Evaluation of the consumer - directed care initiative - Final Report
9.5 Considering the financial sustainability of the initiative
Table of contents
- Executive summary
- Glossary
1 Introduction- 2 The consumer-directed care initiative
- 3 Evaluation of the consumer-directed care initiative
- 4 Profile of participants and the supports they accessed
- 5 Implementation and operation of the initiative
- 6 Impact of the initiative for CDC participants and their carers
- 7 Impact of the initiative for CDRC participants and the people they care for
- 8 Impact on providers and the broader service system
9 Cost assessment and cost-effectiveness of the initiative- 10 Key findings
- 11 Lessons learnt and strategies for consideration
- Appendices
- References
Again, it is too early to say whether the initiative is financially sustainable, given the ongoing costs of the initiative are not fully understood and are likely to change as the initiative continues. Provider costs are likely to stabilise and may even decline as they become more familiar with the initiative and more efficient in administering packages. Costs may also decline over time if more participants take on a greater self-management role.
There is evidence, however, that currently providers are bearing some of the additional cost of CDC and CDRC – in particular the costs of development and set-up, including systems development and changes and some of the ongoing costs of administering CDC (though not CDRC) packages. In the short term, if the number of CDC and CDRC packages were to increase (and costs do not decline), there may be a risk that providers will not be willing to continue to absorb this cost themselves, and may not be willing to take on more packages.
Investment in systems and staff development
As package numbers increase, there will reach a point when providers will need to invest substantial resources in systems development and changes to support CDC and CDRC – including changes to finance and client management systems and the interface between these systems – to support the operation of CDC and CDRC. For the first round of packages providers made some internal systems changes, though stated that they completed a number of tasks manually (for example, producing monthly participant statements) and relied on additional administrative support to complete other tasks (for example, matching client management records with finance records, or entering data multiple times into different systems). It is likely to be costly and inefficient for providers to continue to do this as package numbers increase, and without some investment in systems development, some providers may be unwilling to take on more CDC or CDRC packages. A lack of investment may also undermine key aspects of the CDC and CDRC models – such as transparency (for example, of budgets and package expenditure), and informed choice.Further, during the first round providers did not invest heavily in training and development of their staff, and instead focussed their efforts on developing the skills of one or two coordinators who managed the CDC and CDRC packages allocated to the organisation. As the number of packages increase, there will be a need to undertake more staff training and skills development, including for a greater number of coordinators and potentially for direct care staff and the community care sector more broadly. Again, this represents an additional cost which providers are unlikely to be able or willing to meet, and a lack of investment in staff development and training is likely to undermine the effectiveness of the consumer-directed care approach.
If the initiative is to expand, the Department should consider investment in provider systems development and training to support the operation of CDC and CDRC.
Ongoing financial support in the short-term
Based on available data and discussions with providers, it appears that some providers were not passing on the full cost of administration and care planning and management to participants during the period of the evaluation (the first round of package rollout) – for CDC in particular – and were bearing some of the additional ongoing cost themselves. This is unlikely to be sustainable as CDC package numbers increase, and may result in a number of possible scenarios:- Providers meet the additional administrative and care planning and coordination costs from package subsidies, reducing the amount of resources for direct supports for CDC participants
- Providers are less willing to take on additional CDC packages
- Key features of the CDC model are undermined, and the difference between CDC and standard packaged care becomes less distinct.
Key points – Cost-effectiveness and financial sustainability
- It is too early to say whether consumer-directed care is cost effective, or more or less cost-effective than standard packaged care and respite. Undertaking a full cost-effectiveness analysis should be considered once the initiative has been operating for a longer period – when outcomes from the initiative are clearer and are able to be quantified more precisely, and when costs of the initiative have been fully realised and have stabilised.
- It is also too early to say whether the initiative is financially sustainable, given the ongoing costs of the initiative are not fully understood and are likely to change as the initiative continues. Provider costs may stabilise and may even decline as they become more familiar with the initiative and more efficient in administering packages. Costs may also decline over time if more participants take on more of a self-management role.
- If the initiative is to roll-out further, without additional financial support for set-up costs – specifically for systems development – there is a potential risk that key aspects of the initiative will be undermined.