Smart operations give youth welfare organisations a grip on organisation

Parties in youth care today seem to be drowning in the increased administrative burden. They also often struggle with complex operational management, resulting in parties having insufficient ‘control’ over processes and spending. Smart management leads to more efficient and effective staff, and better care for patients.

Since the transition from the AWBZ to the WMO (2015) and with it the decentralisation of support and guidance to municipalities, youth care providers have faced severely increased pressure on their operations. Both nationally and locally, government agencies were faced with the task of achieving more and more with fewer resources. Although the primary aim of the decentralisation of youth care was to provide better care and assistance, in practice it was accompanied by a substantial budget cut. From the government, the original budget for youth care was slashed and subsequently many municipalities also implemented a cost-cutting target themselves.

More complex healthcare landscape

Youth care providers thus find themselves in a challenging field. The increasingly complicated landscape affects this complexity. As a result of the transition, municipalities and youth care institutions now conclude contracts among themselves. These contracts are often different for each municipality/region. The youth care institution therefore faces the challenge of translating all these different contracts into its activities, operations and deployment. Another challenge is in the area of funding. Prior to the transition, youth care institutions were used to starting delivering care. The funding and administrative obligations would follow afterwards. Today, because municipalities no longer advance but pay for actual production afterwards, youth organisations face an accelerated liquidity issue.

According to Frank van den Bos and Stijn Hubregtse, both healthcare experts at Improven, the two trends mentioned above make it increasingly important for youth welfare institutions to have control over operations. “Now the problem only becomes visible at the end of the process. And then it is often too late”, says Van den Bos. He refers to the importance of ensuring that declarations in care are in line with registrations and what was actually delivered. This is because the process starts with recording the care order. This happens when the client and the care provider record the care order. This request is then scheduled and once the order is executed, the declaration and finally the payment follow.

Mismatch

When there is a discrepancy between the original order, and the recording during execution and/or declaration, the process falters. “An error in the healthcare product name, a deviation of a day in the period or an incorrect tariff code are reasons for rejecting a claim. In addition, a discrepancy in personal data, for example the surname of the mother instead of the father or the entry of an incorrect place of residence, is also a reason for disapproval.”, Hubregtse cites as examples. Such mismatches cost time and money, says the Improven consultant. “The finance and care administration departments then have to constantly put out fires.”

“This also affects the relationship between the youth care provider and patients”, says Van den Bos: “This is because, in practice, the municipality is galvanising more quickly than the youth care provider, which traditionally remains very loyal to the young people.”

Another big challenge lies in contracting care correctly. This is now a complex process involving many parties. For instance, municipalities may engage several parties and often several main contractors and subcontractors also appear in the process. “Sometimes municipalities and institutions enter into contracts that are too complicated. Or they enter into contracts that are not fully enforceable,” Van den Bos explains. “This may have to do with rates received for the product delivered, requirements around accountability, invoicing and lead times for applying for orders.”

Recommendations for better control

For good control over operations, Van den Bos and Hubregtse drew up several pieces of advice for youth care providers. For instance, they emphasise the importance of end-to-end monitoring of the process. They recommend doing this with a director, who monitors the process for correctness and completeness. As a second point, youth care providers should have their data policies in place. “Because a youth care institution now bills its care to a municipality at client level, it is important that all data in the systems are correct and up-to-date,” the care experts say. Again, an incorrect date of birth or disposition number will immediately lead to rejection of the invoice in almost all cases.

Furthermore, it is essential for youth welfare institutions to analyse the billing breakdown, because if many invoices kick back, the money comes in later. Having their working capital in order is a key focus in this respect. Finally, Improven's consultants point to the declaration phase, stressing the importance of correctly analysing declarations and acting on anomalous outcomes.

Van den Bos and Hubregtse conclude: “Contracting, recording and accounting for the care provided requires process control. And that turns out to be more difficult than the sector ever imagined. The trick is to get the process right at the front end.”