BUILDING BUSINESS CAPACITY
OBJECTIVES

 What are some of the “big picture” changes that 

you think are important for success?

 How has this work changed your organization’s 

culture and the way it operates?

 What were some barriers you

encountered? How did you address you those

barriers?

 What were some initial steps or processes you 

completed in creating relationships with health 

care orgs?
COUNCIL ON AGING:

WHO ARE WE?

 41 years of service to older adults, 

families and caregivers

 State-designated Area Agency on

Aging since 1974

 Butler, Clermont, Clinton, Hamilton 

and Warren counties

 One of largest non-profitsin our 

region
OUR MISSION & VISION

 Mission: Enhance the lives of adults by 

assisting them to remain independent

at home through a range of quality

services

 Vision: Every senior adult in our region 

shall have a choice and range of 

services that will assist them to remain 

independent in their chosen 

environment
COA’S CORE FUNCTIONS

 Administrator

 Aging & Disability Resource Connections

 Pre-Admission Review

 Care Management and Care Coordination

 Care Transitions

 Area Agency on Aging
COA BY THE NUMBERS -

2012

 20,459 clients receiving in-home services

 Nearly 2 million home-delivered meals (to

10,011homebound older adults)

 2.1 million hours of in-home care

 280,047 trips to doctors, senior centers

 29,322 requests for information about help for seniors

 160 education and support sessions with caregivers

 102 advocacy meetings with clients and elected officials

From 2012 annual report
BIG PICTURE CHANGES:

COA’S STORY

Moving from:

To:
HOW DO I BEST DESCRIBE

OUR CURRENT SITUATION?

It feels like

this..

We’re more like this... 

just a step ahead of a 

speeding bullet.

but we aren’t 

standing and 

waiting.....
COA IN 2006

"Family" 

orientation

We are "Number

One"

Advocacyand 

"heart"over 

budget

Staff mindset
THE ENVIRONMENT

In 2006

Managed Care Pilot proposed for PASSPORT in the

Cincinnati Region

Pressure to reduce Medicaid spending

Competition for scarce resources

In 2011

Significant budget reductions proposed – state and 

federal

State Integrated Care Delivery System is proposed and 

approved (Duals Demonstration)
c

WHY CHANGE??

Bottom line: We could see our funding streams changing and more

ompetitors entering the market.

 Past: We were reimbursed for our costs from Federal, State 

and Local entities.

Present: Fee for service is here (or almost here)

Care Transitions

 Medicaid waiver services will be provided through a 

managed care company (MCO).

 Future: We will sell our services on a per unit basis to MCOs and

other payers with a promise to achieve certain outcomes.
OUR BIGGEST QUESTION:

In 2006, Can we compete?

 We had the history of being a “monopoly” with state and 

local funding

 We get the money without having to compete for it

 Must rid ourselves of the “entitlement” mindset

In 2011

 Can we compete for business with Managed Care

Companies?

 What are the right products?

 How should we be positioning our organization for 

future relevance?
WHY CHANGE?

In short, we had to prepare for the future and know:

we are able to offer the highest quality services

at a competitive price

to maintain our market share and profit margin.
WAIT A MINUTE...

 Did you say “profit margin”?

 Yes.

 But we are non-profits, isn’t that illegal?

 No.

 I am still not sure this is right.

 Non-profits that earn revenue put their

revenue back into programs and services to

provide Better Service to More Clients.

Disclaimerto make the CFO’s happy: There is a bit more to it and there 

are a few rules, but as long as they are followed, it’s okay for a

nonprofit to bring in more than it costs them to provide services.
BUT WAIT, THERE’S MORE...

 We are nonprofits – why should we be 

concerned about being “competitive” and 

having a “market share”?

 Because:

 Aging is a hot market

high demand + low supply = profit potential

 Others believe they can do it better.

 Others can do it at a lower cost.

 Others can do it and make money at it.

AND...
PLAYING TO WIN•••

•••MEANS WE CAN CONTINUE TO 

SERVE OUR CLIENTS!
BIG PICTURE CHANGES

Culture

Relationships

Strong

Market

Position

Systems

People

Structure
STRATEGIES EMPLOYED

 Reform provider processes and ensure effectiveness and 

efficiency of provider contracting, communication and referral 

process.

 Ensures COA maintains its competitive edge.

 Build a strong organizational culture.

 Innovate both in staffing, technology, organizational 

operations and service package design and delivery.

 Ensure workforce is aligned with new integration models, 

technology, and future care delivery system.

 Ensure composition of the Board of Trustees and Advisory 

Council reflects expertise needed to provide oversight of 

execution of strategic plan.
STRUCTURE TO SUPPORT

HIGH PERFORMING TEAMS

Business Results and Innovation

BusinessIntelligence (analytics)

Business Results (quality)

Project Management

Business Development

Innovative Human Resources – Executive Level

Self Directed Teams

Team Educators

 Creative staffing structures – additional duty, contract 

employees
GET THE PEOPLE IN THE

RIGHT SEATS ON THE BUS
PUT SYSTEMS IN PLACE TO

SUPPORT THE STRATEGY

 Build Cost and Pricing Models

 Bring Program and Finance People Together

 Know how every position is paid for

 Relate cost to services sold

 Train everyone!

 Pay for Performance

 Technology

 Business Intelligence Systems

 Care Management Systems

 VPN access for telecommuting
CREATE THE CULTURE

 Data Driven Decision Making

 Focused on Outcomes, Quality and Results

 Play to Win

 Use Cost and Price Models – to price 

services, understand the cost of operations, 

and drive the culture change
Care Transitions Program 

Carl's Grocery Store Model 

For July 2012

$

FIXED COSTS

Cost Clients

Program Admin Personnel Costs $

Kim Clar k - Kim Hot el - Phy llis Clem on s - Mar y

Whipple - Chr ist ine Bon n er

Telephone & Cell Phones $ 

Depreciation (QMCO) $ 

Professional Svcs- Health Council $ 

Rent $

TOTAL FIXED COSTS $

1 7 ,8 4 9 .0 4

1 9 4 .8 5

1 ,1 1 1 .1 1

2 7 ,4 1 8 .0 0

4 4 8 .0 0

4 7 ,0 2 1 .0 0

37.8

0.4

2.4

58.0

0.9

99.5

VARIABLE COSTS

Coaching Personnel Costs $

Ton i Ar quet t e - Dan ielle Am r ine - Bet h Chopr a -

Vick y DePew - Kier an Flem ing - vict or ia McClain -

Cat hy Van Fossen - Kim Wear

3 1 ,3 1 1 .8 1 66.3
BUILDING THE RIGHT

PARTNERSHIPS
QUESTIONS?

Sharon “Madi” Fusco, BSBA, MHR 

Director of Business Results and Innovation 

Council on Aging of Southwestern Ohio 

(513)746-2645 Direct line 

sfusco@help4seniors.org Link to Help 4 

Seniors website

THE ANSWER.