andFamily Fees6%Contributions6%Adult Day &Therapy33.3%Intervention23%36Jeff City2014-15 AttritionFiscalYear201120122013201420152016St. Louis County (PLB)AllocatedUsed% ,023,076705,44869%City of St. Louis (DDR)AllocatedUsed% cial Risk (Funding Source)Top 5 Funding SourcesState of Missouri (DMH)St. Louis County (PLB)Division of Voc RehabFund Raising & EventsUnited 768535,89915%15%15%14.96%Tod Raeber, Board Member 2016 (est)4,058,7211,023,076653,840553,360491,36017.40%
GOVERNANCE:STRATEGIC DIRECTION Quality: Program Evaluation ImplementationQuality: Adult Day Relocation and TransformationGrowth: DevelopmentGrowth: EmploymentGrowth: Central Missouri HubGrowth: New Program InitiativesTalent: Direct Care StaffingSystems & Facilities: Relocation and RenovationVisibility: Marketing and Brand Recognition, AdvocacyTod Raeber, Board Member
GOVERNANCE:UPDATE ON DIVERSITY PLAN Board MatrixPartnerships with local universities to expandreachPartnerships include local training expertise:FOCUS, RGA Executive on supervisory skill sets,Departments have funds to implement teambuilding exercises as designed by their staffShared learning experiences acrossdepartmentsTod Raeber, Board Member
FINANCE: OVERVIEW FY 19 budget 12.1 million revenue: 81% government fees Fiscal year 2018 projected to close with an unrestrictedsurplus of 345,642 against a budgeted 95,341 surplus Agency cash flow: 11 months of liquidity Added new CFO and Controller positions, both CPA’s Investing in Direct Care staff with bonus potential for allstaff, 2% COLA and 2% merit raise pool Re-bid Investment ManagementRick Aselage, Board Treasurer
FINANCIAL STABILITY Agency revenue includes proceeds from truststhat depend on how the market performs Beginning FY19 budget includes earnings frominvestments as a budgeted line item Conservative budgeting - Program managersaccountable for program budgets Indirect costs below United Way guidelines – 20% Annual audit by Clifton Larson AllenRick Aselage, Board Treasurer
FINANCE: BUDGET TRENDS 14,000,00012,118,093 12,000,00010,402,594 10,000,0009,069,5688,023,689 8,000,000 ,9788,693,0677,403,018 4,000,000 ctual)2017-2018(Projected)2018-2019(Budget) 02011-2012(Actual)Rick Aselage, Board pecialEventsInvestmentRevenueMisc.Income
FINANCE: CURRENT YEAR BUDGETFY 2018-2019 FY 2017-2018 FORECASTEDBUDGETPROJECTEDVARIANCEREVENUE:Public SupportEvent RevenueProgram RevenueInvestment RevenueMisc. RevenueTOTAL REVENUE 945,244 333,995 10,424,978 412,876 1,000 12,118,093 923,001 301,200 8,693,067 483,133 2,193 10,402,594 22,243 32,795 1,731,911- 70,257- 1,193 Repairs & MaintGeneral Operating ExpenseDepreciationEvent Related ExpensesTOTAL EXPENSES 9,175,927 684,950 1,766,940 248,137 131,675 12,007,629 7,344,035 429,669 1,897,857 250,139 135,253 10,056,953 1,831,892 255,281- 130,917- 2,002- 3,578 1,950,676 110,464 345,641- 235,177GAIN/(LOSS)Rick Aselage, Board Treasurer
FINANCE: BOARD OVERSIGHT Finance Committee meets monthly Board members’ expertise includesCPAs, corporate finance, bankers,investment fund managers,employee benefits analysts Finance Committee actively involvedin development of annual budgetRick Aselage: Board Treasurer
FINANCE: RESERVES Reserves at 99%, a reduction of 25%, as UCP invested in criticalsoftware and real estateImplemented Electronic Health Records (EHR), electronictimecards and moved payroll in-house in anticipation ofManaged CareInvested in 8 new accessible vehicles over the last 2 years tocomply with changing CMS regulationsRenovated Jefferson City location to establish a best practicehub in central MissouriRick Aselage, Board Treasurer
CAPITAL BUDGET PROJECTIONS FY18-19Approved Capital Budget FY 17-18Jefferson CityApprovedActual to RemainingBudgetDateto SpendRenovate6343 sq ft. at 94.26 per sq ft / Architect fees 645,153 591,364 53,789Furniture for renovated space (instead of purchasing with year end surplus ) 75,145 0 75,145Total 720,298 591,364 128,934Notesto be expensedVehiclesAdult DayTruck for MaintenanceVans for Jeff City/ColumbiaTotalOther (approved March 2018)2 new serversTotal 40,000- 50,000 each(approved March 2018)TOTAL - CAPITAL BUDGETNOT TO EXCEED 150,000 27,000 131,000 308,000 145,740 28,060 110,489 284,289 4,260- 1,060 20,511 23,711completecompletecomplete 34,000 34,000 23,019 23,019 10,981 10,981purchased in June 1,062,298 898,672 163,626Request for Capital Budget FY 18-19VehiclesAdult Day (2) 40,000- 50,000 each 100,000 100,000BuildingsPerry HouseTOTAL PROPOSED CAPITAL BUDGET FY18-19Rick Aselage, Board Treasurernot to exceed 700,000 800,000 679,853 20,147closed on Oak Tree - Sept 18 120,147 Board TreasurerRick Aselage,
ADMINISTRATION: OVERVIEW Respected 501C3, current with all registrations,ongoing audits from multiple funding sources,awarded an A rating from the BBBSuccession planning: Focus on depth inprogram managementAdded new online training mechanism- Relias.Allows direct care staff more flexibility inaccessing over 20 required trainings.Operations committee conducted overall reviewof personnel policies, new employee handbookJanuary 2018Rich Chong, Board Member, Chair Operations Committee
UCP HEARTLAND ADMINISTRATIVEHEADWINDS AND TAILWINDSTailwindsHeadwindsRegretted Attrition2014-15 – 49%2015-16 - 29%2016-17 - 22%2017-1814.02%National Core Indicator:44.8%Avg pay 13.58 12.59 last year53% taking health insurManaged Care: Uncertainties intiming, impact and revenuegenerationNational Core Indicator 10.72 avg startingMo Avg 12.74 2016Poverty level 13.43 Familyof Four (May 2016 DOL)DMH64%of total budget3% cut 2017United ly164 Direct Care StaffAvg age 36.33dropping57% African American87% Female99%reservesDown from 135% last yearUnited Way 25-75%Real EstateNorth location limited optionsLogistic challenges inrelocations
DIRECT SUPPORT WORKFORCE CRISISRich Chong, Board Member, Chair Operations CommitteeReport to the President 2017: America’s Direct Support Workforce Crisis
ADMINISTRATION:DIRECT CARE WORKFORCE CRISISThe crisis stems from the following factors:1. High staff turnover;2. Growing demand for services due to the growth and aging of the U.S. population in general;3. Increased survival rates for people with complex health needs found among persons withID/DD4. Demographic shifts resulting in fewer people moving into the DSP workforce:5. The persistently non-competitive aspects of direct support employment, including low wages,poor access to health insurance and lack of paid time off (PTO) and other benefits;6. The high stress and demands of direct support employment, including round-the-clock, sevendays-a-week work;7. Insufficient training and preparation for DSP roles; and8. Lack of professional recognition and status for skilled DSPs.Report to the President 2017: America’s Direct Support Workforce CrisisRich Chong, Board Member,Chair Operations Committee
A SUMMARY OF NATIONAL CORE INDICATORSTAFF STABILITY KEY STATISTICSRich Chong, Board Member, Chair Operations CommitteeReport to the President 2017: America’s Direct Support Workforce Crisis
A SUMMARY OF NATIONAL COREINDICATOR STAFF STABILITY KEYSTATISTICSRich Chong, Board Member, Chair Operations CommitteeReport to the President 2017: America’s Direct Support Workforce Crisis
WORKFORCE CONDITIONS THAT DETER ENTRYINTO THE PROFESSIONReport to the President 2017: America’s Direct Support Workforce CrisisRich Chong, Board Member, Chair Operations Committee
STRATEGIES TO REDUCEREGRETTED ATTRITION Agency wide bonus plan Residential beginning base raised to 12: cost 121,987 in 2018-19 budget Employee appreciation: DSP week - 10,000 Employee of the month - 100 gift card holiday gift cards - 10,000 Staff satisfaction survey results and follow up Monthly newsletter includes responses to suggestion boxes CEO Listening lunches bi-annually Investments in supervisory training and developmentRich Chong, Board Member,Chair Operations Committee
GROWTH: ADULT DAY SERVICESTAYLOR CONSULTING PROJECT RECOMMENDATIONS Wash U teamrecommendedNorth Countyas top locationfor relocation of50% ofCanterburyCenterconsumersRich Chong, Board Member,Chair Operations Committee South city andfar southcounty lackingcurrentprovision ofservices
ADMINISTRATION:RISK MANAGEMENT Unknown timeline of managed careStrength in leadership to execute changePotential cuts to MedicaidReal estate investments & programrelocationMaintaining Health Insurance benefitBoard completed facilities assessmentPrioritizing retention of direct care staffRich Chong, Board Member, Chair Operations Committee
THANK YOU UNITED WAY!United Way support is fundamental to continuingto offer high quality services to individuals withdisabilities.
Two programs: Independent Supported Living (ISL) and Independent Supported Living Assistance (ISLA) ISL: 12 accessible homes throughout St. Louis- 19 consumers provided direct care staffing 24 hours per day ISLA: 13 homes throughout St. Louis -15 consumers provided skills training 2 to 10 hours per week Judy Grainger, Senior VP Programs
