What Now For Group Services

Back in June, the NDIA dropped yet another bombshell for group service providers. Only this time, it combined a bombshell with a flip flop. A flipomb, or a bomflop. In June last year, the NDIA announced the extremely-short-notice plan to move group support pricing from a ratio-based model to an apportioned pricing model. The Agency later agreed to give providers delivering group services from Core 12 months to transition to the new pricing model. Then in late June, at the last possible moment, it was announced that the deadline for transition will be pushed out from 1 July 2021 to 1 July 2022. 

The response from the sector has been mixed, ranging from the eye roll emoji to complete surprise to delight. Many providers are breathing a sigh of relief - there was lots to do in the final few weeks. But many others are frustrated that all the work, stress, attention, resources and money that has gone into getting ready for 1 July 2021 could now potentially be for nothing.

Like a bad infomercial, we have to say: but wait! There’s more! Since the Agency announced the new pricing structure last year, providers have been able to choose between billing with the old transitional ratio pricing or the new apportioned pricing model. The apportioned pricing model was going to become compulsory in July this year, but now will next year instead. But  providers can still choose to when to transition. Which means providers of group core supports across the country now have another decision to make: when should we transition to the new pricing? 

Annoyingly and fantastically, there is no right or wrong answer to this question. The decision is going to come down to a number of factors that are unique to each provider. To get the ball rolling, here’s a rundown of some of the considerations for deciding when to transition your service.

Why transition earlier?

• You've done the work already! The vast majority of providers have done the hard yards of system redesign, training, and participant engagement to get ready for the original deadline of 1 July 2021. So transitioning sooner rather than later means all that work over the last 11 months (and the last 2 months of incredible stress) hasn’t gone to a waste. The NDIA has indicated there will be a compulsory transition at some point, so why not get ahead of it? Every week you’re operating with this new model is a week of insight, learning, feedback and testing that you can use to improve your systems and services.
• It's a chance to differentiate from providers who are still using ratios. Generally speaking, the new apportioned pricing model means more transparency for participants to where their plan is being spent. Providers who tell participants “we’ve done the breakdown and this is how your plan would be spent with us across direct group supports, non-face-to-face, Centre Capital Cost and others” can be more attractive to participants who value clarity of plan spend.
• You will know your financial situation earlier. This is particularly important for providers who are still grappling with whether group supports will be profitable in the long run. The sooner you are operating the apportioned pricing model, the sooner you can start collecting data on the financial impacts, mitigating any losses and budgeting for the future. For many providers, ratios are hiding a multitude of service problems and the longer they wait, the more those will become even more ingrained. 
• Some providers have found they can generate more revenue from the new pricing model. Particularly providers that are delivering mixed models of support or have approached the transition from a service design perspective (rather than trying to squeeze a square peg of traditional group services into the round hole of the apportioned pricing model). 

Why transition later?

On the flip side, if you’re thinking of transitioning later, there are also some upsides:

• You will have longer to rebuild services that are more in line with the apportioned pricing model. Switched-on providers have accepted that this isn’t just a minor change in billing - it’s a reworking of support structures and designs. Transitioning later gives more time to engage in genuine co-design to build more stable supports that are fully ready for the new pricing model.
• More time to communicate with participants and families.  This will be particularly important for providers in states that have been hit by COVID outbreaks in recent weeks and months. Those circumstances may have limited your ability (and will continue to limit your ability for the foreseeable future) to meet with people face to face to work through these changes. So transitioning later gives you more time to work through the changes with the people you support.
• More time to iron out any system and IR issues that may be hampering the progress of the transition. If you’ve got a giant IR or CRM challenge, a few months longer to find a solution for those deal-breakers could mean the difference between success and failure.
• Planners and LACs might be clearer as time goes on about how group supports will be funded in plans - although I think this is unlikely. We’ve had feedback from many providers delivering a wide range of group supports that the awareness and understanding from Planners and LACs of how these pricing changes apply in real life service delivery is varied to say the least. The edict has come from high up in the Agency on how the apportioned pricing model will work in participant plans, but there are huge differences on the ground in how Planners and LACs are applying that direction. To say it's been like rolling the dice is probably an insult to dice, as there's only six options on your usual dice and we’ve heard of a lot more than six approaches being used by Planners to make funding decisions under the new pricing approach. With Planners working with two pricing models, I think we are in for another 12 months of inconsistency in planning decisions. All good processes are made better by having another similar-but-confusingly-different system running alongside it, right? 
• There may be even more updates to the Price Guide. We didn't see any significant changes in July 2021 Price Guide, but the NDIA have flagged their intention to do a major review in December 2021. With the NDIA so up-in-the-air with decision making at the moment, it’s difficult to anticipate what will happen next. I don’t think many people would have put money on the NDIA announcing a 12 month extension only a few weeks out from the deadline and it’s impossible to say what else the future may hold. At this stage, I’m not sure even the Agency knows.  
  • Programs of Support are able to be delivered from either transitional pricing or apportioned pricing meaning (at the time of going to print) you can use this new way of delivering supports before you move to the new pricing model. This gives providers the chance to spend more time establishing whether this way of billing services is right for you as a provider and right for the people you support. 

There’s no right or wrong time to transition your pricing model, just like there’s no real right or wrong way to structure supports under the new model. Whether you decide to transition sooner or later, the one piece of advice we can offer is: don't wait until the last minute! This decision took the pressure off the 1 July 2021 deadline, but about the worst thing any provider can do is to pause all this work until May 2022. 

There’s a lot of going on right now (see: Covid...again) but keeping the momentum generated in the last few months just makes sense. ‘Wait and see’ doesn’t equal ‘do nothing’. So keep working through the transition activities, keep talking to participants and families about these changes, and keep an eye out for a stack of DSC training content across 2021/22 to help you redesign and restructure your services, make key decisions and transition.