Center for Elders Independence

20 08-2011 Strategic Plan

S T R AT E G I C P L A N N I N G

CEI Strategy Development

What is a Strategic plan? What purpose does it serve?

• A robust and compelling plan that guides the organization as a whole toward the realization of the mission and informs decisions about resource investment, operations, and people • A “sticky” story that provides a common context: it tells where we are going and when and why and how each person’s efforts contribute to our success • A call to action grounded in our mission: our commitment to making a difference for those we serve and having impact on the way health care is provided

VALUE TO STAKEHOLDERS Board Planning horizon:

3-5 years Planning Cycle:

Develop a plan every three years, with biannual progress reports and 18 month refinement of objectives

Builds trust and confidence in CEO’s decisions Creates capacity to capitalize on opportunities

CEO

Creates capacity to capitalize on opportunities Informs talent management Basis for communication and reinforcement of priorities

Senior Leadership Informs talent management Basis for communication and reinforcement of priorities Informs alignment and negotiation of trade-offs Establishes accountability Starting point for defining tactical plans Establishes priorities and articulates business rationale

S T R AT E G I C P L A N

Employees Provides guidance; enables greater independence Allows integration across the organization Informs standards, jobs, performance Builds trust and confidence in senior leadership Shapes a common identity

Participants / Potential Participants Defines focus of the program and outreach efforts Encourages better service Encourages trusts and confidence in the organization and staff

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S T R AT E G I C P L A N N I N G

The Planning Process Engagement as strategy

In February 2007, the Board conducted a SWOT analysis and identified three mandates:

1. Achieve and maintain operational excellence 2. Grow and expand PACE 3. Explore and implement new markets and new products • In Summer 2007, the chiefs discussed and considered the Board’s charge and decided to engage Claros Group for a more robust process • Claros Group involvement began in early fall of 2007, the chiefs discussed the functional purpose of a strategic plan and developed a strategic framework. Recognizing the benefits and necessity of involving others in crafting the goals and objectives, they committed to a strategy of engagement • In November and December 2007, the CEO and COO hosted staff meetings to build a shared understanding of the history of growth and accomplishments of CEI and the PACE business model and solicited input on what it would take to achieve the three strategic imperatives • Between late February and early June 2008, over 30 directors, managers and coordinators participated in a series of planning meetings to generate vision, values, goals, and objectives for achieving operational excellence. Applying systems thinking, participants also identified the underlying structures, beliefs or assumptions that are blocking movement toward the vision • In May, the development planning staff joined direct service directors and managers to map out a streamlined and standardized approach to opening a new site • Between April and June, the Executive Team developed a strategic IT plan, significant financial systems, a performance dashboard, and recommendations for an evolving management structure * Bolded purple text indicates document to follow

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S T R AT E G I C P L A N N I N G

Benefits of collaborative approach to Strategy Development We know that as organizations grow in size and complexity and experience leadership transitions, people often struggle with issues of trust, cohesion, and alignment. CEI leadership chose a collaborative approach because we believe that people contribute their best when they have information, influence, shared identity and pride, and confidence in leadership. Beyond the great thinking that informed the development of this plan, we have seen other benefits: LEADERSHIP DEVELOPMENT

This planning process was led by the COO and a core team of directors who framed the questions, facilitated the discussions, and modeled transparency, respectful listening, and rigorous inquiry DELIBERATIVE SKILLS

More than 30 CEI leaders participated in over 20 hours of participatory discussion and collaborative decision-making. To date, 15 leaders have been trained in the ToP method of participatory planning. The workshop method has become a part of CEI’s culture

COMMITMENT People commit to what they co-create. Because chiefs, directors, managers, and coordinators

generated recommendations for goals and objectives, they have ownership and will be able to model and communicate the ideas and the thinking behind them

ALIGNMENT

Through this approach CEI has created a robust and compelling plan that can guide decisionmaking about resource investment, operations, and people. Each manager understands how the strategies and goals and objectives map to his/her department, job, and daily actions

CROSS-FUNCTIONAL CONNECTIONS

Accountants and social workers, transportation and IT, nurses and development planning staff, HR and intake, 15 year veterans and new hires brought their different perspectives, built on common values and discovered their interdependencies

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S T R AT E G I C P L A N N I N G

Strategic Planning Framework TERM

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DEFINITION

VISION

A shared understanding of what we want the organization to look like over the next 3-5 years

CORE VALUES

Statements that define how we want the organization to be. Values clarify and resolve issues, help determine direction and build community

GOALS

Broad statements of what the organization hopes to achieve

CONTRADICTIONS

The underlying structures, assumptions, and beliefs that will block progress towards our visions and goals

OBJECTIVES

Specific measurable statements of results. How we know we achieved our goals

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CEI MISSION AND VISION

CEI Mission and Vision MISSION The Center for Elders Independence provides high quality, affordable, integrated health care services to the elderly, which promote autonomy, quality of life and the ability of individuals to live in their communities

FIVE YEAR VISION We will build a solid foundation of operational excellence and continue to evolve our organizational structure so that we grow in ways that are healthy and sustainable We will extend the reach and impact of PACE programs and explore new business opportunities consistent with our mission

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CEI MISSION AND VISION

CEI M ISSION The Ce nter f o r El d er s I n d ep en d en ce provides high qualit y, affordable, i nte g rated h ea l t h c a re s er v i ces to the elderly, which promote autonomy, qualit y of life and t he ab i l i t y o f i n d i v i d ua l s to l i ve i n their communities

F I V E YEAR V I SI ON We w i ll b ui l d a s o l i d f o un d at i o n o f operational excellence and continue to evolve our org ani z at i o n a l s t r uc t ure s o t h at we grow in ways that are healthy and sustainable We w i ll ex ten d t h e rea c h a n d i m p a c t of PACE programs and explore ne w bu s i n es s o p p o r t un i t i es co n s i s tent with our mission

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San Pablo

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Josie Barrow 2011

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I . AC H I E V E A N D M A I N TA I N O P E R AT I O N A L E X C E L L E N C E

I. Achieve and Maintain Operational Excellence Core Values and Goals

1. Excellent & Engaged Workforce • • • • • • •

Develop and maintain a well trained and competent workforce Foster open and effective communication throughout the organization Encourage and support career growth and development Reward and acknowledge excellence in staff Provide competitive wages and benefits Maintain adequate staffing Promote a culture of collaboration, accountability and empowerment

2. Leadership Integrity • • • • • • •

Demonstrate courage in difficult situations Practices and expects responsibility and accountability Listens and communicates effectively and diplomatically Is consistently fair and objective Consistently has a grasp of relevant issues Intentionally leads by example Fosters connectedness by building a culture of openness and respect

3. Effective Fiscal Management • Individuals & groups are educated & accountable for how their actions impact the overall financial health of the agency • Develop & implement a fiscally responsible budget with individual line item accountability linked to agency fiscal goals • Create a mindful culture that minimizes errors & waste of resources & efforts • Actively explores cost options with an awareness of fiscal efficiency • Ongoing monitoring & adjustments to ensure desired achievement of fiscal outcomes

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I . A C H I E V E A N D M A I N TA I N O P E R AT I O N A L E X C E L L E N C E

4. Efficient Infrastructure Systems & Processes • • • • • • •

Centralize materials management Streamline recruitment & hiring Improve data capture & integration Define process for choosing and integrating new systems Assure IT system reliability and security Improve intra-agency communication through a CEI intra-net webpage Standardize new site planning

5. Collaborative Community Relationships • • • •

Enrich participant experience by partnering with community resources Expand donor base Partner with other organizations to advance policy that supports CEI mission Strengthen relationships with caregivers (hospitals, B&C, SNF, individual caregiver) to ensure participant safety • Cultivate participant and employee referral sources

6. Current & Innovative Practices • Improve access to and increase range of services for participants • Create an organized approach to develop and apply best practices (includes: data collection, research and teaching) • Evaluate our current practices, processes and outcomes to measure and achieve quality standards

7. Customer Service Orientation • Awareness and consideration of cultural diversity • Define CEI customer service standards • Build CEI community cohesion through collaboration and engagement

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I . AC H I E V E A N D M A I N TA I N O P E R AT I O N A L E X C E L L E N C E

UNDERLYING CONTRADICTIONS Contradictions are blocks and barriers that prevent us from realizing our vision. They include external policies, patterns or structures and internal assumptions, perceptions or mindsets that get in the way of progress towards our vision. In a very challenging set of discussions, CEI leaders examined their history, their culture, and their challenges to identify the following patterns: Contradictions:

1. Competing priorities resulting in inefficient deployment of staff resources 2. Siege mentality and emphasis on short-term needs prevents attention to communication and teamwork needs 3. Conflicting regulations and inconsistent interpretation by regulators 4. Fear that growth and standardization mean loss of individuality and family atmosphere 5. Fear of considering cost over quality and the belief that better quality is associated with cost

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I I . G r o w and E xpand PAC E

OBJECTIVES: specific, measurable accomplishments July 08-January 09 The final workshop(s) asked directors, managers and coordinators to look across the seven values and 40+ goals and to keep in mind the contradictions that had been described.

The following high leverage, high impact objectives were identified:

STRATEGIC PLANNING OBJECTIVES FOR OPERATIONAL EXCELLENCE

Q1

Q2

Jul/Aug/Sep 2008

Oct/Nov/Dec 2008

Promote fiscal / budget responsibility by providing each manager with monthly financial statements

Develop strategy to address mental health needs

Chief Owner: C FO Create strategic recruitment plan and streamline hiring process Chief Owner: C OO Implement new health care wishes approach & tools

Chief Owner: COO

Implement Successfactors (pay-for-performance) Chief Owner: C OO

Select EHR Product Chief Owner: C TO

Chief Owner: COO

Open Josie Barrow site Chief Owner: CEO/COO

Stabilize finance and health plan function / staffing Chief Owner: C FO

Q3 Jan/Feb/Mar 2009 Department & disciplines will develop and share performance improvement objectives consistent with the strategic framework Chief Owner: C OO Build a data warehouse / reporting facility Chief Owner: C TO

Q4 Apr/May/Jun 2009

Develop an internal communication plan that reinforces CEI’s culture and teamwork Chief Owner: C EO/COO

Q5

Q6

Jul/Aug/Sep 2009

Oct/Nov/Dec 2009

Evaluate and respond to employee recognition needs Chief Owner: COO

Centralize inventory and purchasing Chief Owner: C FO

Implement management training program

Permanent executive team established

Chief Owner: C OO

Chief Owner: CEO

Go live on new HRIS system Chief Owner: C TO

Upgrade Plexis Chief Owner: C TO

Migrate servers to manage hosting Chief Owner: C TO * Developed 9 objectives from strategic planning process. Boxes in bright green are already in progress.

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I I . G r o w and E xpand PAC E

II. Grow and Expand PACE Goals & Objectives: 18-36 months

What is the Opportunity for Expanding PACE? CEI has a market penetration of about 11% in our existing service area which stretches from El Sobrante to South Hayward. That means we serve only 1 out of 9 dually eligible (Medi-Cal and Medicare) seniors living in our service area

WHAT IS OUR PLAN FOR GROWTH? 1. Open PACE Programs within our service area: Hayward and Richmond

• A Richmond site has been selected and the city and community have been quite supportive. Design has begun and we expect the site to open in 2010 • A Hayward site is still under research. A possible smaller site has been identified. Since we would not be able to build a significant amount of affordable senior housing on site, staff is researching affordable senior housing in the area 2. Streamline and standardize our site planning and start up process

A planning workshop with operations and development staff identified the steps in the process for opening a new PACE site. Our development team has drafted a streamlined Gant chart showing the specific duties of each department. See chart, next page 3. Be aware of and ameliorate competition and market exclusion by Organized Health Systems and other detractors.

This will require greater vigilance and activity in the public policy arena.

Eastmont Josie Barrow PACE Center under construction

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I I . G r o w and E xpand PAC E

OPENING A NEW PACE SITE Planning Department Market study- identify area Community PR - develop support Identify site Identify design team Design PACE Center Work with city/county planning on design approval Apply to State (DHCS) for PACE expansion shepherd expansion application through DHCS/CMS Identify construction team and bid project Review FF&E list with staff for changes Get building Permit Construction process Interior design Apply for clinic license Apply for Home care license Order FF&E Install FF&E Fire inspection Occupancy license Center Readiness review from State Contracting Department Identify needed network expansion Contract with new providers Quality & Compliance Department Develop needed P&Ps for PACE application Review P&P's for needed changes with new site Create and produce new training manuals Train new staff Human Resources Labor market analysis for new area Develop recruitment plan Recruit new staff Fund Development Fundraising to cover FF&E and vans Plan and hold ground breaking ceremony Plan and execute grand opening event Finance Update claims system with new providers Set up cost center on G&L Create chart of accounts for new center Set up payroll Marketing Revise marketing materials (submit & print) Educate referral sources in new area Develop marketing plan for new area Marketing effort for new PACE Center Increase current Center enrollment Outreach to current participants about transferring Transportation Analyze new routes Hire and train new drivers

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Quarter 10

Quarter 9

Quarter 8

Quarter 7

Quarter 6

Quarter 5

Quarter 4

Quarter 3

Quarter 2

Quarter 1

Opening

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I I I . N E W B U S I N E S S D E V E LO P M E N T

III. New Business Development Goals & Objectives: 12-24 months Why grow beyond PACE? Demographics: Seniors are the most rapidly growing segment of the population and the number of people over 65 will double in the next 20 years. The fragmented, disjointed and inefficient non-system that exists today is poorly suited to serve this large bulge of the “boomer” generation.

Funding Uncertainties: There is continuing uncertainty about the PACE Medi-Cal and Medicare rates. In some states, with the rise of home and community-based services (HCBS

are generally cheaper than SNFs) the Medicaid rate for PACE has plummeted. There is some risk that the basis for a percentage of fee-for-service methodology to determine PACE Medicaid rates will erode dramatically. Without other revenue streams, the PACE program itself would be threatened.

WHAT NEW OPPORTUNITIES ARE WE EXPLORING? Expansion in service area

It takes about five years to launch a PACE center in a non-adjoining geographic area. The greatest concentrations of seniors in adjacent service areas are in Pittsburg/Bay Point/Antioch and Vallejo areas. Since Vallejo is in a third county, we will be beginning to cultivate the Contra Costa county areas in the next two years • Complete market research of the area including Pittsburg Bay Point and Vallejo. See map, next page • Develop relationships with Contra Costa County officials, providers and affordable housing entities the way we have with Alameda County groups • Recruit Contra Costa board members • Apply for zip codes through Antioch when we apply for the Richmond PACE center in Fall of 2008 • Begin a site search in the Pittsburg/Antioch area in late 2008

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I I I . N E W B U S I N E S S D E V E LO P M E N T

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I I I . N E W B U S I N E S S D E V E LO P M E N T

Fulfilling our Mission Our mission includes finding many different ways to help seniors retain their independence and stay living in a place they call home. Not only does that include expanding the PACE program, it includes developing new products that reach seniors who are not quite yet eligible for PACE or seniors from the middle class who are not on Medi-Cal but need help to stay at home.

This means considering product and service development; options include: • Combine PACE with the Continuing Care Retirement Community (CCRC) model • Given a trend of middle and upper income seniors are engaging private care managers to help them manage their care, evaluate the Continuing Care at Home model for use by CEI • Look into opening our own assisted living Board and Care facility It means looking at new markets: • • • •

Working poor Middle Class Veterans Developmentally Disabled

Goals for the next 12 – 24 Months: • Continue to work towards the development of the Encinal Project in the City of Alameda. This would combine PACE with a CCRC model for middle income people • Look into developing minimal assisted living (B&C) units with the Hayward PACE center • Research other organizational structures

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I V. O R G A N I Z AT I O N A L E VO LU T I O N

IV. Organizational Evolution It is time to stabilize the executive team and to design team roles for individual and collective success. We have recognized the need to build our operational infrastructure -the processes, procedures and systems that will support our current programs and those we will open over the next 5 years. It is equally important to evolve our management structure in a way that will drive results, reinforce accountability, and manage risk.

A. STructure & Succession 1. Roles & Functional Responsibilities

• We propose to move the QM function under the new CMO • As our interim CFO completes her charge of building out Finance systems and Health Plan functions, we will move toward hiring a permanent CFO. • In recognition that information systems will result in needed efficiencies that then enhance our ability to deliver high quality care and services, we will hire a permanent CTO • With the expanded demands of a fifth site, we will recommend elevating HR leadership to a chief level • With the expanded demands of a fifth site, we propose to shift responsibility for Compliance to the CFO 2. Transitional Plans

Our interim chiefs have been building the systems and processes critical to our future. As they complete the work they came to do, they will develop transition plans that ensure continuity and forward momentum

B. Managing for Results 1. Risk Management Dashboard

Our success and stability depend on our ability to effectively manage risk. This requires clear accountabilities, timely and consistent measuring and monitoring of key indicators, and early and effective response

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I V. O R G A N I Z AT I O N A L E VO LU T I O N

RISK MAN AGEM EN T Indicator Operations (COO) Membership (Census) Utilization Day Center Home Care B&C Finance (CFO) Revenue Collection (collection vs expected) MediCare Medical Part D Claims Compliance 90% clean claims in 30 days 100% clean claims in 45 business days Share of Cost Clinical (CMO) Sentinel Events Utilization Hospitalization Pharmacy SNF Human Resources (COO) Workers Comp Staff Turnover (voluntary vs. involuntary) Staff Vacancies (cost/time to fill) New Hire Success by Department

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Measurement Unit

Data Source

Target Date for Fully Functioning Indicator

Total members; Enrollments; Disenrollments (by type); Net

PACECare

Aug - 08

Avg ADA # of hours # of prt; avg cost

QM Manual Finance Ops; Finance

Sept - 08 Sept - 08 Aug - 08

% % %

TBD TBD TBD

Jan - 09 Jan - 09 Jan - 09

% % %

Plexis Plexis Fin Manual

Aug - 08 Aug - 08

#

QM Manual

Aug - 08

days per 1000/annum pm/pm % of census

UR Data Finance UR Data

Aug-08 Aug-08 Aug-08

# of claims, mod factor # Cost & time to fill % success rate

Suhr Risk HRIS HRIS Manual

Aug - 08 Jan - 09 Jan - 09 Sept - 08

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Susan Davis, Layout and design Paintbox Productions 510 839-7229 sdavis@paintboxproductions.com

Laura Peck, Consultant Claros Group 510 524-3150 lpeck@clarosgroup.com