According to the Centers for Medicaid and Medicare, approximately 100 million Americans receive Medicare, Medicaid or Children’s Health Insurance Program benefits. These numbers are likely to grow in the near term, with an additional 33 percent increase in eligible members in 2013 when provisions of health care reform become effective and community-based services become mandatory.
This increase in enrollees, combined with a tight budget environment, compels states to be smarter about how they spend money. Further, the programs offered for those eligible for assistance are rarely coordinated, resulting in an inefficient, often redundant system.
In 1997, the Providence Service Corporation (PSC) was founded by now-CEO Fletcher McCusker in response to this fragmentation of care and the growing need for Medicaid-funded human services. Since then, the PSC network of owned and managed providers has grown from serving 1,300 clients under one contract in one location to serving approximately 50,000 clients through 547 contracts in 43 states and Canada. PSC’s services have expanded to include workforce development, non-emergency medical transportation, educational services and community corrections programs. As the scope and reach of PSC have grown, so has the need to maintain a well-trained staff of professionals with a wide range of skills and expertise.
Why Transform Learning?
Throughout this rapid expansion, PSC leadership has maintained a decentralized management structure with all programs tailored to meet the needs of each community served. The number of senior executives — six — is tiny for a public company with nearly $1 billion in annual revenue. Within this decentralized structure, PSC requires only two annual learning events for all staff, and until recently any additional learning was driven by the needs of a state or contract. This structure presents a challenge for the company to ensure that staff members are able to access the learning they need.
In 2003, the early seeds for the Corporate University of Providence were planted during a leadership retreat in Dallas. McCusker challenged leaders to develop a strategic plan to standardize — not centralize — best practices for all clinical, business and technological operations. Because PSC services vary widely and are tailored to the local community, a centralized, cookie-cutter approach to providing care and mandating business decisions from the top has never been a goal. Still, any national company must be able to draw on efficiencies of scale to operate within the slim margins dictated by governmental contracts.
Fifty leaders from across the country, representing major departments and disciplines within the organization, began to examine ways the company could increase cross-distance collaboration and decrease duplication of efforts while maintaining the unique operations in each PSC location. Subsequent initiatives resulted in the implementation of a secure intranet, a national quarterly newsletter, shared documents folders, an online message board to exchange ideas and online learning courses, many of which are commonplace in the world of business but not so much in the field of human services.
The foundation for a national approach to distance learning also was put into place, and in 2005 the Corporate University of Providence (CUP) was formalized with its stated mission: To support strategic goals by providing learning and development opportunities that cultivate ethical leadership and professional and personal growth for staff at all levels.
From the outset, PSC’s commitment to its decentralized management structure presented a challenge to implementing a national learning and development approach. With only two annual compliance learning events for all staff, CUP needed to marshal national resources to keep costs down and learning effectiveness high while also meeting local needs. CUP administrators worked with key company leaders to identify duplicate learning needs that could be met across distance. Clinical learning emerged as a priority.
Many PSC employees carry licenses in social work, therapy, counseling and service-specific categories such as substance abuse or community mental health. It can be costly to maintain these licenses, and in the past, individual staff members often assumed the cost. In response, CUP leaders completed a lengthy application and review process, and in 2005 CUP became a licensed provider of continuing education units (CEUs), first receiving accreditation by the National Social Work Licensing Board and later a number of National Counseling boards. CUP also subcontracted with Essential Learning, a provider of online health-related courses, to increase CEU availability, expanding certification from three to 21 national and state accrediting boards.
The Impact of Decentralization
Over time, the need to measure distance learning’s impact became a priority, and in late 2010 CUP studied the fiscal and clinical viability of three learning modalities: classroom-based, online courses and a blended learning approach, which combines teleseminars — human interaction is an important way to gain abstract clinical skills — with the convenience of online learning material. The results showed comparable effectiveness in knowledge transfer and application, with a tremendous cost benefit for the virtual learning modalities versus traditional in-person options — $18.50/$19.64 per unit of online/teleseminar courses compared with $66.74 per unit for classroom-based instruction.
Part of this study calculated the actual cost to provide a distance learning course. To reach a dollar amount, the research included the hours needed to develop a course, technology costs, staff productivity lost and instructor cost, and found the cost to provide virtual training is approximately $48 per unit. During the first three quarters of 2010, PSC staff completed nearly 70,000 online training hours eligible for CEUs. An additional 900-plus staff completed CUP teleclasses offering more than 2,600 CEUs. With the aforementioned cost data, CUP provided training valued at $3.5 million in less than a year.
In 2009, CUP began to offer a high-potential leadership development program (HiPo) to enhance skills in leaders who demonstrate talent, commitment and the ability to advance within the organization. The HiPo program responds to PSC’s decentralized business model needs by embracing the company’s core values and vision as a whole and focusing on the unique challenges of each region’s leadership.
Effective leadership requires a director to think and act quickly as well as balance staff and client needs with the realities of a tight budget. New leaders and even seasoned professionals do best when given the guidance and support they need along with the freedom to be autonomous. The HiPo program seeks to counter the Peter Principle where every employee tends to rise to his or her own level of incompetence using individual responsibility as a critical success factor. Rather than ask managers to complete a standardized leadership learning event or seminar, the coaching model promotes self-awareness and personal accountability so that leaders can develop their strengths and seek support when needed.
Each participant works with his or her direct supervisor and a coach to identify benchmarks that are monitored throughout the program. These benchmarks could include fiscal performance, staff engagement and retention, and service outcomes along with leadership development and personal goals. Some staff successes for those who completed the first two rounds of the coaching program include:
• Competitive bids won in two states, with another pending
• Reduction in outstanding accounts receivables from $275,000 to $25,000
• Increased revenues: The goal was $8 million; the actual number was $8.3 million
• Reduction in payroll costs by 11 percent
Additional anecdotal metrics are being gathered through follow-up surveys.
Spread Learning Around
PSC is currently beginning a third round of the HiPo program by soliciting nominations from high-level company leaders. Participants who complete the initial program continue to meet online and via teleconference to maintain and build on their progress and business results. Through this new community of practice, leaders can exchange information, success stories and challenges in an arena that provides support and a human connection for ongoing professional growth.
CUP initiatives also include other business units in the company. Monthly roundtables are held within functional departments such as human resources and quality assurance so that employees with similar responsibilities can exchange support and success stories. A supervisor boot camp has been created so that line staff promoted to supervisory positions can gain management knowledge regarding FMLA (Family and Medical Leave Act) and EEOC (Equal Employment Opportunity Commission) regulations, how to operate within a budget and more. Social networking also is gaining acceptance as a way to transmit information when needed in real time. As awareness of CUP as a company resource has grown, train-the-trainer classes also have been developed to draw on more talent throughout PSC.
Expansion of the global business community means the decentralized workplace is becoming the norm. Even when business decisions are directed from the top of the leadership pyramid, the message is interpreted differently by each manager along the line. The Providence Service Corporation has created a culture that values autonomy partnered with accountability. The Corporate University of Providence provides a growing network of communication and learning across distance to ensure continued success — even during these uncertain economic times.