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When the NDIA announced a suite of changes to group pricing in June, we knew it was big. Fundamentally changing the way claims are structured was always going to send shockwaves through the sector. Since the changes were announced, we’ve consulted with and delivered workshops to hundreds of group support providers. What has been starkly clear is that the practical implications of these changes for participants and providers have been even more significant than we had anticipated. Here’s what we’ve learnt about how the sector is responding to the new world:
1. GOODBYE BUSINESS AS USUAL
The knock-on effect of changing how group services are billed is that it also necessitates a re-think of how the supports are delivered. Adding to these pressures are the social and financial impacts of COVID-19 and the fact that consumers are becoming much savvier. What has worked in the past will no longer work today. Participants want to know what is changing and what it means for them, and, in practice, it’s primarily up to providers to help them understand. And the first step for leaders is to understand the details of these changes.
2. GROUP PROVIDERS ARE EXITING THE MARKET
These changes have resulted in a steady trickle of group support providers exiting the scene since June. From what we have seen, they are usually providers who deliver group supports as a smaller part of what they do rather than their central support offering. This (hopefully) unintended consequence of pricing changes is bad news for participant choice and control.
3. NON-FACE-TO-FACE SUPPORT PROVISION AND THE GREAT UNKNOWN
A quick recap: some group support providers can now claim non-face-to-face supports. In previous Price Guides, this was not allowed. Based on our modelling, this is the biggest financial lever providers have at their disposal to ensure billing reflects the work they really do. Generally, the response from group providers has been really positive.
But one reaction has been even stronger: confusion. There are still a lot of unknowns, and all providers have to go on is 400 words in the Price Guide and 8 examples. Providers are asking: What’s in? What’s out? Can we claim for X under non-face-to-face? What are the grey areas? This is the biggest group services restructure in recent memory, and there is not a lot to go on.
We recommend that providers start with a non-face-to-face time audit. Ask staff to begin recording all the time they spend outside of direct support provision.
4. CULTURE EATS PROCESS FOR BREAKFAST
It’s one of our favourite sayings at DSC. And these changes have once again proved it true. Many providers come to us with a service design or process or system challenge, but it doesn’t take them long to realise that culture is usually a far bigger issue.
Billing of non-face-to-face supports could involve asking workers to track multiple support items, record mileage and travel time, and justify why a particular support is the best use of funds. All these things might be new to organisations and workers and consequently have the potential to create cultural challenges. In the past, workers have been recruited on the basis of their ability to deliver great direct supports. Those same workers are now being asked to complete non-face-to-face tasks, track hours and record multiple items for a straightforward shift. We have noticed that the organisations that have had the most success with the new pricing model are the ones that tackle the cultural challenges first.
5. ENGAGEMENT IS THE FOUNDATION FOR SUCCESS… AND SURVIVAL
Truth is, it is easy to develop group supports that are financially viable under the new pricing model. That’s just about sitting down with your finance people and the Price Guide for a few hours. What is more challenging is to develop financially viable supports that people want to buy. The missing piece is engagement – understanding what people want, and how they want it.
Many providers we meet are still in satisfaction-focussed engagement mode (“On a scale of 1 to 10, how happy are you with the services we provide?”) or service-focussed engagement (“On Tuesdays, do you prefer to go bowling or to the pool?”). But the engagement for success is more person-focused (“How can staff best support you to achieve your goals?”) and design-focussed (“What would it look like if you achieved your goals?”). Goals, best ways to support, plans, interests, passions, fears – genuine engagement is more than an annual satisfaction survey.
The structural change to group services also means providers need more flexibility in the delivery of support. The Henry Ford approach of "Any customer can have a car painted any color that he wants so long as it is black" can no longer ensure a smooth transition.
6. THE EMERGING CHALLENGE OF UNREGISTERED PROVIDERS
We’ve been surprised by the number of providers who have responded to these pricing pressures by deciding to operate as unregistered providers. But it makes sense –unregistered providers working with self-managed participants are not bound by the conditions and caps in the Price Guide. For providers with a unique or boutique offering, who are happy to not compete in the mass market, the impact of these changes to group pricing and structures could be minimal.
All providers need to be across the unregistered element of the market. Rates of self- and plan- management have been on the rise since Day 1 of the NDIS. The upcoming changes that require plan managers to record the ABN of businesses they make payments to will give us more visibility of this market.
We think that unregistered providers are going to be a significant area of growth in 2021 and beyond – and larger, traditional registered providers should ignore them at their peril.
7. NOT ALWAYS LOGICAL
We’ve also spent the last six months trying to understand the logic behind some of the changes. There are parts that make sense but others less so. For example, it was announced in June that Capacity Building providers who deliver group supports were not able to claim Centre Capital Costs, nor would they get the same 12-month transition as Core providers. The costs of running services out of a centre can be similar for Capacity Building and Core providers; so, we are not sure why this payment was not an option for the former. It also acts as a disincentive for providers to design innovative, flexible mixed models of support.
The changes are a tremendous challenge for providers, a new way of purchasing for participants and a fantastic opportunity to turn group supports into a flagship of contemporary disability practice.
