Planning for Fee-for-Service Opportunities

by Michele Martin on January 22, 2016

Over the next several weeks, we will be doing a series of posts featuring material drawn from the CIL-Net self-study manual, Establishing and Managing Fees for Service in Centers for Independent Living. This week we’re talking about how to begin planning for Fee-for-Service opportunities.

Planning is the key to successful fee-for-service activities. For a CIL that is considering adding an FFS revenue stream, planning is the foundation for the organizational shift. Planning fee-based services is best accomplished as part of the organizational strategic planning process which is a responsibility of the board of directors. Larger organizations with lots of staff and other volunteers can ease the burden of scheduling the meeting(s), arranging facilities, hiring a facilitator, conducting needs assessments, and preparing the final document. However, in the final analysis the board of directors has to assure that the planning gets done. Typically strategic planning takes place in three-year increments. Consider including activities described below in the planning process as the CIL plans for fees-for-service.

Engaging the Board and Staff

The CIL needs to get genuine buy-in from the board of directors and staff. There is no one correct way of doing this. It is dependent on the organization’s culture. Look at how changes are typically made. Consider how information routinely gets shared, and identify the aspects of the hierarchy and structure of the CIL. Develop strategies to include the board and staff in the entire process. You might for instance, invite everyone to respond to an online survey that asks for his or her thoughts and ideas. Or, engage them in brainstorming, planning activities, as members of committees, workgroups, and teams; and provide frequent informational meetings.

An important aspect of including the board and staff is to be clear about how final decisions are made. Is the decision to be made a policy one that the board is responsible for or an administrative one that the executive director or administrative team is responsible for? Clarity is critical to ensure that everyone knows the process for being heard and believes their input will be taken seriously.

Include staff as active participants in the change process because they can be both a barrier and a facilitator of change. Their knowledge acquired from providing services to individuals with disabilities and personal experiences with disability is important data to be considered in the deliberations. If they disagree with the direction the center is going, they may resist or even derail the efforts. That’s not to say that all staff must agree with every decision that’s made, but that they should have an opportunity to give input into the key elements of the new direction. A CIL should involve all staff in generating ideas for change and educating staff about the differences between grant-funded services and fee-based services including requirements for staff qualifications, staff training and new job opportunities, consumer results, and changes required in the CIL infrastructure.

To actively involve staff in the preparations for the addition of FFS, form committees or workgroups to address quality assurance issues, space changes, technology requirements, new job descriptions and interview questions, policies and procedures, and recruitment of new staff.

Make sure that the board and staff support the venture even when things get tough―this is when having a process to design and monitor a plan can be especially valuable. Such a process can guide difficult decisions such as when to cut your losses with certain ventures. Identify staff members that are willing and capable of designing such a process, and monitor services and program outcomes often.

External Input

Most effective strategic planning invites input from both internal and external sources. In addition to involving the board and staff, it is very important that external input is actively solicited, analyzed, and utilized. This can include things like formally requesting feedback from other service providers and holding listening sessions for consumers in regions within the CIL’s catchment area, especially more remote regions where access to the CIL is more challenging. Other specific resources can add to the thoroughness of the strategic plan. Auditors bring fiscal insight and other CILs who are successfully operating FFS programs can provide both management and programmatic insight. In addition, other nonprofits can provide useful, practical mentoring to the CIL leaders.

As the planning becomes more targeted, the CIL needs to establish priorities with accompanying goals, objectives, activities, timelines, and who’s responsible. Do your homework before you start anything. This includes assessing your organization by asking the following questions:

Do we have a viable idea that will produce income?
Do we have an infrastructure that works?
Do we have direct service staff that can do what is needed?
Do we have the potential for recruitment of new staff?
Do we have an ability to market a service, both directly and indirectly?
What level of risk are we willing to take?

If the fee-for-service will involve a contract, the plan should identify the contract(s) that the CIL will be pursuing and the process required to acquire each contract. The best teacher is experience and when beginning an FFS contract, the CIL needs to learn as much as possible about the reality of such a contract. Learning from an experienced contractor is helpful. If the CIL does not have strong relationships with contractors in its area, seek out and contact contractors providing the same service in other areas. Key information that will help guide the CIL’s FFS bid includes: how to develop a competitive rate, staff training requirements, the quality of services provided, the consumer outcomes, relevant state/county requirements, identifying a reasonable service area, and possibilities for making a profit.

As part of the plan include the following elements:

Specify each step in the acquisition of the contract, and the contract expectations.
Identify how the plan will be monitored and adjust as needed.
Detail how the steps for the FFS will be reviewed and specify a timetable such as at least monthly, if not more often. This helps to keep the plan active.
Specify when and how the staff and board will be updated.

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