Joan O’Connell, PhDCircles of Care Evaluation Technical Assistance Center

American Indian and Alaska Native Programs

University of Colorado at Denver and Health Sciences Center

Circles of Care August 2007

Feasibility Assessment:Using Resources Wisely

Feasibility Assessment

Specific Components

I. Model Description II. Needs Assessment

III. Human Resources/Other Inputs Analysis IV. Management Analysis V. Financial Analysis

VI. Economic Analysis

I. Model Description

Target PopulationDefinition of SEBDNumber of youth and locationHow they are identified?

Model for a System of Care

Programs Elements/ServicesNew program elementsModification of an existing program(s)

Add elements Expand existing services

Using Resources Wisely

• Financial Analysis: Is the program practical and fiscally sound? Is the program sustainable?

• Economic Analysis: Does this program providing value when compared to other programs?

• Why Conduct Both Types of Analyses?

Using Resources Wisely

• Obtain support for the proposed program.

• Promote discussions of financial sustainability

• Resources are limited and resources could be used for other valuable programs.

V. Financial Analysis - QuestionsV. Financial Analysis - Questions

1. How are program resources utilized?1. How are program resources utilized?

2. Are there sufficient resources to meet 2. Are there sufficient resources to meet the needs of the target population?the needs of the target population?

3. How does the average program cost per 3. How does the average program cost per child served compare to costs of other child served compare to costs of other health programs?health programs?

V. Financial Analysis - QuestionsV. Financial Analysis - Questions

4. How do program costs change overtime?4. How do program costs change overtime?

5. Is the program fiscally sound? Do 5. Is the program fiscally sound? Do program revenues cover program costs?program revenues cover program costs?

6. How do program revenues change 6. How do program revenues change overtime? Is the program sustainable?overtime? Is the program sustainable?

Financial Analysis – Resource NeedsFinancial Analysis – Resource Needs

• Building Space• Outdoor Space• Office Supplies• Program Supplies• Computers, Software• Utilities• Travel• Training

• Human Resources– People with human

service knowledge and skills

– People with cultural knowledge and skills

– People with compassion & people skills

Financial Analysis – Resource Allocation

Model 4 Model 5 Model 6

Equipment, machinery, and other capital 5% 1% 1%

Personnel (salary and benefits) 62% 61% 73%

Rental, utilities, supplies, and materials 3% 3% 9%

Consultants 17% 11% 1%

Travel (for staff, family, and board) 4% 5% 3%

Other (including organization indirect costs) 10% 18% 13%

Total program spending $1,342,584 $1,948,939 $2,530,524

COC Grantee Model Budget Summaries. Program Annual Expenditure Estimates.

Percent of Annual Expenditures

Financial Analysis – Human Resources

Job Responsibilities Model 1 Model 2 Model 3

Management and Supervisory 3 2 3

Service Provision Clinical (mental health, substance use, etc.) 1 2 13.5 Case management 5 9 6.2

Administrative (administrative, financial, etc.) 4 3 7.5

Cultural Activities and Traditional Healing 2 Traditional Healing Services 11 Training -- 0.2 0.1

Community Outreach, Marketing, Education 1 -- -- Youth Coordinator 1 1 1

Data and evaluation -- 1 Other 2 3 1

Total number of clinical and case management staff 6 11 19.7

COC Model Summaries. Number of Full-time Equivalent (FTE) Positions.

Financial Analysis Staff per Youth Served

Model 1 Model 2 Model 3

Service Provision Clinical (mental health, substance use, etc.) 1 2 13.5 Case management 5 9 6.2

Total number of clinical and case management staff 6 11 19.7

Number of youth/adults served 50 45 144

8.3 4.1 7.3

COC Model Summaries. Number of Full-time Equivalent (FTE) Positions.

Number of youth/adults per clinical and case management position

Financial AnalysisEstimated Costs per Child Served

Model 4 Model 5 Model 6

Total program spending $1,342,584 $1,948,939 $2,530,524

Number of youth/adults served 50 45 144

Cost per youth/adults served $26,852 $38,979 $17,573

COC Grantee Model Budget Summaries.

Program Annual Expenditure Estimates.

Financial AnalysisEstimated Costs per Visit

Service related Total annual expenditures $327,968

Number of day treatment sessions 5000Cost per serivce hour $66

Non-service related

Expenditures not related to the provision of services Evaluation and Research $100,000 Year 1 community awareness activities $6,000

Feasibility

Financial AnalysisProgram Phases

Planning

Year 1

Ongoing

Planning or pre-implementation phase

Year 1: May include a start-up or pilot phase

Ongoing: Years 2-4

Financial Analysis

Planning

Year 1

Ongoing

The planning or pre-implementation phase includes:

Recruit and train staff

Data collection

Develop relationships other

organizations (in-kind support)

Establish revenue sources

Financial Analysis - SpendingPre-implementation Phase

OngoingList services and items provided by sponsors, etc. to quantify the amount of matching funds.

Items / Services Expenditures

Estimates for Sponsored/

Donated Goods & Services Total Value

Office space $16,800 $16,800Office equipment $3,000 $2,000 $5,000Personnel $180,000 $50,000 $230,000Utilities $1,000 $2,000 $3,000Supplies $4,000 $3,200 $7,200Consultants $5,000 $5,000Total $193,000 $74,000 $267,000

Planning

Year 1

Financial Analysis

Planning

Year 1

Ongoing

The planning or pre-implementation phase questions:

Are there sufficient resources for the proposed work?

Are the cost estimates (or value of donations/in-kind support) correct?

Financial Analysis

Planning

Year 1

Ongoing

Other questions:

Are sufficient resources allocated to staff recruitment and training?

Are sufficient resources allocated to youth identification and assessment?

Financial Analysis - Revenue Pre-implementation Phase

Ongoing

Revenue Source Amount

Estimates for Sponsored/

Donated Goods & Services

Total Value

Service provision $33,000 $0 $33,000 Medicaid $25,000 $25,000 Third party $6,000 $6,000 Patient fees $2,000 $2,000Grants/ Other $160,000 $74,000 $234,000 SAMHSA $100,000 $100,000 I H S $40,000 $40,000

Tribe $20,000 $74,000 $94,000Total $193,000 $74,000 $267,000

List services and items provided by sponsors, etc. to quantify the amount of matching funds.

Planning

Year 1

Financial Analysis – Year 1Spending

Planning

Year 1

Ongoing

Services are provided.Services are provided.

Provision of services may be limited:Provision of services may be limited:

• A pilot or start-up phase may serve fewer A pilot or start-up phase may serve fewer patients or provide limited servicespatients or provide limited services

• Staff planning and training time may be Staff planning and training time may be greater during the first yeargreater during the first year

Financial Analysis Ongoing Phase: Year 1

Program Costs = Revenues

Salaries Grants

Supplies Reimbursement

Utilities Matching funds

Travel Service fees

Training

Is the Program Fiscally Sound?

Financial Analysis – Year 1Revenue

Planning

Year 1

Ongoing

There may be several sources.There may be several sources.

Some revenue sources may depend upon Some revenue sources may depend upon the volume of services.the volume of services.

With a pilot project and the provision of With a pilot project and the provision of fewer services, revenues may differ from fewer services, revenues may differ from program operation during later years.program operation during later years.

Example: Medicaid funds home visits and travel Example: Medicaid funds home visits and travel costs but only if service is provided.costs but only if service is provided.

Financial AnalysisOngoing Phase: Years 2-4

Planning

Year 1

Ongoing

Service provision increases.Service provision increases.

• Additional staff are hired to provide Additional staff are hired to provide servicesservices

• Expenditures increase with the Expenditures increase with the increase in services increase in services

• Service revenues increaseService revenues increase

How do expenses and revenue change How do expenses and revenue change overtime?overtime?

Financial AnalysisOngoing Phase: Years 2-4

Planning

Year 1

Ongoing

Costs: ? Office space (rent, mortgage)

Salaries and training

Utilities, supplies, travel

Program operations

Revenues:

Grants

Sponsor donations, in-kind support

Revenue from service fees

Financial AnalysisOngoing Operational Phase: Years 2-4

Planning

Year 1

Ongoing

The best time to answer questions:

•How does the average cost per service compare to service fees and

reimbursement?

• How does the average cost per child served compare to alternative

programs such as residential treatment programs?

Financial AnalysisGrantee Work Session

Goal: To identify human resource needs for the program component(s) addressed in the feasibility assessment - service provision only

Group: Grantee community

Time: 30 minutes

Report Back: approximately 5 minutes each on Wednesdaymorning

CircleOf

Life