Providers of services and Conflict-Free Case Management agencies have a great responsibility to ensure people are directing and leading their Person-Centered Plans. People receiving Home and Community-Based Services (HCBS) are excluded from the planning process far too often, and sometimes they are even excluded from their own support meetings. As HCBS continue to transform across the United States, there are numerous opportunities for Case Management agencies and HCBS providers to deepen their partnerships to truly promote people directing their own Person-Centered Plans.
Case Management services have evolved over time to ensure that it is conflict-free, meaning these agencies cannot provide any other HCBS except Case Management. In the early years of the HCBS Waiver program, case management services could be provided by organizations that also delivered waiver services. This created perceived and actual conflicts of interest, with some Case Management agencies steering people to their provider for other services under HCBS, raising concerns about financial incentives, a lack of impartiality, and questions of fairness. In 2014, the Centers for Medicare and Medicaid Services (CMS) issued guidance encouraging states to adopt strategies making case management separate from service provision and having systems for identifying and minimizing potential conflicts of interest.
Today, it has become common for states to adopt procedures requiring that Case Management agencies develop the Person-Centered Plan and separate HCBS providers implement that plan. In teams with strong partnerships between all members, people receiving services are not only at the center of the team, but they are also directing the team. In these systems, HCBS Providers provide information, tracking data, and assessment tools to assist the Case Manager in developing the plans, with the person driving the changes.
Promoting Partnerships: Tips from Providers
In this Capstone, CQL worked with a provider organization and a Case Management agency to bring some helpful tips on how to promote partnerships so people receiving services can achieve the things that are important to them. CQL asked EP!C in Peoria, Illinois for ways they have built strong partnerships with Independent Service Coordination agencies (ISC) agencies – the conflict-free Case Management agencies in Illinois. Conversely, CQL asked a Case Management agency, Benchmark Human Services in South Dakota, for tips and information on how they have built strong relationships with HCBS providers and people receiving those services.
Tip #1: Person-Centered Discovery
You must know what a person wants from their services to have a strong team.
The strongest teams focus on what the person wants for their services. This changes over a person’s life, so teams will need to discover what the person wants, both initially and continually. As Benchmark’s Director of Case Management Tacey Dunwoody explains, “Our network of case managers helps individuals, and their parents/guardians understand and navigate their options so they can make clear choices. We do this by getting to know the individual and what is important to and for them… We [also] have ongoing training with Person-Centered Thinking Tools and the Charting the LifeCourse philosophy.”
The tools mentioned are some ways that agencies can gather information, as well as assessments, observations, and conversations. But there are numerous tools available to organizations. EP!C utilizes CQL’s Personal Outcome Measures® (POM) to discover a person’s goals for their life, as Doris Hayes, EP!C’s Chief Operating Officer, describes “The POM interviews are our driving force. We have worked to interview more people to gather information needed to know a person well. We changed our onboarding for new staff to understand the person is the driver for all services and staff are a support. We onboard our staff to assume competence in everyone and that no outcome is unrealistic.”
Organizations can assist in information being passed to new team members by outlining the information learned from these tools in the Person-Centered Plan. This ensures that valuable information discovered about the person stays with the person.
Tip #2: Leading Meetings & Directing Services
People should be supported to lead their team meetings and direct their services.
People should lead and direct their meetings and services, so it is important that all team members adequately support the person in doing so. Tacey Dunwoody (Benchmark) knows the importance of the person leading their meeting, mentioning that “Individuals are encouraged to take as much ownership … in leading their annual ISP’s and team meetings.” The person owns the plans and the services, so they should determine how services assist them in achieving any goals they choose.
Some people may need more support to direct their planning meetings. Doris Hayes (EP!C) describes their process, explaining “We have pre-meetings with the person and conduct our POM interview prior to all annual meetings. Then our QIDPs meet with the person to determine any outcomes they would like EP!C to support them in achieving. Our QIDPs support the person to prepare and support them to discuss these outcomes and anything else they wish to discuss. We do pre-planning meetings to have a healthy discussion on what the person wants to accomplish. Once that is determined, we become the support and they become the lead in discussing their plans and how they see it. We train our QIDPs to take the back seat during the planning process and nothing is unrealistic or unachievable for someone.”
Team members change over time. The only constant is the person who is receiving services. Tandy Dunwoody (Benchmark) summarizes what most services providers have been experiencing, “We continue to struggle with DSP shortages and staff consistency/turnover. These are always a big challenge when trying to establish goals and dreams for the people we support.” People who lead and direct their services can help create stability in teams that oftentimes change, so that the person can still achieve the goals they set for their life.
Tip #3: Open Communication
Honest and open communication is key between all members of the team, most importantly, the person receiving services.
All good partnerships and teams have a foundation of honest and open communication. This is key to ensuring that the team can work effectively together to achieve what the person wants from their services. Tacey Dunwoody (Benchmark) makes this clear, “We believe that having open, honest dialogue and discussions with all team members that we work with on a day-to-day basis result in strong relationships. We do this because everyone deserves the best options available to manage life’s opportunities.” Strong relationships take concentrated effort from all people involved; they do not immediately occur just by being a team member.
Working closely together to collaborate requires frequent communication, Doris Hayes (EP!C) explains that the teams meet with Case Management providers at least quarterly, “this is a good way to introduce new staff and answer any questions regarding programming and with the consent from the person, we also share pertinent information related to the personal plan. Communication and planning have increased to help provide better services to the people of EP!C.” Doris Hayes suggests “regular, scheduled meetings with an agenda and do not cancel. Hold everyone to attending and communicating honestly.”
Tip #4: Nurturing Partnerships
Strong teams are made stronger by learning and growing.
Both EP!C and Benchmark have implemented changes to their process to create stronger partnerships across providers, services, and communities. Doris Hayes explains that EP!C has “…offered more education to the community and all stakeholders in general.” Educating those stakeholders and the general community creates social capital that helps people meet their goals.
Tacey Dunwoody mentions how Benchmark has strengthened their process, sharing that “We continue to partner with outside entities and natural support networks to strengthen our case managers abilities in advocating for the individuals we support… Benchmark strives to have strong relationships with all Community Support Providers as well as State Departments. Our directors have a very transparent and open relationship with these entities and promote partnerships to best support the individuals in achieving their best life… Each individual success story becomes part of our mission.” All members of the team should leverage their social capital to expand the opportunities that are available for people to grow.
Developing Partnerships At Your Agency
Improving the services that people receive transforms the roles and partnerships between HCBS providers and Case Management providers. The tips provided by Benchmark Human Services and EP!C provide practical guidance on how to promote partnerships by knowing what the person wants for their services, ensuring they are directing their services and meetings, cultivate honest communication within the team, and continue to learn and grow.
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